A response to the book World Without AIDS (Phillip Day and Steven Ransom, Credence Publications, 2000).
The basic thesis of this book is that HIV doesn’t exist. It’s a more extreme version of the case most infamously put by molecular biologist Peter Duesberg, who granted in the early 1980s that HIV did exist, but said it was a harmless retrovirus and AIDS was the result of toxic lifestyles, drug use and amyl nitrate.
Authors Philip Day and Steven Ransom deny HIV exists. AIDS, they reckon, is caused by ‘toxic living’ in the vile, decadent West while in Africa, the ‘invented’ virus which isn’t the cause of AIDS has been cannily exploited to carry out a covert agenda: population control through poisoning whole countries with HIV treatments. That the authors of this book produce no evidence for this seriously bizarre allegation doesn’t matter a whit. Facts here are apparently beside the point, or can be perverted to fit any paranoid fantasy.
When Peter Duesberg first claimed HIV didn’t cause AIDS, considerably less was known about HIV. Though the majority of his colleagues even then were pretty sceptical of his insistence that AIDS was caused by chronic overstimulation of the immune system and recreational drug use, Duesberg’s ideas did engender some discussion. But they have long since been rejected by the vast majority of the HIV/AIDS scientific community – with the most direct nail in the coffin being the overwhelming evidence that HIV treatments, which work directly by targeting the virus, have dramatically reduced rates of disease progression and AIDS in countries where they are available. In those countries where they are not, people with HIV continue to develop and die from AIDS at horrific rates.
Ransom and Day call themselves ‘health researchers’, which sounds innocuous enough. They’ve also apparently produced “previous shocking health fraud exposes”, one on cancer. But examine their style of ‘research’ more closely, and you find it’s a house of cards. Pretty much every source quoted in this book as ‘evidence’ that HIV doesn’t exist is a secondary source. Nearly all of this material comes from writers who also believe HIV doesn’t cause AIDS. Rarely do Ransom and Day tackle the overwhelming body of scientific evidence confirming that HIV, untreated, is the cause of AIDS, take on any of the literature which has rejected the Duesberg thesis as untenable, or consider the epidemiological facts about HIV and AIDS. In place of peer-reviewed journals or discussions there’s just unsourced and ambit claims from obscure websites, self-made stars of the AIDS dissent movement, and first-name-only testimonies from people ‘formerly’ living with AIDS, who tell us things like “reading this book … I felt I had been born again.”
The book relies on a tiny but loud-mouthed group of researchers (and some groupie journalists) who huddle collectively under the banner ‘AIDS dissidents’. The term suggests a kind of activist heroism, ‘little guys’ putting their fists up to the Big Capitalist System. This plays very well in such times, when international drug companies appear to behave as a moral law unto themselves, and capitalism seems to reign without ethical restraint. But the global conspiracy theory industry (and is an industry) has grown proportionally as fat – and as ethically dubious—as the very system it so often claims to question.
Global capital may well may be rotten to its core, but that doesn’t mean that everyone who mounts any old theory attacking the interests of Big Pharma or Big Science is any more interested in telling the truth. The AIDS dissidents make quite a din, but their dishonest case does not hold up to the most basic scrutiny.
Ransom and Day ignore pretty much all of the current scientific literature on HIV. There are no interviews with leading scientists on either side of this so-called ‘debate’. All the signs you would expect from a balanced, credible piece of research are absent. Their approach would be like writing a history of the Holocaust based entirely on the discredited claims of the anti-Semite Holocaust denialist David Irving and a neo-Nazi website.
Those thousands of doctors and scientists (and millions of people living with HIV) have reached the conclusion that HIV causes AIDS because the evidence is clear and unequivocal, not because they have been tragically denied Ransom’s and Day’s “revelations”. Nor are they conspiring to mask the truth.
But let’s proceed on to some of the claims made in this book.
Claim: No one has ever found or isolated HIV.
Fact: HIV has been repeatedly isolated from people with AIDS; the virus has been cultivated in human CD4 cells, and HIV can be cultured in test tubes for replication. 
Claim: HIV antibody tests [the “AIDS test”] are so inaccurate as to be meaningless
Fact: There is a clear distinction between HIV (the virus) and AIDS (a syndrome of conditions and illnesses which are the result of severe immune damage, specifically caused by the depletion of the body’s infection-fighting cells, specifically, CD4 T-cells). HIV infects and replicates inside CD4 T-cells, killing them during this process. CD4 T-cells are crucial to the body’s immunity, as they help to ‘orchestrate’ the human’ body’s response to diseases, infections and allergies. The less CD4 T-cells you have, the more at risk you can be of developing illnesses that your body would normally fight off. It is in this way, because it infects and kills these important cells, that HIV, over time, will in most cases lead to AIDS – if treatment is not taken to slow or arrest this process.
That HIV is not the same as AIDS is one of the most important distinctions in this area of medicine. Ransom and Day either do not get this distinction, or they blur it to their own ends. Here is some “evidence” for their claim that the “AIDS test” is “fraudulently misleading” and that commercial HIV tests are invalid.
In investigating this claim, they point to the manufacturers’ own disclaimer. It reads:
“This test for the existence of antibodies against AIDS-associated virus is not diagnostic of AIDS and AIDS-like diseases. Negative tests do not exclude possibility of contact or infection with the AIDS-associated virus. Positive tests do not prove AIDS or pre-AIDS disease status nor that these diseases will be acquired.”
There is, in fact, as the authors themselves point out, no such thing as an “AIDS test”. And the manufacturers are quite right: a positive antibody test to HIV tells you nothing about AIDS or the likelihood of developing it. Whether you have AIDS does not depend on whether you have HIV, rather, the amount of damage which HIV has done to your CD4 T-cells. In addition, it can take up to three months for antibodies to HIV to develop in your blood following contact with the virus, so during this period, it is possible the test may not show positive even if you have been exposed to HIV. That’s why people usually won’t rule out HIV infection until tests are done at least three months after the possible exposure, when any antibodies produced against the virus would show up.
The ELISA test for HIV antibodies is not administered on its own. In Australia, Canada, the USA and Europe, a second kind of HIV antibody test is used to confirm if a person is positive to HIV. Only when the two tests come back positive is HIV diagnosis confirmed.
When (or if) a HIV positive person develops AIDS depends on a number of factors: how long a person has been infected at time of diagnosis; treatment; the virulence of the strain of virus; and highly individual factors about the immune system—all of which make it impossible to infer from a HIV positive diagnosis any particular outcome in terms of disease progression or development of AIDS.
So the manufacturers’ comments are perfectly appropriate.
HIV RNA testing, which can directly quantify the amount of HIV viral genesThe most basic unit of genetic information. in the blood, was one of the most damning pieces of evidence against the Duesberg claims, but one that the AIDS dissidents have been extremely poor in answering. This kind of testing has enabled researchers to document the presence of HIV genes in virtually all patients with HIV. This is the test called viral loadA measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma.. Numerous studies confirm a predictive relationship between a high viral load (a high presence of HIV the blood), and the loss of CD4 T-cells with an increased risk of AIDS. In one major US study involving 1,604 HIV positive men, the risk of developing AIDS over six years was strongly predicted by a higher HIV viral load. In people with viral loads of greater than 30,000, 80 percent of these men developed AIDS within six months. In people with viral loads of less than 500, less than 6 percent developed AIDS within six months3.
This is absolutely consistent with the knowledge that HIV infects and kills CD4 T-cells, eventually destroying so many over time as to cause AIDS. The more HIV is replicating in your body, the more damage is being done.
Claim: There’s no evidence AIDS is caused by a transmissible agent
Facts: Of all the claims made in this book, this is one of the most appalling. The “evidence” dredged up to support this argument is absurd. Drawing from the work of ‘health researcher’ Christine Johnson, it demonstrates the authors’ complete failure to engage with anything resembling current scientific practice or knowledge in their area of research.
Infectious illnesses, it is claimed, always “spread equally among the sexes and across the age range”. This is not true in the first instance, since the likelihood of developing some infectious illness is mediated by a range of particular and environmental factors, like age, poverty and the mode by which the disease is transmitted. The authors’ feeble response to the argument that AIDS is caused by an infectious agent is that “in the early years, AIDS cases were being reported almost exclusively in younger males.”
This, of course, ignores the rather inconvenient if obvious question of what happened in ‘the later years’? (AIDS cases are indeed seen across a wide gamut of the population). But it also demonstrates a stunning ignorance of the epidemiologyThe branch of medical science that deals with the study of incidence and distribution and control of a disease in a population. of AIDS.
AIDS as a phenomenon was first identified among gay men. This is entirely plausible, given that HIV, the virus that causes it, is present in both blood and semen, and unprotected anal sex (which can involve both) is a practice linked unequivocally with risk of transmission. (For those doubters needing more proof, there is the further evidence in that transmission, even if one partner is positive, can be prevented by using condoms.) But AIDS was also identifiable in other people: people who had had blood transfusions; people who injected drugs and shared the needles; sex workers; and people who were the sexual partners of people in these risk groups.
HIV is transmitted more commonly by heterosexual sex in Africa and other parts of the world. We know that, as with other infectious diseases, the spread of infection is often mediated by a set of things, including (but not only) poverty, and the prevalence of other infections and illnesses. Women in Africa frequently have generally poorer levels of sexual health. Having other infections makes it easier to contract HIV, partly because of the possible presence of ulcers, and other issues around the health of vaginal mucosa. There are thought also to be other immunological factors involved.
In still other areas of the world, other risk factors are associated with transmission of HIV. In eastern Europe, where injecting drug use among young people is extremely common, and there is no access to clean needles or syringes, HIV is commonly transmitted through shared injecting equipment.
But (I hear Ransom and Day exclaim), that is just it: how do we know that this drug use, and not HIV, is not the cause of AIDS?
One telling answer to this is the Australian epidemiology of HIV. Australia was one of the first countries to respond to HIV by making clean needles and syringes available to injecting drug users through government programs. The incidence of HIV infection among Australian injecting drug users is therefore extremely low: less than three percent of injecting drug users are HIV positive. Consequently, Australian rates of heterosexual infection have also remained lower, since there are fewer people to potentially pass HIV on to their sexual partners. In the United States, however, where no such programs exist, about 25 percent of HIV infections are among injecting drug users. In the former Soviet Union countries, where there is almost no access to clean injecting equipment, and very high rates of injecting drug use, infection rates have exponentially increased.
Finally, there is the question of babies of HIV positive women who are born with HIV antibodies and may also develop AIDS. There can be no other logical explanation for HIV in this group than that it is an infectious agent. There is not a shred of evidence that maternal drug use or bad ‘lifestyle’ causes babies to develop AIDS. In vast parts of the world, babies are born HIV positive to mothers who do not use drugs, with the risk factors being untreated HIV, a high HIV viral load, a low CD4 count, and breast-feeding. Babies who are not born HIV positive do not develop AIDS. Some babies with extremely rare inherited immune disorders, however, can develop a syndrome similar to AIDS because they are susceptible to infections and illnesses normally fought off by a healthy immune system. This is, however, exceedingly rare. Without antiviralA medication or substance which is active against one or more viruses. May include anti-HIV drugs, but these are more accurately termed antiretrovirals. treatment, it is estimated that between 20 and 30 percent of the babies of HIV positive mothers will be HIV positive. With antiviral treatment and other interventions this figure is reduced to about 3 percent.
Such patterns offer unequivocal evidence that HIV is transmissible, primarily by blood, semen, breast milk and less commonly, vaginal fluids. HIV has been isolated repeatedly in each of these body fluids.
Claim: lifestyle factors, not HIV, cause AIDS
Facts: Duesberg argued AIDS is caused by lifestyle factors including drug use – most notoriously, he blamed amyl nitrate (poppers) – poor diet, and a range of other things leading to a hyperstimulated or stressed immune system.
The evidence against this is clear. But let’s pick apart some of the assumptions.
Depending on exactly how you define immune deficiency, such a phenomenon certainly did exist before HIV was ever identified, albeit very rarely. Immune deficiency – leading to increased susceptibility to common and less common illnesses—can be caused by things such as cancer and its treatment, malnutrition, and major infections like tuberculosis.
So what about AIDS? In the early 1980s, a certain kind of very severe immune deficiency, leading often to rapid development of very rare illnesses and conditions, and usually death, began to be identified among groups of people who could be linked together epidemiologically based on certain practices or apparent behaviours, and within specific communities – initially, gay men. This led to the immediate suspicion that the cause of this was an infectious disease. The specific thing about what was called AIDS was that when they tested the blood of people dying from it, they all had extremely, dangerously low levels of a particular kind of protective immune cell, called a CD4 T-cell – and there was no obvious explanation for this unheard of phenomenon.
Many of the people developing this syndrome were gay men who indeed had some or part of the lifestyle factors described by Duesberg. But plenty were not. AIDS was also being identified in women, heterosexual men, and the new-born children of women with AIDS. Many of these people did not have any of the “excessive” toxic lifestyles which Duesberg has insultingly claimed cause AIDS. (And I am sure we all know people whose lifestyles would be considered by some extremely toxic – but they don’t have AIDS).
Ransom and Day pick up the “toxic lifestyle” argument with gusto. It’s really the core of their argument. They argue that the numbers of AIDS diagnoses in the US between 1981 (a few dozen cases) and 100,000 (in 1993) can be explained by a dramatic national rise in recreational drug use (heroin, cocaine, nitrates) during this same period. But that two phenomena should exist independently offers no evidence that drug use causes AIDS. For this theory to hold true, you would need to demonstrate that basically all people with AIDS have a history of injecting drug use on a scale significant enough to cause such massive immune damage. You would also need to exclude other causes, and then explain why many people who use drugs regularly don’t lose all their CD4 cells or develop AIDS. (As mentioned, HIV/AIDS affects only a small percentage of Australia’s injecting drug use population). And you’d have to look at how these two answers related to the presence or absence of HIV antibodies.
Babies with HIV/AIDS are also a bit of an inconvenience to the ‘AIDS lifestyle’ argument, since babies tend on balance to prefer feeding and sleeping over circuit parties and life in the fast-lane.
The ‘lifestyle’ argument can’t explain AIDS in other groups of people whose lifestyles do not conform to Ransom and Day’s caricature of drug snorting, hardcore backrooms and general satanic depravity – but who are positive to and do have a plausible route of transmission for a blood-borne infectious virus. In Australia, prior to the introduction of routine blood screening for HIV antibodies, there were around 300 cases of HIV and AIDS among people whose only risk factor for contracting HIV was a blood transfusion or the receipt of blood products. Following the introduction of HIV antibody screening in the blood bank, in 1985, only one case of HIV transmission through this route has been reported (in 1999). In the absence of antiviral treatment, many of these people developed AIDS.
The chapter on ‘lifestyle’ is a lurid and eye-popping account of the supposed excesses of gay life. Being gay is portrayed by nurses, counsellers and ‘former homosexuals’ as an endless stream of semen, piss, saliva and bodily fluids. Heterosexual “fast-track” lifestyles also come in for a savaging. AIDS, it is declared, is “a plague of toxic excess, affecting all who indulged in irresponsible drug and sex lifestyles”.
Apart from the appalling cultural biases and imperiously sweeping assumptions evident here, this argument overlooks a number of confounding facts.
- Nearly everyone who has AIDS has antibodies to HIV. A survey of 230,179 AIDS patients in the United States showed only 299 HIV negative people out of that total. Further tests showed 131 of these people were indeed infected with HIV. A further 34 died before their antibody status could be confirmed.
- Individuals from incredibly diverse backgrounds have developed AIDS, with the only common denominator being that they are HIV positive.
- The specific immunological profile of HIV-related AIDS – a persistently low CD4 count – is extremely rare in the absence of HIV infection or other identifiable, explicable causes of immunosuppression, such as genetic disease. The National Institutes of Allergy and Infectious Diseases in the United States (NIAID) supported a study of 2,173 HIV negative gay and bisexual men and found only one of these men had a CD4 T-cell count persistently less than 300. This man had been receiving a treatment known to suppress the immune system. Similar results have been found in other studies. HIV-related AIDS is defined by a CD4 T-cell count of less than 200.
How treatments targeting HIV prevent AIDS
HIV and its treatment have changed dramatically since the early 1990s, when only AZT, and then two other drugs from the same class of treatment (ddI and ddC) were available. The authors of this book, however, still seem to believe that in 2000, treating HIV with just one drug is common. This is another characteristic it shares with similar books: an obsession with AZT. That things have moved on since the days of AZT used alone seems irrelevant to Ransom and Day. New HIV treatments are only discussed insofar as to grandstand about their side effects. But the authors steer carefully clear of any discussion of the principles or outcomes of combination HIV treatment, since treatments themselves provide probably the most obvious nail in the coffin of their HIV denialist argument.
Antiviral drugs target HIV. They can prevent HIV from replicating and destroying CD4 cells. This totally alters the “natural” history of HIV. In the absence of treatment, AIDS can develop as a result of HIV infection, usually within five to ten years. With treatment, many people previously diagnosed with serious AIDS-defining illnesses are now leading lives free of AIDS, many years after having been literally at risk of death.
The correlation between the availability of these treatments and the dramatic fall in AIDS diagnoses and AIDS-related opportunistic infections is incontrovertible evidence that HIV causes AIDS.
- There is overwhelming evidence that combinations of drugs that specifically interfere with the replication of HIV have dramatically reduced deaths in people diagnosed HIV positive. If HIV did not exist, and did not cause the CD4 cell depletion leading to AIDS, this effect would not be seen: that, or it would be the most extraordinary manifestation of the placebo effectA physical or emotional change, occurring after a substance is taken or administered, that is not the result of any special property of the substance. The change may be beneficial, reflecting the expectations of the participant and, often, the expectations of the person giving the substance. known to history. In one study of more than 7,300 people with HIV in 52 separate European HIV clinics, rates of AIDS-defining illnesses declined massively between 1994 (prior to the availability of HIV protease inhibitors) and 1998, when the majority of these patients were receiving combination HIV treatment including protease inhibitors.
- In Australia, once relatively common AIDS-related illnesses in people diagnosed HIV positive plummeted following the availability of HIV protease inhibitors and other new antiviral drugs. In 1991 (prior to the protease inhibitors) there were 1,205 cases of the AIDS-related pneumoniaAn inflammation of the lung, usually caused by infection with bacteria or other microorganisms, in which the air sacs of the lung become filled with inflammatory cells which solidify and inhibit breathing. PCP, compared to just 165 cases in the years 1998-2000. This disease was about 7.3 times more common prior to widespread treatment for HIV, which protected the immune system from damage from the replicating virus. In 1991, a total of 3,420 opportunistic infections were diagnosed in people with HIV. By 1998-2000, this had dwindled to 689, a decline of just about 80 percent. All of this corresponded with the rapid uptake of HIV treatments among Australians with HIV.
Attacking AZT is easy. Used alone it is a woefully inadequate treatment for HIV. In early trials, extremely high doses were used, leading to unacceptable toxicity. Like any available HIV drug, used on its own it will have at best a very short-term effect against HIV, because HIV will quickly develop resistanceHIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant. to it.
At the time that AZT was available, there were no other options for treating HIV. Many of the people taking AZT were also extremely sick with AIDS. One of the most objectionable, historically insulting practices of HIV dissidents is to ignore exactly this fact, as if so many people with AIDS would have been alive today had they not taken AZT. But the majority of people who die from AIDS around the world now do so because they do not have access to antiviral therapy.
All HIV treatments have long and short-term side effects. Many of these are serious; in a small number of cases, they have been fatal. Neither HIV positive people, nor their clinicians nor anyone else involved in HIV or AIDS care is under any dewy-eyed illusions about HIV treatments. These drugs can be toxic and must be used very carefully.
AIDS in Africa
The second part of this vile book deals with ‘African AIDS’. Their take on the issue of AIDS in Africa can be summed up thus: the Western media have conspired with scientists to promote the myth that HIV causes AIDS in Africa to cover up their secret aim: population control. Hence quotes like:
“Today, at the start of the new millennium, under the finest crystal chandeliers, population control is just one of a number of elitist ideologies being planned for world-wide implementation.”
This “entire operation,” we are told, “will be well planned and centrally co-ordinated, so as to be consistent and sustained. Officials will be thoroughly familiar with their audience, and able to gauge its possible reaction to the campaign … They will endeavour to keep this whole operation and its purpose concealed from the enemy.”
“What began as a policticised error has now developed into a convenient conduit for delivering highly toxic drugs to nations that do not need them … The facts indicate we are witnessing the ongoing eradication of a population.”
Except: if there is a plot to deliver toxic drugs for a non-existent virus into Africa to control population, then surely it is one of the most stunningly inept conspiracies of all time, since only about 30,000 people across a continent of millions are actually thought to have any access to these same drugs?
Yet this palaver goes on for pages. This, as HIV positive activists around the world finally begin to have some legal victories against the pharmaceutical industry – notably in relation to accessing treatment to prevent mother-to-child transmission in some countries.
To accept this book, you ultimately have to believe that all of those in the world—HIV positive people, scientists, researchers, community activists, health care workers, and government – involved in the struggle to provide HIV treatment to people who need it, and some degree of dignity and quality of life to all people with HIV, are either too stupid or brainwashed to have seen the truth, or are so evil as to be part of a plot to deliberately cover it up.
It’s one thing to be sceptical. But in this assumption—as in everything else in this dreadful book—Ransom and Day display their pathological aversion to what the rest of us like to call facts.
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