Sunday Times, South Africa - April 30, 2000
Vinodh Gathiram

The first cases of AIDS were diagnosed in 1981 in homosexual men with rare types of pneumonia and cancers that resulted from the loss of a specific type of blood cell (helper T-lymphocytes) which helps in the normal functioning of the immune system. In 1983 and 1984, three groups of scientists, in France and the US, independently isolated a unique type of virus from patients with AIDS, subsequently named HIV, that was able to kill lymphocytes.

It has been conclusively shown that homosexual men who do not have any evidence of HIV infection do not develop AIDS. Similarly, men and women with other sexually transmitted infections do not develop AIDS in the absence of HIV infection.

These findings contradict the arguments of "AIDS dissidents" like Peter Duesberg, who have asserted that factors such as promiscuous homosexual activity and repeated venereal infections are the cause of AIDS. They have targeted one factor at a time as the cause of AIDS. They have never substantiated their theories with scientific evidence.

Each time, the scientific community has been able to refute the theories of these sceptics with solid scientific proof showing that HIV is the cause of AIDS. At other times, these dissidents have asserted that drug abuse and the repeated use of antibiotics are the cause of AIDS. Although there is some evidence that drug use by injection can cause certain immunological abnormalities, there is no evidence that drug abuse can cause a sustained decline in the numbers of helper T-lymphocytes, and those who are not infected with HIV do not develop AIDS even after many years of addiction.

Although some individuals maintain that treatment with anti-AIDS drugs like AZT has compounded the AIDS problem, reports from the drug trials provide evidence to the contrary.

There are now more than 30 drug trials carried out in many countries that have used AZT either alone or in combination with other drugs. All show that these medicines lead to a drop in the number of HIV viral particles in the blood and a rise in the number of helper T-lymphocytes. The use of these medicines also delays the development of AIDS in HIV-infected patients, leads to fewer opportunistic infections and fewer hospitalisations from AIDS-related conditions and delays death in patients with AIDS.

Of course, these medicines, like all others, are potentially toxic and can cause anaemia and liver, pancreas and nerve damage. However, their benefits outweigh their potential to cause damage. AIDS was recognised at least seven years before AZT was licensed and available for use by the public.

The sceptics also argue that in Africa, AIDS is nothing more than a new name for old diseases. It is true that the diseases that have come to be associated with AIDS in Africa, for example, severe weight loss, persistent diarrhoea and TB, have long been the cause of many deaths in Africa, especially in malnourished people and the aged. But these diseases are now the cause of even more deaths, especially in young and middle-aged adults.

South Africa has also seen an unprecedented increase in the number of TB patients since the beginning of the HIV epidemic than before.

Laboratory workers, doctors, nurses and other health professionals accidentally exposed to high concentrations of HIV either via needle-stick exposure or exposure in the laboratory have become infected with HIV. Many of them have developed AIDS, and some have died of AIDS-related conditions. These individuals have had no other reason for developing a defect in their immune system.

In conclusion, HIV and AIDS have been repeatedly linked in time, place and population groups. The appearance of HIV has coincided with the appearance of AIDS in every country and region where AIDS has been noted. Researchers have also demonstrated a correlation between the amount of HIV in the body and the progressive loss of helper T-lymphocytes from the blood and the subsequent development of AIDS.

Despite this plethora of evidence, the notion, expressed by a few dissidents, that HIV does not cause AIDS continues to find an audience in the popular press. This has a potential negative impact on HIV-infected individuals and on public health efforts to control the epidemic.

HIV-infected individuals may be convinced to forego anti-AIDS treatments that can delay the onset of serious AIDS-induced infections and cancers. Pregnant mothers may dismiss the option of taking AZT, which can reduce the likelihood of transmitting HIV to their babies. People may be discouraged from being tested for HIV, thereby missing the opportunity for counselling as well as treatment with drugs to prevent AIDS-related infections.

Most troubling is the prospect that individuals will discount the threat of HIV and continue to engage in risky sexual behaviour.

If the public health measures are diluted by the misconception that HIV is not responsible for AIDS, the catastrophe of otherwise preventable cases of HIV infection and AIDS will occur. This will add to the global tragedy of the pandemic.

Given the overwhelming amount of evidence that HIV is the cause of AIDS, the medical faculty of the University of Natal does not support the need to redebate the relationship between HIV and AIDS. What is urgently required is a concerted effort to educate the public about preventive measures and to stimulate the development of HIV vaccines and other therapies appropriate for the needs of developing countries.

Professor Gathiram is head of infectious diseases at the University of Natal's faculty of medicine
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