What to do about science denialists

This week's column from the Kingston Whig-Standard.

One of the privileges that comes with being an academic is that one is comparably mobile, the world really is one’s job oyster.
I chose to work between 2000 and 2005 in a medical school in Johannesburg, South Africa. Sub-saharan Africa at the time was the world’s region worst hit by HIV and AIDS. At a time when HIV infected people in the West got used to the idea of living to old age, people around me literally were dropping like flies. Talk about culture shock! In the condo-complex where I lived, several of our staff members died preventable AIDS-related deaths. One of my staff member’s life-partner died from AIDS, too. He had just matriculated from college.

Many of our students were infected and discussions began in the university whether we had a responsibility to sponsor medical insurance to ensure their survival while they were enrolled with us. To the outsider this might look like an issue best understood as people in the developing world being unable to afford access to life-preserving medication. And, to be fair, the price tags of essential medicines in many developing countries remain unacceptably high. However, this is not what actually caused in excess of 360,000 entirely preventable HIV-related deaths in South Africa.
The country’s president at the time, Thabo Mbeki, and his health minister, Manto Tshabalala-Msimang subscribed to wild conspiracy theories involving Western agencies wanting to crush African people’s aspirations. In their paranoid world AIDS medicines were a means to poison Africans. HIV was not the cause of AIDS, and AIDS didn’t quite exist as a new disease. They duly found a high-profile, ironically white, United States academic and a few of his, ironically white, allies to confirm their worst fears. Being the country’s president, Mbeki quickly set up a presidential expert panel involving mainstream scientists and a bunch of denialists. A funny idea to create a sparring match between discredited academics and mainstream academics and encourage them to entertain your paranoia. Mbeki clearly thought that a scientific consensus is reached not by evidence but by discussion and some kind of compromise (as if HIV could cause AIDS just a little bit, depending on the compromise reached).

Well, Mbeki and his side-kick Tshabalala-Msimang enforced policies aimed at keeping as many impoverished South African AIDS patients away from life-preserving medicines as was possible. HIV infected pregnant women were not given access to medicines proven to drastically reduce the risk for their newborns to be HIV infected. Thousands and thousands of HIV infected newborns came into this world as a result of these crazy policies. A Harvard University study estimated that in excess of 360,000 South Africans died preventable AIDS deaths during Mbeki’s reign. Some of the medical doctors in public sector hospitals who prescribed and provided AIDS drugs to their infected patients were disciplined by hospital managers carrying out the health minister’s orders.
Ask yourself how the world would have responded if such genocidal policies had been implemented by the apartheid regime preceding the ANC government that’s running the country today. No doubt international bodies would have busily prepared genocide charges. No doubt international campaigns would have got off the ground blaming the racist government for the preventable deaths of such a large number of South Africans. A black politician with liberation credentials presiding over what could demonstrably be described as genocide barely led to people batting their eyelids. Human lives clearly remain cheaper even today in that part of the world than elsewhere. Another, even crazier, head of state, Gambia’s president Yahya Jammeh insists that a herbal concoction he invented cures AIDS. Foreign aid workers disbelieving the story end up being kicked out of the country, and any Gambian criticizing his take on this medical problem end up in jail. Meanwhile Jammeh instructed HIV infected people to stop taking AIDS drugs.

What bothers me greatly is that government policies leading demonstrably to large numbers of preventable deaths remain unpunished. It is one thing if Mbeki had said that his government decided not to provide AIDS drugs due to their high cost. If you don’t have the resources to treat everyone it is fair game to allocate resources. But denying access to life-preserving medicine to large numbers of impoverished South African public sector patients because of truly crazy ideas about Western conspiracies is surely something else. Yet Mbeki walked away, enjoying today his generous retirement pay-out. His alcohol guzzling health ministerial side-kick died eventually of liver cirrhosis. Even there she remained true to her unethical form by jumping the queue toward a donor liver.

Well, enough on AIDS. This week United States talk show host Katie Couric used her show on national TV to peddle nonsense about the HPV vaccine. In Mbeki style she juxtaposed scientific mainstream views with anecdotes supplied by vaccine critics. The impression created was that there is a genuine debate, that there are genuinely two sides to this vaccine, when patently there are no two sides. While some of the stories presented were genuine human interest stories, they showed nothing relevant at all with regard to the safety and efficacy of this vaccine. It was clearly irresponsible of Couric to give a high-profile stage to quacks promoting their anti-science agendas. Almost certainly as a result of her action people who would clinically benefit from getting vaccinated won’t get vaccinated. Some of these women will eventually go on to develop cervical cancer. Is it acceptable, for the sake of ratings to promote quacks’ views on national television? I doubt it.

To be fair, Couric’s case is different to Mbeki’s actions. Women choosing not to get vaccinated did it on bad information they received through her TV show. Arguably women making such important health care choices would do better than to listen to anecdotes on a talk show when making important health care related choices affecting themselves. Let the buyer beware, as the old Romans said. On the other hand, the impoverished HIV infected South Africans depended on the national health care system to deliver life-preserving medicines. They did not have the luxury of choice to begin with. So, while the blame for bad choices in Couric’s cases arguably should be shared between those who act on anecdotes heard on her talk show and those who produced the show, the blame in South Africa falls squarely on Mr. Mbeki’s shoulders. Remarkably until today he was neither prosecuted nor did he ever utter an apology for the genocidal policies he presided over.

Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.

Ethics of dealing with irresponsible HIV/AIDS denialist parents

A fellow Facebook addict from Toronto sent me a message asking me what I thought about the case involving Barbara Seebald and a commentary written by Matthew Weait, a law scholar with particular expertise on HIV/AIDS and human rights issues who is based in London. Weait wrote a monograph arguing that the criminalization of HIV transmission, and indeed the criminalization of infected people who knowingly subject others to the risk of infection, are bad news. He basically thinks that the criminal law ain't a good tool to achieve desirable public health objectives, at least not with regard to HIV/AIDS. This may or may not be true, but - as I have argued in a lengthy review of this book - there can be another good reason for keeping some HIV transmissions a criminal offense, namely the fact that they demonstrably harm other parties. The same case can probably be made for subjecting some third parties to the risk of HIV infection, too. Read my review of his book. I do, in fact, agree with Weait on many HIV policy and legal issues, but I do think there are circumstances were an HIV transmission could constitute reasonably a criminal offense.

Here's Weait's take on the Seebald case.

Seebald is the second case known to me involving an HIV denialist whose belief that HIV is not the cause of AIDS has translated into serious bodily harm for her offspring. Seebald has chosen not to take antiretrovirals during pregnancy, thereby increasing significantly the risk of her off-spring being HIV positive. One of her children has been hospitalised as a result of HIV-related pneumonia. She breastfed her newborn at the time, thereby further increasing the child's risk of HIV infection. She also misled the midwife assisting in her natural birth to avoid the cesarean section required to reduce the HIV risk. Seebald's children have since been removed from her (yes, they do live with foster parents to protect them against their mother's irresponsible conduct) in order to permit medical doctors to treat them to the best of their professional abilities, an option unavailable to them while the children were with their biological parents. Seebald's - also HIV infected denialist - husband died in May 2010.

As I mentioned, this is the second case that I am aware of that deals with the harmful conduct of HIV denialist parents toward their children. Christine Maggiore, she since died on AIDS, arguably indirectly killed one of her children by ensuring the child did not receive proper medical care.

Matthew Weait, in keeping with what seems his primary legal concern: namely to ensure that the transmission of HIV remains decriminalized (or becomes decriminalized), runs the following line of reasoning to make his case with regard to an Austrian court finding against Barbara Seebald. The court issued a 10-month suspended sentence against Seebald because of her refusal to protect her newborn reasonably against HIV infection. Weait doesn't like the verdict at all. Here are what I take to be the crucial bits from his analysis (please do read his complete analysis here):

He begins by pointing out that for retributive justice to work we need a moral blameworthiness (ie a bad intention - undoubtedly not the case in either Seebald's or Maggiore's case), or the people whose actions we are concerned about need to have been grossly negligent (it's a no-brainer that this applies to both the Seebald as well as the Maggiore cases). I do think Weait's analysis is as seriously flawed as quite some of that presented in his monograph. In this particular instance he rehearses reasons from his monograph that clearly do not apply to these cases. The argument that Seebald and Maggiore were arguably criminally negligent has nothing at all to do with public health concerns (the numbers are too small for this). They have to do with something I elaborated on at great length in my review of his book: gross negligence leading to serious bodily harm to third parties. In this case the third parties were not even volunteering sexual partners, in this case the third parties were these women's own children! As an HIV clinician pointed out in this context: '...infants whose HIV infected mothers listen to AIDS denialists never got the chance to make their own decisions. The Maggiore case received wide publicity. Christine Maggiore is a person who’s proselytized against the use of antiretrovirals to prevent HIV/AIDS. She’s a classic AIDS denialist, and she gave birth to a child who died at age three late last year of an AIDS-related infection. The coroner’s report clearly reports that the child died of AIDS. That was another unnecessary death.'

Weait's analysis, on the other hand is concerned not really about the kids that have been grossly negligently infected by their nuttish mothers, but about the genuinely held dissident views of their parents. How dare we to ignore 'It follows that someone who honestly (even if misguidedly) denies the relationship between HIV and AIDS cannot legitimately be punished for onward transmission of HIV, unless one takes the view that such honest belief is to be ignored' he writes. And further, to drive this important insight home, 'And if we ignore it, then we fail to take seriously the reasons - whatever those might be – for denialism. These might be grounded in a person’s particular life story; or they might result from misinformation or misunderstanding. Whatever its cause, and however difficult it might be to understand that denialism or to sympathise with it, our incomprehension cannot be a sufficient justification for criminalisation and punishment.'

This shows, to my mind, the trap the decriminalization crowd is finding themselves in, with their blanket refusal to acknowledge that there can be circumstances where HIV transmission deserves to be dealt with thru our criminal justice system. Why should it make any difference to our evaluation of the Seebald and Maggiore cases (where idiotic views demonstrably led to serious bodily harm inflicted by these pregnant women on their off-spring), that these people held such idiotic views genuinely, that they ignored overwhelming clinical evidence to the contrary and so on and so forth. Is the argument that their circumstances were such that they were unable to compute the evidence that would have been available to them, had they cared to clear their minds? If this is the argument, perhaps removing their kids from them would have been a sensible choice. It doesn't appear to be the case then that they were strictly speaking competent to bring up these kids to begin with. Surely it is unreasonable to risk one's child's life in order to test the hypothesis of a negligible number of dissident scientists. It's here where Weait moves too quickly to discard the grossly negligible rationale as the basis for a criminal prosecution. This all, of course, is in the service of the blanket decriminalization policy he propagates.

And, just to be on the safe side, Weait quickly throws some mud at those disagreeing with this take, 'doing otherwise effectively makes a failure to accept what most other people believe a sufficient justification for punishment, and that has a frighteningly totalitarian ring to it.' This is bollocks, of course. Failure to believe what other people believe would never lead to punishing anyone, unless that failure leads to the deaths of other parties, or serious bodily harm inflicted upon third parties. Harm to self is fair game, harm to others ain't. That's why even Jehova's Witnesses today in most jurisdictions won't get away with preventing their off-spring from receiving life-preserving blood transfusions when that is clinical indicated. They can harm themselves, but they must not harm others. Nothing totalitarian about this.

Of course, there's never a chance lost to lament 'the effects of HIV-related stigma and prejudice', and so Weait concludes his analysis with general stuff about stigma and prejudice. I pretty much lost it at that point: Here's pregnant women that deliberately decided to disregard mainstream medical advice, and who so chose to risk their children's well-being (with the terrible consequences of death in the Maggiore's child's case, and of life-long serious chronic illness in the Seebald's case). The thing is, virtually all pregnant HIV infected women do NOT act like Seebald and Maggiore, hence Weait's other claim, namely that of 'systemic failures in HIV/AIDS education' is obviously baseless. - None of this has anything at all to do with HIV-related stigma and prejudice.

It goes without saying that these cases are tragic, and thankfully they occur very infrequently. The broader policy point, however, is this: Parents do not own their children. Their kids' lives ain't a free for all. The state has an interest in protecting children against abusive behavior that parents engage in, regardless of whether parents feel strongly that their behavior is not abusive when it actually is. While it might be of interest to Matthew Weait and a lot of sociologists and psychologists to figure out what drives such parents (check out the Darwin Awards in case you've doubts that there's plenty of nutcases out there), at the end of the day society needs to step in and prevent such abuse in its tracks. That's the objective. If currently that can only be achieved thru the criminal justice system, then so be it.

And the weekend good news: Manto Tshabalala-Msimang is dead

I like the hypocrisy of people insisting that we must never speak bad of the dead. Why not? If the dead were bad people, what's wrong with wishing them good riddance. A case in point is Manto Tshabalala-Msimang (better known as Dr Beetroot), the former South African health minister. Her policies and that of her boss Thabo ('I don't know anybody who died on AIDS in South Africa.') Mbeki led to about 300,000 preventable deaths among infected people. Beetroot insisted that it ain't clear that HIV causes AIDS, and claimed that anti-retrovirals for Africans were an evil scheme by the CIA and the pharmaceutical industry to poison Africans. Those suffering from, and dying on AIDS she offered, well, you guessed it, beetroot, lemon juice and garlic. Moron that she was she thought nothing of it to jump the waiting list for organ transplantations in order to grab a liver when her old failed as a result of her marriage to alcohol. Excuses were found for why this woman, in her 60s at the time, was deserving of the liver (ie public sector clinicians, working for her, colluded in lies about her legitimate rank on the waiting list). During the time it became public knowledge that as a hospital doctor in Botswana she was convicted of stealing patients' property while they were in surgery. It didn't occur to the ANC and its senior officials to fire Dr Beetroot. Well, I was elated when I found out that the transplant liver crapped up on her, and the system refused to offer her yet another one. Good riddance Dr Beetroot. Thabo, we're waiting for you to join her. After all, you also like your booze and there's some 300,000 people who are dead today because of you. Why don't you also call it a day?

On a slightly more analytical (as opposed to purely angry) level (even though my anger about these two South African politicians' murderous policies knows few boundaries, I have admit): What is of interest is that there's a pattern of colonial mentalities in play in South Africa as well as in Uganda. In South Africa, black nationalist politicians happily ganged up with Western crank scientists against their own people, because they were suspicious of mainstream Western science and knowledge. White Westerners taught them stuff that translated into genocidal policies costing about 300,000 predominantly black people's lives in that country alone. The attempted political emancipation drove these black nationalists straight into the hands of crackpots, that's how substantial their concern was that hooking their people onto life saving medicines was just another ruse by the West to poison and keep Africans down and dependent on the West. Incomprehensible. As good nationalists are wont to do, they insisted on 'local solutions', hence beetroot, garlic and lemon juice. African scientists and medical doctors standing up to them were fired and bullied sufficiently that Stalin could have taken a page from that book (Beetroot managed this without actually killing the scientists, she simple removed them from jobs and funding).

Uganda is another example. It has become clear by now, that draconian anti-gay legislation, threatening gays with the death penalty, was inspired by US evangelicals, white US evangelicals. How ironic that Africans, busily trying to assert themselves against 'evil Western values', are being goaded by other Westerners (crazy ones) to implement seriously civil rights violating policies against their own people ... bizarre stuff. The only good news is that they're being opposed frequently by younger generations of Africans who won't stand for that sort of crap.

Anyhow, Manto is gone, let's go and drink to her demise :).

Another AIDS denialist bites the dust - AIDS related death

Schadenfreude is that uniquely German expression describing the pleasure someone derives from watching/enjoying someone else's misery. Of course, we should not really enjoy someone else's misery, even less so someone else's premature, preventable death. Sometimes though, especially when the harm is self-inflicted and very predictable, one can't help but feel somewhat schadenfreudig.

Well, on this occasion, another HIV denialist bit the dust. Christine Maggiore died of an AIDS related illness (a typical AIDS indicator disease, pneumonia) late December. Maggiore's main claim to fame (other than founding the Italian design company Allessi) was that she was HIV positive but refused to take any anti-HIV medication. She belonged to a small band of HIV denialists who continue to insist that HIV has nothing to do with AIDS.

Worse than her harming herself, however, being pregnant twice, she also refused to take HIV mother-to-child-prevention medication during pregnancy, with the result that one of her kids became HIV infected, and eventually died on AIDS. All of this she did in the face of overwhelming empirical evidence of the life-preserving capacities of standard HIV medicines. The coroner in the US, at the time, declared the child's death to be AIDS related. A HIV denialist retained by Maggiore (a veterinary toxicologist of all things) declared that her daughter died as a result of an allergic reaction to amoxicillin. Maggiore lived a 'healthy life', ie a life without any drugs. According to the denialist community she should have been able to live forever, sadly at the age of 52 she died a premature death caused by AIDS.

Well, what can one say other than that stubbornness in the face of overwhelming evidence is a pretty silly thing. One got to give her credit tho for sacrificing her life in order to be able to stick credibly to her obviously false beliefs on HIV.

HIV/AIDS: The ANC facilitated genocide seems to be swinging back into higher gear

Interested observers will know that South Africa is currently run by the ANC's President Thabo Mbeki (who informed interviewers repeatedly that he doesn't know a single person who died on AIDS in his country, and who expressed doubts that HIV is the cause of AIDS).

His Minister for Health Prevention is Manto Tshabalala-Msimang (who offered at one point in her illustrious career beetroot, the African potato and garlic as a means to prevent AIDS). They both continue to conspire against millions of HIV infected South Africans with a wide array of truly idiotic statements and every effort to slow down the roll-out of antiretroviral treatments as good as is feasible (ideally without getting caught).

Eventually they were forced by mostly court decisions to stop the HIV related genocide that they were quietly organising and presiding over. Still, things happen even to truly nasty people like the Pres and his sidekick Manto. Manto, who would fit nicely into Scotland, given her interest in booze, had to be taken out of action to get a new liver (as her old liver truly couldn't handle the amount of alcohol she's guzzling). While she quickly jumped the queue to get a new liver (makes sense, who else would assist so kindly in executing Thabo Mbeki's genocidal activities), her Deputy Minister Nozizwe Madlala-Routledge took over. She is an old hack of the South African communist party and so a member of a party belonging to the triparty alliance making up the government of the country. Being not an ANC cadre she didn't have to insists that the earth is flat, pigs can fly and AIDS is a conspiracy against Black people organised by the CIA and the international pharmaceutical industry bent on selling poisonous AIDS drugs to South African Blacks. There was no need for her to peddle 'African solutions' such as beetroot, African potatos etc etc (as Manto suggested in between a couple of drinks during one of her conference appearances).

Well, Madlala-Routledge worked tirelessly toward getting AIDS ttreatment programs off the ground while Tshabalala-Msimang jumped the liver transplantation queue. It was only a matter of time until she would be cancelled by Thabo and his sidekick, and today she was. The pretext was that she went to (would you believe) an AIDS conference in Spain even though Thabo the Pres explicitly refused her travel. Stupidly Madlala-Routledge seems to have dragged her son and various hangers-on along so this had all the make-up of a junket trip. A good pretext to fire her. Here's a statement on her dismissal from the South African HIV/AIDS Clinicians' Society that I received a few minutes ago. I would normally encourage you to write to the SA High Commission or Embassy in your country and ask that you criticise her dismissal, but what's the point, thhe High Commissioners and ambassadors would report back to Thabo the Pres who is the bloke who fired her in the first place... welcome to the ANC owned rainbow nation in action.

'Statement by the Southern African HIV Clinicians Society (9th August 2007)

We are an organisation of over 12 000 health professionals working in HIV care in the Southern Africa region. http://www.sahivsoc.org/ We support the Rural Doctors Association of Southern Africa (RuDaSA) statement issued on 9th August 2007, National Women’s Day. We believe that Deputy Minister Nozizwe Madlala-Routledge has played a fundamental role in bringing civil society and professionals together to support the government’s National Strategic Plan (NSP) for HIV/AIDS, on an unprecedented level. She demonstrated compassion and commitment to South Africa’s population, with a respect for science and public health that made us realise what we should demand from all public servants. The manner of her dismissal (on Women’s Day), when so much positive work has been done in the area of HIV, to provide political and public leadership for the first time, is deeply distressing. Furthermore, it comes when we are seeing alarming signs of a return to the rhetoric and confrontation of the past over HIV. The Society has asked for urgent clarification, as have others, as to why the mother-to-child HIV prevention programme (PMTCT) has not been expanded beyond 30% coverage after 5 years, and why more effective regimens have not been implemented. Yet again, court action is being threatened as the last resort to force action on this issue. Fewer than 20% of adults requiring antiretrovirals are receiving them, after more than 3 years of publicly available ART. Minister Manto Tshabalala-Msimang, since her return from sick leave, has not addressed these worrying problems. Instead she has focused on the (unsubstantiated) high price of future antiretrovirals, claims of good geographical ‘coverage’ for PMTCT and ART access, and continued references to South Africa having the ‘largest and most comprehensive response’, without critical appraisal of those who do not access HIV care. For HIV infected people, their families, and their caregivers, this looks like more of the same – the Minister demonstrating antagonism to the one thing that can save their lives – antiretroviral therapy. It is deeply ironic that price is cited by the Minister as an issue in access to antiretrovirals, when it has taken the bravery of activist groups and professionals, rather than her own department, to fight for current affordable HIV care. Finally, we remain deeply concerned that the targets set for the NSP for 2007 look increasingly unrealisable. Since their publication, no plan has been forthcoming on how to attain the ambitious targets set in the Plan. Our country desperately needs trusted and brave leadership in the area of HIV. The deputy minister gave us hope that this was possible. We wish her well, and thank her for giving us hope and leadership. We recommit ourselves to ensuring that government, the elected steward of our health system, is held accountable for decisions regarding health care for HIV-infected people. On behalf of the Executive, SAHCS.'

Sorting out HIV/AIDS denialists

For those of you who have never heard of a small but all the louder band of scientists and activists who deny that HIV is the cause of AIDS, you might find this paper\ interesting that I published in the Journal of medical ethics a few years ago. I was surprised to read today in Toronto's Globe and Mail a piece by Mark Wainberg who is director of McGill university's AIDS Centre and John Moore, a medical professor at Cornell University's medical school. They argue essentially that we should prohibit HIV dissidents from campaigning among the lay public for their warped views on HIV/AIDS. They argue that these dissidents' views are akin to scientists telling teenagers in school cafeterias that smoking is healthy. Very much in line with the arguments I advanced years ago in the Journal of medical ethics. Check it out!

Here's their commentary:

AIDS and the dangers of denial

MARK WAINBERG AND JOHN MOORE

July 4, 2007 at 12:46 AM EDT

Imagine the scenario: The cafeteria at your child's high school is frequented by a few individuals telling your children that it's fine to smoke. They make passionate exhortations that statistics linking cigarettes to cancer, stroke and heart disease are flawed, because many people have smoked regularly without ever suffering ill effects. They say lung cancer is twice as common in women as it was two generations ago because of other causes, such as exposure to jet fuel fumes, a super-poison unleashed by rogue former KGB agents or a shadowy oil-driven cabal. They tell your child that the link between cigarette smoking and cancer is a hoax perpetrated by personal injury lawyers.

What would you do? Would you contact the school board or the police department and ask that these crackpots be removed from the premises? Or would you defend freedom of speech as an important right that must be preserved under all circumstances, even if it might provoke reckless behaviour and even death?

We live in an time when information is available and disseminated to society, including our children, in myriad ways. In the absence of an effective filter to protect the vulnerable, disinformation can kill. And while we spend billions of dollars worldwide in public service announcements educating our children about the perils of drug use and unsafe sex, we do little or nothing to counter the bewildering chorus of voices arguing that HIV, a virus that has killed more than 25 million people around the world in the course of a single generation, is utterly harmless.

People who argue that HIV does not cause AIDS have formed clubs, published newsletters and freely disseminated terribly harmful information on this subject through the Internet and other widely available channels. Attempts to shut down these sites or to prevent the dissemination of denialist literature are routinely dismissed on the grounds that dissenters have a right to express their views and that the public interest is better served by the defence of freedom of expression.

The latter sentiment appears in a letter to us — researchers on the front lines of the global AIDS crisis — from the provost and vice-president of a well-known U.S. university, after we complained that one of his faculty members had written a book based on an HIV-AIDS denialist position. The university should have shown leadership on the issue and dismissed the faculty member from her position, rather than hiding under the cloak of academic freedom.

We submit that the same standards of public health enforcement should apply to HIV-AIDS as to cigarette smoking and to other organisms, such as tuberculosis, that cause epidemic infectious disease.

We have long accepted that free societies do have an obligation to impose restrictions on freedom of speech in the interest of public safety. Among other jurisprudence, Supreme Court Justice Oliver Wendell Holmes famously opined in Schenck v. United States (1919) that the right to free speech does not permit one to falsely yell "fire" in a crowded movie theatre because of the injuries and deaths that would ensue as people stampeded toward the exits.

HIV denialism is lethal. It is responsible for the infections of at least several hundreds of thousands more people around the world than would have otherwise been infected and died. South African President Thabo Mbeki and his health minister, HIV denialists until last year, were among those in Africa whose refusal to be content with mere ostrich-like obliviousness, whose insistence on propagating flagrant disinformation about the disease, amounted to an arguably criminal abrogation of leadership.

Last summer, when political pressure generated by the International AIDS Conference in Toronto caused them to finally reverse their position, a scientific presentation there estimated that the number of HIV-infected people in South Africa was approximately 25 per cent higher than otherwise because of that country's policies.

The reasons for AIDS denial are probably as varied as the deniers themselves, but they're clearly not all motivated by political expediency. In the United States, the daughter of an HIV-infected woman named Christine Maggiore died of AIDS two years ago because she was not treated with anti-HIV drugs. The mother's reasoning was that the drugs could not possibly have done any good, since they act against a virus that has nothing to do with AIDS. In Canada, a similar case resulted in the custody of two HIV-infected children being transferred to foster parents who ensured that proper care was received. Those children have thrived.

In a recent case in Australia, a man was charged with transmitting HIV to several sexual contacts. He had been fully aware of his HIV-positive status, but argued that it had not been conclusively proven that HIV was the cause of AIDS. The defence based its case in part on information found on the websites of members of HIV denialist movements. The man was convicted, but is now appealing, and a spate of similar cases are pending in North America and elsewhere.

Our lawmakers need to enact legislation to put appropriate limits on such irresponsible expression and to counter the ongoing damage perpetrated by denialists. The scientific evidence that HIV causes AIDS is no less incontrovertible than the evidence that cigarette smoking causes cancer and heart disease. At a time when progress in HIV-AIDS drug treatments and life expectancy is informing an alarming new complacency in our children, policy-makers should defer to proven scientific fact and stop the transmission of deadly lies.

Dr. Mark Wainberg is director of the McGill University AIDS Centre at the Jewish General Hospital in Montreal. He was co-chairman of the International AIDS Conference in Toronto in August, 2006. Dr. John Moore is a professor of microbiology and immunology at Cornell University's Weill Medical College in New York.