Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy. by Seth Kalichman. Springer: 2009. 205 pp. $25. Inadequate health policies in South Africa have reportedly led to some 330,000 unnecessary AIDS deaths and a spike in infant mortality, according to estimates by South African and US researchers. This carnage exceeds the death toll in Darfur, yet it has received far less attention. Seth Kalichman, a US clinical psychologist, shows in Denying AIDS how words can kill. His marvellous book should be read alongside Nicoli Nattrass's Mortal Combat, covering similar ground but from the perspective of a South African. The tragic events in South Africa have been exacerbated by AIDS 'denialists' who, Kalichman alleges, assert that HIV is harmless and that antiretroviral drugs are toxic. The author discusses the psychology of denialism, which he says is "the outright rejection of science and medicine". He recounts the history of an HIV-infected US woman whose daughter died from an AIDS-related disease, and who recently died herself, to demonstrate the downward path from "ordinary psychological denial to malignant denial to denialism". Kalichman dismisses denialists' attempts to portray themselves as intellectually honourable dissidents who question accepted wisdom. He draws clear distinctions between dissidence and denialism; the latter, he says, is merely a destructive attempt to undermine the science. These attitudes are not unique to HIV. Denialism, notes Kalichman, is "partly an outgrowth of a more general anti-science and anti-medicine movement". Groups that support intelligent design, doubt global warming, claim that vaccines cause autism, argue that cigarettes are safe, believe that the terrorist attacks of 11 September 2001 were an intelligence-agency plot or deny the Holocaust all use similar tactics.

South Africa is one of the countries most severely affected by HIV/AIDS. At the peak of the epidemic, the government, going against consensus scientific opinion, argued that HIV was not the cause of AIDS and that antiretroviral (ARV) drugs were not useful for patients and declined to accept freely donated nevirapine and grants from the Global Fund. Using modeling, we compared the number of persons who received ARVs for treatment and prevention of mother-to-child HIV transmission between 2000 and 2005 with an alternative of what was reasonably feasible in the country during that period. More than 330,000 lives or approximately 2.2 million person-years were lost because a feasible and timely ARV treatment program was not implemented in South Africa. Thirty-five thousand babies were born with HIV, resulting in 1.6 million person-years lost by not implementing a mother-to-child transmission prophylaxis program using nevirapine. The total lost benefits of ARVs are at least 3.8 million person-years for the period 2000-2005.

A new study by Harvard researchers estimates that the South African government would have prevented the premature deaths of 365,000 people earlier this decade if it had provided antiretroviral drugs to AIDS patients and widely administered drugs to help prevent pregnant women from infecting their babies. The Harvard study concluded that the policies grew out of President Thabo Mbeki’s denial of the well-established scientific consensus about the viral cause of AIDS and the essential role of antiretroviral drugs in treating it. Coming in the wake of Mr. Mbeki’s ouster in September after a power struggle in his party, the African National Congress, the report has reignited questions about why Mr. Mbeki, a man of great acumen, was so influenced by AIDS denialists.

The impact of the AIDS denial movement — which refuses to accept that HIV is the cause of AIDS — is a ripe area for research because of its potentially lethal consequences, argue Tara C. Smith and Steven P. Novella in this PLoS Medicine article. Many doctors and researchers are unaware of the existence of organised denial groups or ignore them as an inconsequential fringe, they say. This helps erroneous beliefs to spread unchallenged, particularly on the Internet, which is an effective tool for targeting young people and high-risk groups.

It may seem remarkable that, 23 years after the identification of the human immunodeficiency virus (HIV), there is still denial that the virus is the cause of acquired immune deficiency syndrome (AIDS). This denial was highlighted on an international level in 2000, when South African president Thabo Mbeki convened a group of panelists to discuss the cause of AIDS, acknowledging that he remained unconvinced that HIV was the cause [1]. His ideas were derived at least partly from material he found on the Internet [2]. Though Mbeki agreed later that year to step back from the debate [3], he subsequently suggested a re-analysis of health spending with a decreased emphasis on HIV/AIDS [4].

The Internet is serving as a fertile medium for "HIV denialists" to spread false ideas about HIV/AIDS, which could have terrible public health consequences, say scientists in a policy paper in PLoS Medicine.

This website presents the scientific evidence that HIV is the cause of AIDS and that benefits of antiretroviral drugs (ARVs) outweigh the risks. The website was created by research scientists and community advocates engaged in the worldwide struggle against HIV/AIDS.