Regurgitated HIV/AIDS Denialism and Anti-Science Libertarianism

There are few places more cognitively dangerous to a rational mind than the intersection of political ideology and pseudoscience. Libertarians are increasingly being associated with various anti-scientific beliefs, such as vaccine rejectionism and climate change denialism. This is harmful to traditional libertarian causes, such as curbing excessive bureaucracy and government intrusion into civil liberties because it allows critics to dismiss libertarians as denialist cranks without a second thought.

It is therefore disturbing that the libertarian website LewRockwell.com recently published a screed promoting HIV/AIDS denialism written by medical doctor Donald W. Miller Jr. Despite being an actual medical doctor, he repeats many of the same fallacies that HIV/AIDS denialists commonly deploy. In reality, antiretrovirals decrease progression to AIDS and death rates, HIV can be transmitted sexually and HIV testing is highly accurate.

The specter of “the government”

A common approach used by anti-science libertarians is to portray the mainstream scientific and medical consensus as “the government” or “the official story”. This is a common technique to marginalize their opponents by associating them with something they intensely dislike. However, mainstream scientific communities are not slaves to the government or to politicians. They can design and carry out scientific research and interpret their results on their own.

Initiating antiretroviral therapy regardless of CD4 count

Miller makes a big deal out of the fact that the newest guidelines for treatment of individuals with HIV/AIDS recommend that antiretroviral therapy is given to individuals who are HIV+ regardless of CD4+ count. Had he read the report he is referencing in detail, he would have understood that there is a clear medical reason for why this is done (HHS Panel on Antiretroviral Guidelines for Adults and Adolescents, 2014):

The recommendation to initiate ART in individuals with high CD4 cell counts—whose short-term risk for death and development of AIDS-defining illness is low is based on growing evidence that untreated HIV infection or uncontrolled viremia is associated with development of non-AIDS-defining diseases, including cardiovascular disease (CVD), kidney disease, liver disease, neurologic complications, and malignancies. Furthermore, newer ART regimens are more effective, more convenient, and better tolerated than regimens used in the past.

In other words, untreated HIV infection (even with a high CD4+ count) increases the risk for a number of diseases. To disable the emotional threat of “forced government medicine” or similar, it can be noted that the guidelines specifically states that the wishes of the individual should be taken into consideration, together with a large number of other factors:

Regardless of CD4 count, the decision to initiate ART should always include consideration of a patient’s comorbid conditions, his or her willingness and readiness to initiate therapy, and available resources.

It is both sad and entertaining to see that denialists rarely read the papers and reports that they themselves reference.

AZT did not kill 150 000 HIV+ individuals, HAART just saved more

Another common attack on antiretroviral (ARV) medication is to claim that early AZT monotherapy killed over 100 000 people. The basis for this assertion is astonishingly twisted. HAART (a combination therapy) replaced AZT monotherapy in 1996 and lead to a considerable drop in death rates among individuals with HIV/AIDS. To scientists and medical researchers, this is taken as evidence that the new treatment is much more effective than the older one. To HIV/AIDS denialists, it instead means that the older treatment killed the people that HAART kept alive.

In reality, multiple lines of evidence show that denialist “interpretation” is wrong. The number of ARVs increase, the risk of death or progression to AIDS decline. Three are better than two, two are better than one and one is better than placebo. Also, uninterrupted treatment is better than episodic and immediate treatment of infants is better than postponed. None of this facts can be explained by HIV/AIDS denialism (AIDSTruth, 2009a).

It is true that ARVs have side-effects, but they are clearly better than going untreated.

HIV can spread via sex and denialists misunderstand basic probability

HIV/AIDS denialists often reject the fact that HIV can be spread via unprotected sexual contact. They typically prop up their false belief by citing scientific studies examining the efficacy of condoms for preventing HIV transmission. These generally show that condoms prevent most transmission events, which they interpret as HIV not being sexually transmitted, rather than the correct conclusions that condoms work.

Another denialist approach rests on a fundamental misunderstanding probability theory. Here is how Miller frames it:

Among them, a key feature in the HIV/AIDS theory is that the virus is sexually transmitted. It turns out, however, that only 1 in 1,000 unprotected sexual contacts transmits HIV. […] One in 275 Americans is “HIV-positive.” Therefore, with this prevalence of HIV in the population the average uninfected U.S. citizen would need to have 275,000 random unprotected “sexual contacts” to get HIV.

The probability of winning the Powerball jackpot is 1 in 175 223 510 (CNN, 2013). By Millers flawed logic, the average lottery winner would have to buy over 175 million tickets before he or she could win. Clearly, this is an absurd conclusion. In reality, some kinds of sexual contacts are riskier than others. Depending on who you are having sex with and what kind of sex you are having, the risk of HIV transmission can be considerably higher than the baseline mentioned by Miller. The population incidence of HIV probably also vary depending on geographic location and between different groups, which would influence the risk calculation as well.

Prostitution and HIV transmission

Miller claims that sex workers do not become HIV+ unless they are using drugs. This is a deceptive half-truth based on the observation that sex workers in Europe who use drugs have a considerably higher prevalence of HIV than those sex workers who do not use drugs. In reality, this is only because there is a low baseline prevalence of HIV in Europe, so drug use is risker than being a sex worker. In countries with a higher baseline prevalence, sex work is going to be considerably more dangerous (Kalichman, 2009 p. 75). Thus, the perceived inconsistency between sex work and relatively low HIV prevalence evaporates.

An HIV+ antibody test is corroborated with additional tests

HIV/AIDS denialists often attack HIV tests used for diagnosis and monitoring. The initial test used is often an immunoassay that tests for the presence of antibodies to HIV. If this is positive, a western blot to test for the presence of viral proteins is used to corroborate the immunoassay. These tests are better than most other diagnostic tests for infectious diseases. Here is how National Institutes of Allergy and Infectious Diseases puts it in their article on the evidence that HIV causes AIDS (NIAID, 2010):

MYTH: HIV antibody testing is unreliable.

FACT: Diagnosis of infection using antibody testing is one of the best-established concepts in medicine. HIV antibody tests exceed the performance of most other infectious disease tests in both sensitivity (the ability of the screening test to give a positive finding when the person tested truly has the disease ) and specificity (the ability of the test to give a negative finding when the subjects tested are free of the disease under study). Current HIV antibody tests have sensitivity and specificity in excess of 98% and are therefore extremely reliable WHO, 1998; Sloand et al. JAMA 1991;266:2861).

Progress in testing methodology has also enabled detection of viral genetic material, antigens and the virus itself in body fluids and cells. While not widely used for routine testing due to high cost and requirements in laboratory equipment, these direct testing techniques have confirmed the validity of the antibody tests (Jackson et al. J Clin Microbiol 1990;28:16; Busch et al. NEJM 1991;325:1; Silvester et al. J Acquir Immune Defic Syndr Hum Retrovirol 1995;8:411; Urassa et al. J Clin Virol 1999;14:25; Nkengasong et al. AIDS 1999;13:109; Samdal et al. Clin Diagn Virol 1996;7:55.

In other words, HIV tests work and they are very accurate.

The dangers of HIV/AIDS denialism

Miller is a good illustration of the dangers of HIV/AIDS denialism. He says that if he is ever diagnosed, he will refuse medical treatment:

In the unlikely event that I should test “HIV-positive,” I would never let anyone push me down the HIV/AIDS rabbit hole. No way. Knowing beyond a reasonable doubt that the HIV theory is fallacious and that HIV does not cause AIDS, I would never consent to “treatment” with antiretroviral drugs.

If Miller ever becomes infected with HIV and does not accept treatment, it is very likely that he will die from it. This has happened to many HIV/AIDS denialists who ended up HIV+. The classic case is that of Christine Maggiore. She became HIV+ and refused to use life-saving methods to prevent mother-to-daughter transmission. Her daughter, Eliza Jane Scovill died of an AIDS-related opportunistic infection at the age of three. A few years later, Maggiore also died from AIDS. HIV/AIDS denialists desperately try to explain aways these deaths by blaming them on allergic reactions and stress. There are plenty of other HIV/AIDS denialists who have died from AIDS (AIDSTruth, 2009b).

People who believe in conspiracy theories about HIV/AIDS are less likely to practice safe sex, less likely to get tested and less likely to undergo treatment with antiretrovirals (Nattrass, 2013):

Survey data from the United States (US) and South Africa (the only countries for which quantitative data exists) suggest that a significant minority of people endorse such beliefs and that this matters for public health. In the US, AIDS conspiracy beliefs are associated with lack of condom use (Bogart and Bird 2003, Bogart and Thorburn 2005, Bogart et al. 2010a), not testing for HIV (Bohnert and Latkin 2009) and not adhering to antiretroviral treatment (Bogart et al. 2010a). In South Africa they are associated with never testing for HIV (Bogart et al. 2008, Tun et al. 2011) and failure to use condoms (Grebe and Nattrass 2011).

Thus, HIV/AIDS denialism has real consequences for HIV prevention and treatment, as well for human lives.

HIV kills CD4+ T cells and is not a harmless passenger virus

Here is a challenge for people who think HIV is just a harmless passenger virus: inject yourself with HIV. Do you dare? Why not, if HIV is perfectly harmless? This challenge has been issued to Peter Duesberg, but he has not yet injected himself. He claims that this is because he needs a grant to do it, but this is just a smokescreen.

In reality, the evidence that HIV is not a harmless passenger virus comes from in vivo, ex vivo and in vitro studies. CD4+ T cells can be infected and killed by HIV infection in cell culture, studies on tissues removed from humans and other animals reproduce the CD4+ T cell deaths observed in cell culture and research on humanized mice (with a human immune system) also replicate this observation (AIDSTruth, 2010).

Flawed economic analysis

Once again, Miller turns on the anti-government rhetoric. Apparently, according to Miller, the approximately 30 billion USD that the U. S. government spends on HIV/AIDS is a waste of taxpayers money. This is obviously a selective analysis, because the loss of human life and productive ability to work due to HIV/AIDS going untreated would be enormous. Presumably, the government would have to pay even more taxpayer money to manage the consequences of untreated HIV/AIDS than to prevent and treat it. In the end, this is a cheap attempt by Miller to stir emotions over alleged wasting of taxpayer money.

The Galileo Gambit

The Galileo Gambit occurs when a proponents of pseudoscience compares themselves to a famous scientist of the past. Typically, this is Galileo Galilei, Albert Einstein or Ignaz Semmelweis. The idea is to make it look like they are oppressed martyrs of a viewpoint that will, at any moment, become the accepted mainstream scientific position. However, as Norman Levitt pointed out, “While Galileo was a rebel, not all rebels are Galileo.” Indeed, some rebels are just rebels whose ideas have no scientific merit whatsoever.

The rebel that Miller compares with Semmelweis is none other than Peter Duesberg, the father of the HIV/AIDS denialist movement. The narrative that Miller prefers is that Duesberg was destined for a Nobel Prize until he dared to question to established orthodoxy of HIV/AIDS. In reality, Duesberg made (and keeps making) flawed arguments that are contradicted by the vast scientific knowledge that has accumulated about HIV/AIDS. He did not become a marginalized researcher because he questioned the fact that HIV causes AIDS. In reality, he was marginalized because he became a pseudoscientific crank.

Conclusion:

In a previous article on libertarian climate change denialism that was published on this website in late 2011, the following warning appeared (about anti-science in libertarian communities):

This is an unfortunate tendency because if libertarianism can be associated with fringe anti-science groups, then this makes libertarianism as a whole an easy target for naive critics. They can ignore the problems with large bureaucratic governments and the reduction in civil liberties and just focus on the fact that certain libertarians reject mainstream climate science and thereby portray libertarianism as an irrational form of anti-science denialism, in the same way many liberals view creationist republicans as intellectually left behind.

This is as true now as it was three years ago. What can pro-science libertarians do to counter this disturbing trend? Internal policing and avoidance of unnecessary politicization of science are two potential suggestions.

References:

AIDSTruth. (2009a). Benefits of antiretroviral drugs: Evidence that the benefits of HAART outweigh its risks. Accessed: 2014-06-29.

AIDSTruth. (2009b). AIDS denialists who have died. Accessed: 2014-06-29.

AIDSTruth. (2010). Myth: HIV is a harmless passenger virus. Accessed: 2014-06-29.

Nattrass, N. (2013). Understanding the origins and prevalence of AIDS conspiracy beliefs in the United States and South Africa. Sociology of Health & Illness, 35(1), 113-129.

NIAID. (2010). The Evidence That HIV Causes AIDS. Accessed: 2014-06-29.

CNN. (2013). Eyeing $600M Powerball jackpot? You have better chance of death by lightning (webcite). Accessed: 2014-06-29.

Kalichman, S. (2009). Denying AIDS: Conspiracy Theories, Pseudoscience and Human Tragedy. New York: Copernicus Books.

HHS Panel on Antiretroviral Guidelines for Adults and Adolescents. (2004). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Accessed: 2014-06-29.