Book Review: AIDS denialism is not the same as AIDS dissent

Denialists of any kind are irritating. AIDS denialists are doubly irritating, since AIDS is an inherently contentious issue. A common antidenialist response is anger. Hence, writing about AIDS denialism presents a daunting challenge to any researcher's wish to be dispassionately objective. Seth Kalichman's assessment of AIDS denialism in his new book relies mostly on the cerebral, rather than adrenal, cortex. But for one notable exception, Kalichman succeeds in objectively describing and analysing the history, principal actors, scripts, arguments and shortcomings of what I dub the AIDS Denialism School.

Kalichman, a clinical psychologist and professor of social psychology at the University of Connecticut in the USA, who is also the editor of the behavioural science research journal AIDS and Behavior, stumbled upon the AIDS Denialism School by visiting one of its websites, confessing: ‘My reaction was one of absolute outrage. I mean I was really angry. I was in an emotional upheaval. I surprised everyone around me, including myself, by my seemingly irrational reaction’. Prior to this encounter Kalichman had, like nearly all other AIDS scientists, ignored it, admitting that: ‘I was in denial about denialism. I knew it was out there, but I pushed it to the back of my mind’. To Kalichman the central tenet of the AIDS Denialism School – that HIV does not cause AIDS – is not only an affront to the depth and breadth of the empiric evidence that HIV does indeed cause AIDS but, far more importantly, has potentially serious health consequences for HIV-infected patients who believe it. Such an erroneous belief can cause at-risk persons not to be tested for HIV infection or, if tested, to ignore a positive HIV test result; to reject scientifically monitored therapies in favour of vitamin and nutritional supplement regimens of unproven or much lesser efficacy; and to facilitate downstream HIV transmission if denialists were to dispense with safer-sex cautions. To Kalichman, AIDS denialism is ultimately destructive because it corrodes trust in scientific medicine and public health.

He describes, in substantial detail, the birth of the denialist movement a quarter century ago, its chief protagonist, the distinguished scientist Peter Duesberg and, in lesser detail, disciples and congeners; Appendix B consists of nearly 20 biographical vignettes of what could be called The Rogue Gallery of Principal AIDS Denialists. He devotes much space to probing why denialists propagate ‘myths, misconceptions, and misinformation to distort and refute reality’. His sections on denialist pseudoscience, proselytizing techniques and political strategies make for genuinely interesting reading, as do the sections on how to get out of AIDS denialism using the power of critical thinking – in my view, always easier recommended than done. That AIDS denialism may be more of a generic than specific turn of mind is suggested by his pointing out that AIDS denialists also frequently subscribe to irrational, even paranoid (especially conspiratorial), points of view in other fields of inquiry. Kalichman refrains from imputing evil motives to denialists. From what is presented, readers will have problems deciding whether, with denialism, one is dealing with a heart of darkness or a mind of darkness or both.

The singular exception to Kalichman's otherwise objective assessment of AIDS denialism is his inclusion of two researchers (with whom I have published many papers) who should properly be classified as AIDS dissenters. Denying the evidence is not the same as interrogating it and Kalichman clearly confuses the two when reporting on the probing scholarship of Drs David Gisselquist and Stuart Brody. A careful and open-minded assessment of their publications will show that the basis for their questioning what is driving HIV transmission in sub-Saharan Africa is grounded in epistemology (quality and validity of evidence issues); ¹ on solid bench science findings (healthy genital tract tissue in women could not become infected by application of huge quantities of HIV);^2,3 and on empiric evidence that contradicts the mainstream view.^1,4–6 Each of these evidentiary avenues leads, especially in light of the many observed anomalies, ⁷ to the legitimate questioning of whether ‘heterosexual sex’ (an inherently fuzzy concept) can account for the virtually 10 times greater efficiency of HIV transmission in Africa than elsewhere. Rather than being inappropriately subsumed under the ‘Pseudo-epidemiology’ section, Gisselquist and Brody should be classified, in Kalichman's own words, as ‘Legitimate dissidents in AIDS science [who] should also have greater visibility’.

Kalichman, whose professional paradigm is clinical rather than epidemiologic, accepts the received wisdom about what is driving the HIV epidemics in Africa without according recognition to the existence of the considerable evidence undermining it and of its serious methodological shortcomings. He seems not to know (recognize?) that the fundamental weakness of mainstream epidemiologic studies in sub-Saharan Africa has been its 20-year track record of dismissing non-sexual modes of transmission as being insignificant, in the absence of studies comprehensively assessing the contribution to HIV incidence of skin puncturing (blood) exposures. He also uncritically accepts the current mantra that a special form of sexual concurrency in heterosexual African populations accounts for much of the observed HIV transmission when, in fact, the empiric evidence for this idea is virtually non-existent. ⁸ Not automatically believing what the experts say when rational methodological and empiric evidence undermines their view is sound science, not pseudo-epidemiology or denialism. Au contraire.

In summary, Kalichman's treatment of AIDS denialism is a good, if somewhat partisan, review. I also suspect that if he carefully considered the arguments and evidence of legitimate AIDS dissenters such as Gisselquist and Brody, rather than indefensibly dismissing their work as pseudo-epidemiology, Kalichman might well change his mind. From my understanding of this book, I doubt AIDS denialists would, which makes its reading all the more important for those interested in countering the denialists’ baleful influence.