The circular reasoning scandal of HIV testing

The circular reasoning scandal of HIV testing

By Neville Hodgkinson
21 May 2006

(See original in The Business on line)

IT WAS an icon of compassion, a sign you cared. To wear the red ribbon
meant to express solidarity with HIV/Aids victims everywhere. It
signified you knew the importance of antiviral drugs and HIV testing,
Aids awareness and condoms – and of the urgent need for a vaccine.


Red ribbons Image Unesco: Young Digital Creators

In contrast, if you cast doubt on the ever-burgeoning and massaged
HIV/Aids statistics; or suggested the billions raised for HIV research
and treatment might be better spent on established medicines and in
fighting poverty; or – perish the thought – if you questioned the
theory that Aids is caused by a sexually transmitted virus, you lost
your right to be considered a sensible and decent member of the human
race. You were a "denialist", a "pariah", a "flat-earther", a
"crackpot". Even if you were a leading scientist, your funds would
disappear and your ability to publish in mainstream journals reduced
to zero.

Today, whether it is frightening the residents of a Cornish town with
a cluster of purported infections, or causing the former head of South
Africa's National Aids Council to apologise for having unprotected sex
with an HIV-positive Aids activist, or enabling U2 front-man Bono to
edit an issue of the Independent newspaper dominated by impassioned
accounts of Africa's HIV/Aids plight, the virus that has held such
sway in the popular mind for more than 20 years is still never long
out of the news. It is now very big business: American Express,
Motorola, Gap, Converse and Armani are among the corporate giants
supporting Bono's RED campaign promoting special products to raise
funds for Aids in Africa.

But unreported in Bono's Independent (or in any other edition of the
paper, which for years has followed an unquestioning line on Aids)
there are signs that the power of the red ribbon is in serious
decline. In the United States, where respectable opinion has long held
the HIV theory of Aids to be immune to questioning, a controversial
15-page critique in the influential Harper's Magazine has caused
culture shock. As well as detailing a cover-up by government
scientists regarding Aids medication trials, the article approvingly
quotes scientists who have argued for years that HIV is not the cause
of Aids.

Meanwhile the Washington Post last month published an investigation
headlined "How Aids in Africa was overstated", arguing that
"increasingly dire" and inaccurate assessments of HIV infection by
UNAIDS (the Joint United Nations Programme on HIV/Aids) had "skewed
years of policy judgments and decisions on where to spend precious
healthcare dollars".

In India, a proposed Red Ribbon Campaign through the national rail
network has been abandoned, following a national convention on HIV in
Bangalore last October attended by more than 1,500 HIV-positive people
where the once-fashionable symbol of Aids awareness was ceremoniously
rejected. In front of television cameras, a six-foot red ribbon was
cut into pieces as a protest against the "oppressive and patronising"

Speakers said there were no similar icons of solidarity for people
suffering from other diseases. The ribbon's connotations that
"HIV=Aids=Death" – the scientific orthodoxy subscribed to by UN
agencies, pharmaceutical interests and thousands of activists around
the world – was said to further the isolation, discrimination and
sense of doom suffered as a result of an HIV diagnosis. Veena Dhari,
the first woman in India to declare herself HIV-positive, said that
when HIV-positive people see the ribbon "we feel like committing
suicide". She called on all Aids organisations to stop using it.

The story appeared on the front pages of newspapers as well as
national television in India, where media have proved more resistant
than in most African countries to huge pressures to conform to
international opinion on HIV/Aids.

Two years ago Richard Holbrooke, former US Ambassador to the United
Nations and now president of the Global Business Coalition on
HIV/Aids, an alliance of 200 international companies promoting Aids
testing, treatment and support, said in Washington that a major
impediment in dealing with Aids globally was that many governments –
and people – were still in "a denial phase – they believe they have no
Aids problem."

Citing India as an example, he said that if it did not change its
policies, it would soon have the highest HIV/Aids tally in the world.
By last year that had already happened, according to Richard Feacham,
head of the Geneva-based Global Fund to Fight Aids, Tuberculosis and
Malaria, the main beneficiary of the Product RED initiative.

"The epidemic is growing very rapidly. It is out of control," Feachem
said in Paris. "There is nothing happening in India today that is big
or serious enough to prevent it." India had to wake up, because
without action, "millions and millions and millions are going to die."

That is not the view of Anju Singh, of JACKINDIA, a Delhi-based Aids
policy study group. Singh, chief guest at the Bangalore convention,
told The Business last week that "there are no reports – not even
anecdotal ones – that reflect visible proof of an epidemic in this
country." The official estimate for HIV infections is around 5m; but a
dearth of Aids cases – averaging 10,000 a year over the past 10 years
- suggests that is grossly wrong.

Nor has there been any abnormal increase in death rates, even in
suspected "high risk groups" such as red light areas. The Indian
government does not publish data for Aids deaths; but "questions we
got asked in Parliament have elicited a cumulative figure of 1,100."
When UNAIDS published a figure of 310,000 Aids deaths in India in 1999
alone, and a cumulative total of 558,000 Aids orphans, JACKINDIA
challenged them publicly. In late 2001 the figures were withdrawn –
but only after being used earlier that year to project the state of
the epidemic in India at the UN General Assembly Special Session on
HIV/Aids in New York.

"For years now, agencies like the CIA, World Bank, UNDP, UNAIDS, a
plethora of NGOs as well as articles published in respected science
journals have been talking of an exploding epidemic in India, and
Africa-like conditions," Singh said. "We have consistently challenged
the agencies that claim India is underplaying figures and is in
denial; none of them has been able to provide any alternative data or
evidence to substantiate their claims."

The iconoclastic Harper's article, entitled "Out of Control: Aids and
the corruption of medical science", has sparked intense debate.
Greeted by a chorus of condemnation and calls for the resignation of
Harper's editor, it has nevertheless found many defenders. It was
written by Celia Farber, a journalist and long-standing critic of the
science surrounding the HIV theory.

In an editorial, the Columbia Journalism Review accused the magazine
of "racing right over a cliff" in publishing Farber. A blog called New
Aids Review responded that the editorial was "a poor specimen of what
journalism students are learning at one of the great universities",
adding that the author would do better to write a thesis on "The Media
in Aids: How Journalists Failed the American Public".

But even some long-standing HIV/Aids activists have admitted
themselves shaken by the facts Farber set out about the lethal
potential of some antiviral drugs; and the controversy has also taken
the lid off a claim made repeatedly in response to attempts to reopen
debate on the causes of Aids, that only a handful of scientists
question the orthodox view.
Thanks to the internet, an association started 14 years ago to press
for a scientific reappraisal of the HIV/Aids hypothesis now lists more
than 2,300 public dissenters, including Nobel Laureates in chemistry
and medicine on its website
( Many have advanced
degrees in the sciences and medicine as well as direct experience of
working in the public health sector in Africa and other supposedly
HIV-ravaged parts of the world.

One of these is Dr Rebecca Culshaw, assistant professor of mathematics
at the University of Texas, a mathematical biologist who for 10 years
studied and published models of HIV disease and treatment. In an
internet posting entitled "Why I Quit HIV", Culshaw calls for a ban on
HIV tests. She says they do "immeasurably more harm than good" because
of an "astounding" lack of specificity and standardisation; she adds
that many people are being treated with drugs on the basis of an
insupportable theory. "My work … has been built in large part on the
paradigm that HIV causes Aids and I have since come to realise that
there is good evidence that the entire basis for this theory is wrong."

In Australia, the idea that anyone can be diagnosed as infected with
HIV is to face a court challenge. In a hearing set down for July, the
lawyer for a man found guilty of endangering the lives of three women
through having unprotected sex (one woman has tested positive, while
the other two are negative) is to call evidence from a Perth-based
group of scientists who during nearly 25 years researching the
scientific literature on Aids have come to an even more radical
conclusion than the American dissenters quoted in Harper's. The group
( will testify that "HIV" has never been
isolated from the tissues of Aids patients; and that in consequence
the HIV test has never been validated and there is no proof HIV is
transmitted sexually.

Dr Robert Gallo, the American government researcher whose team
developed and marketed the first test kits, says in a letter in this
month's Harper's that "no test in medicine is perfect, but done
correctly and with a confirmatory second test, the HIV blood test
developed in our laboratory comes close." Gallo and others, including
activists promoting anti-viral drugs in South Africa, make similar
assertions in their rebuttal of Farber's article stating that: "HIV
tests were highly accurate from the time they were developed in 1984
and have become much more accurate over time as the underlying
technology has evolved. HIV tests are amongst the most accurate
available in medical science."

In fact, as demonstrated in a two-part investigation published in The
Business in May 2004 (see panel), experts have known since the early
years of Aids that "HIV" test kits could not be used to diagnose Aids.
Delegates at a World Health Organisation meeting in Geneva in 1986
heard that the kits were licensed to protect blood and plasma
donations, not as a screen for Aids or people at risk of Aids. But,
dictated by public health needs, usage had expanded and "it was simply
not practical" to stop this, as Dr Thomas Zuck, of the US Food and
Drug Administration, put it.

The 100 experts from 34 countries heard that, though the tests were
useful in safeguarding blood supplies, something more was needed to
distinguish genuine infection with HIV. Dr James Allen, of the US
Centres for Disease Control Aids programme, said studies suggested
some people were reacting to components of the cell line used to grow
HIV for many of the test kits licensed in America. Other reactions
occurred because of antibodies to normal cell proteins, naturally
occurring in the body. Allen warned that the problems could be
magnified in areas of the world that did not have the sophisticated
facilities of America.

The meeting was told that a so-called "confirmatory test", called
western blot, relied on the same principle as the test kits it was
supposed to be checking and so was liable to the same kind of
false-positive reactions. Subsequent research has repeatedly confirmed
this problem: more than 60 conditions that cause such false-positives
have been documented. One is tuberculosis, which produces symptoms of
Aids as defined in Africa and is immensely widespread among
impoverished people.

As the HIV/Aids paradigm won worldwide acceptance, increasingly
complex procedures for trying to make a reliable diagnosis came into
being. But the basic problem – not being able to validate any of these
procedures against pure virus taken from patients – still remains.

Harper's has published pages of letters in the latest (May) issue in
response to Farber's article, which appeared in March. Roughly half
are supportive, half against. The first letter is from Culshaw, who
writes: "This debate should have happened long ago, before an unproven
hypothesis of an immune-destroying retrovirus was thrust upon a
vulnerable public, and without being thoroughly critiqued in the
scientific literature. Despite the promises made in 1984, there is
still no cure and no vaccine. Instead, there has been a fundamental
erosion in scientific and clinical-trial standards, with implications
reaching far beyond HIV.

"To do the best we can for those affected by Aids – including those in
Africa, where Aids presents a clinical picture quite different from
that in the developed world – there urgently needs to be an honest
scientific debate."

There is an association between testing HIV-positive and risk of
developing Aids. This is the main reason why scientists believe HIV is
the cause of Aids. But the link is artificial, a consequence of the
way the test kits were made.

It never proved possible to validate the tests by culturing, purifying
and analysing particles of the purported virus from patients who test
positive, then demonstrating that these are not present in patients
who test negative. This was despite heroic efforts to make the virus
reveal itself in patients with Aids or at risk of Aids, in which their
immune cells were stimulated for weeks in laboratory cultures using a
variety of agents.

After the cells had been activated in this way, HIV pioneers found
some 30 proteins in filtered material that gathered at a density
characteristic of retroviruses. They attributed some of these to
various parts of the virus. But they never demonstrated that these
so-called "HIV antigens" belonged to a new retrovirus.

So, out of the 30 proteins, how did they select the ones to be defined
as being from HIV? The answer is shocking, and goes to the root of
what is probably the biggest scandal in medical history. They selected
those that were most reactive with antibodies in blood samples from
Aids patients and those at risk of Aids.

This means that "HIV" antigens are defined as such not on the basis of
being shown to belong to HIV, but on the basis that they react with
antibodies in Aids patients. Aids patients are then diagnosed as being
infected with HIV on the basis that they have antibodies which react
with those same antigens. The reasoning is circular.

Gay men leading "fast-track" sex lives, drug addicts, blood product
recipients and others whose immune systems are exposed to multiple
challenges and who are at risk of Aids are much more likely to have
raised levels of the antibodies looked for by the tests than healthy
people – because the antigens in the tests were chosen on the basis
that they react with antibodies in Aids patients. But this association
does not prove the presence of a lethal new virus.

The tests do discriminate between healthy blood and the blood of
patients with Aids or Aids-like conditions, because Aids patients
suffer a range of active infections and other blood abnormalities,
some of which are transmissible. This is why the tests are useful as a
screen for the safety of blood supplies.

But to tell even one person that they are HIV-infected on the grounds
that they have antibodies that react with the proteins in these tests
is an unwarranted assault.

Neville Hodgkinson is a UK-based journalist who has been writing about
Aids for 20 years. He is the author of AIDS: The Failure of
Contemporary Science (Fourth Estate, 1996).

posted by Sepp Hasslberger on Tuesday May 23 2006