Correspondence to:
Dr U Schüklenk
Head, Division of Bioethics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Wits 2050, South Africa;
udo@udo-schuklenk.org
Abstract
This article describes how a small but vocal group of biomedical scientists propagates the views that either HIV is not the cause of AIDS, or that it does not exist at all. When these views were rejected by mainstream science, this group took its views and arguments into the public domain, actively campaigning via newspapers, radio, and television to make its views known to the lay public. I describe some of the harmful consequences of the group’s activities, and ask two distinct ethical questions: what moral obligations do scientists who hold such minority views have with regard to a scientifically untrained lay audience, and what moral obligations do mainstream newspapers and government politicians have when it comes to such views. The latter question will be asked because the "dissidents" succeeded for a number of years in convincing the South African government of the soundness of their views. The consequences of their stance affected millions of HIV infected South Africans severely.
Introduction
Ever since the retrovirus HIV was declared to be the cause of AIDS, a small but vocal group of scientists has argued in professional journals and publicly either that HIV is not the cause of AIDS, or that there is no evidence that HIV exists at all.
Scientists should be aware of the social harm that can result from the premature proclamation of claims that are weakly founded. Scientists must be particularly careful when their science deals with questions of human import. They have entered the political arena.1
The self declared "HIV dissidents" blame other putative causes for AIDS, including the health consequences of highly active sex lives involving drug taking and multiple partners in developed countries, and/or poverty in developing countries.2 They allege that essential AIDS drugs are one of the real causes of AIDS. A corollary of this position has been the view that AIDS is not infectious at all.
Jürgen Habermas’s insights into our "erkenntnisleitendes Interesse" encourage me to come clear at this stage and declare that I was one of those vocal HIV dissident academics. Some years ago I changed sides in this dispute and accepted that mainstream views of HIV and AIDS are correct. Since I changed my views on this matter, I also happen to have changed my employer. I moved from developed world Australia with its rather small number of people with AIDS, to developing world South Africa, reportedly the country with the largest number of AIDS cases worldwide. Prevalence rates in the country among persons aged 15–49 years old are around 15%.3 Perhaps surprisingly for the uninitiated observer, the South African government’s publicly expressed views on HIV and AIDS, and its policies with regard to the provision of essential AIDS drugs have for a number of years mimicked, in important ways, the views of HIV dissidents. There is some evidence that the government stance on HIV/AIDS moved closer to mainstream views in 2002, but the question of whether this will translate into realistic HIV/AIDS policies remains unanswered at the time of writing. The publicly expressed views of the South African President, Mr Thabo Mbeki, and his health minister, medical doctor Manto Tshabalala Msimang, are very strongly influenced by the views of HIV dissidents.
In this article, I describe in some detail the inner workings of the HIV dissident group, and its impact on high risk groups in developed countries, as well as its impact on South African government policies. My attention will then turn to two interesting ethical questions that arise in this context. The first question is to do with the issue of what responsibilities biomedical professionals have towards a scientifically unqualified public. In the case under consideration, HIV dissidents took their initially scientific dispute out of the arena of biomedical journals, with their standard processes of anonymous peer review, into the public domain, campaigning on TV and in gay magazines, daily newspapers, and similar publications. Indeed, their internet based offerings4,5 persuaded South African President Thabo Mbeki to take their views seriously. The consequences for the provision of essential AIDS drugs to those HIV infected among the country’s impoverished masses were grave.
The question I should like to pose is this: if you are a biomedical scientist who fails to convince your peers of your views on a particular matter of legitimate scientific inquiry, is it acceptable that you take your minority views "to the streets" in order to drum up public and media support for your stance? I will also examine whether one can legitimately blame the proponent of such a minority position for decisions made by members of the public who decide to act on such a minority view.
The second ethical question is to do with the ethical responsibilities of leading politicians and government officials towards their sovereign, the citizens of their country. I shall argue that the South African government has, over many years, neglected its moral obligations towards HIV infected individuals and people with AIDS, while pursuing AIDS policies strongly influenced by dissident views.
