Denying AIDS and the Rwandan Genocide?

An example of the dishonesty of Valendar Turner and at least one of
Christian Fiala, David Crowe, David Rasnick, Etienne de Harven, Henry Bauer,
Ken Anderlini, Kevin Corbett and Martin Maloney

By Nathan Geffen and Jeanne Bergman, Ph.D.
4 June 2006

This article builds upon an issue raised by Nathan Geffen, Nicoli Nattrass
and Glenda Gray in a letter in Nature (Nature 441, 406, 25 May 2006).1 In
places we copy directly from that letter without reference. It is reprinted
after this article.

There are so many instances of AIDS denialists egregiously misrepresenting
facts that one can only reach the conclusion that they are dishonest or
incompetent. Incompetence probably underlies their persistent rejection of
scientifically proven facts and erroneous, obsolete, and thoroughly debunked
claims. But we recently came across an apparently deliberate
misrepresentation of legitimate research findings so deplorably wrong that
it deserves special mention.

We recognize the seriousness of charging with dishonesty Valender Turner
(who, as far as we can ascertain, first made this misrepresentation) and,
for reiterating and signing their names to his error, at least one of
Christian Fiala, David Crowe, David Rasnick, Etienne de Harven, Henry Bauer,
Ken Anderlini, Kevin Corbett and Martin Maloney. We would comfortably defend
our accusation in a court of law, because it is with high probability a true
statement in the public interest. Some of the denialists, of course, have
already been shown to be dishonest in other respects. For example, David
Rasnick has repeatedly misrepresented a prior temporary affiliation with the
University of California, Berkeley, despite requests from the University
that he desist from doing so.2

The deception at hand began with a letter by Valendar Turner, an active
member of "The Perth Group" of HIV denialists, last year in Nature ("HIV
drug remains unproven without placebo trial" Nature 435, 137; 2005).3 Turner
wrote that without a placebo-controlled randomized trial, statements that
the efficacy of single-dose nevirapine in reducing perinatal transmission
has not been invalidated are unwarranted. He contrasted the HIV transmission
rate of 13.1% reported in the HIVNET 012 study4 (which he notes "abandoned
its placebo group... under pressure of complaints that the use of placebo
was unethical") and stated that the "HIVNET 012 outcome is higher than the
12% transmission rate reported in a prospective study of 561 African women
given no antiretroviral treatment (J. Ladner, et al. J Acquir. Immun. Def.
Syndr. Hum. Retrovirol. 18, 293-298; 1998)." Turner's inference is clear:
perinatal HIV transmission was no better, perhaps even worse, with
antiretroviral treatment than without it.

Turner's point was then amplified by a group writing to defend denialist
Celia Farber from searing criticisms by Gallo et al. (2006)5 of her infamous
article6 in Harper's Magazine (March 2006). Farber had quoted Turner's
letter and written that he had "unpegged the core claim of NIAID and its
satellite organizations in the AIDS industry regarding nevirapine's
"effectiveness".7

The group of individuals listed above-Fiala, Crowe, Rasnick, de Harven,
Bauer, Anderlini, Corbett and Maloney-repeated the Turner claims in their
effort to defend Farber. Their document is sloppy and littered with errors
and admissions, but that's beyond the scope of this article. Our concern
here is that they wrote:

Turner is referencing an African study published in 1998 that stated that
"Presence of HIV-infection was assessed in 158 children [of HIV-positive
mothers]. Overall, 19 children were diagnosed as HIV-infected [12%, even
though there was no access to antiretroviral therapy or other
interventions]" (Ladner J et al. Chorioamnionitis and pregnancy outcome in
HIV-infected African women. J Acquir Immune Defic Syndr. 1998 Jul 1; 18(3):
293-8).
(Fiala et al., 2006, brackets in the original)8

If it were true, a finding that only 12% of the children born to a group of
untreated HIV-positive Rwandan women were themselves infected with HIV would
be surprising. Of course, it would not refute the findings of the HIVNET 012
study, which was a randomized controlled study and has far greater empirical
value than a retrospective comparison of two cohorts from completely
different studies. Nevertheless, the argument raised by Turner and Fiala et
al. appeared on the face of it to have some, albeit small, merit.

A rebuttal to Turner's letter was published in a subsequent issue of
Nature9, but it did not mention our critical point: the claim made by Turner
and echoed by Fiala et al. that the Ladner et al. study10 found a 12%
prevalence rate for a cohort of HIV-positive women not taking
antiretrovirals is a gross misrepresentation of what the study reported. It
is true that Ladner et al. found a 12% prevalence rate in 158 children born
to untreated HIV-positive women. But those 158 children were only a fragment
of the full cohort born to 275 HIV-positive women. The authors did not and
could not examine the full cohort for the simple reason that many women and
children had been lost to follow-up. Some of these had probably died of
AIDS.

Ladner et al. had enrolled 275 HIV-positive women (and 286 HIV-negative
women) in the study between July 1992 and August 1993.11 The women were
between 24 and 28 weeks gestation. The researchers determined the HIV status
of 158 of the children of HIV+ mothers enrolled in the study by antibody
testing them at 15 months or by PCR tests at 3 and 6 months of age. Why only
158 of them?

What Turner and Fiala et al. neglect to point out is Ladner et al.'s
sentence immediately preceding the section quoted by Fiala et al. above:
"Follow-up of the cohort was interrupted by the events of the Rwandan civil
war." (Ladner et al., op cit., emphasis ours.)

This statement about the disruption of the Rwandan civil war, one of the
greatest human tragedies in recent history, not only immediately precedes
the Ladner et al. quotation used by Fiala et al.; it is the first sentence
of that paragraph! And, lest the point be missed, Ladner et al. return to
the problem later, noting again that "We do not know the HIV status of the
entire sample of children born to HIV-infected mothers as a result of
interrupted follow-up."

It is immediately clear to anyone with a rudimentary background in
statistics (or just some common sense) that they're not comparing apples to
apples here. The low 12% figure, seized upon by Turner, Farber and Fiala et
al. to understate the rate of perinatal HIV transmission by mothers without
access to nevirapine, is an artifact of war, of genocide, and of AIDS
itself.

The Ladner et al. study enrolled 275 HIV-positive pregnant women. 13.1% of
these pregnancies ended in still births and 7.5 % of the newborns died, for
a total reduction to the cohort of 20.6%--that's 57 children, leaving 218
available for follow up. Only 158 of these children were tested for HIV, and
of these 19 (12%) were found to be HIV-positive 3, 6 or 15 months later.

What happened to the other 60 missing children?

Fifteen months is long enough for many HIV-positive children and their
mothers to have died of AIDS. In a study conducted in Uganda between 1994
and 1998, Brahmbhatt et al. found that 30.9% of the children perinatally
infected with HIV died before their first birthday, and 54% by their second
(Brahmbhatt, H. et al. Mortality in HIV-infected and uninfected children of
HIV-infected and uninfected mothers in rural Uganda. J Acquir Immune Defic
Syndr 2006; 41:504-508).
In Ladner et al.'s study, some of the children were possibly killed in the
war --women and children sick with AIDS would have been less able to escape
to safety. The surviving sample of the initial cohort was not
representative, but rather skewed in favor of HIV-negative children. The
actual figure for perinatal HIV transmission was almost certainly much
higher. (Brahmbhatt et al. found perinatal HIV transmission rates in Uganda
of 20.9%.)

We are by no means criticizing Ladner et al. Their paper is well worth
reading. It is competent and interesting science conducted in staggeringly
difficult circumstances. It was not their intention to determine vertical
HIV transmission rates in the absence of antiretroviral intervention.
Rather, the primary purpose of their paper was to compare Chorioamnionitis
and pregnancy outcomes in HIV-positive and HIV-negative African women. The
12% statistic was a detail they included while carefully repudiating its
statistical value.

The failure of Turner and of at least one of Fiala et al. to acknowledge the
interruption of the follow-up of the cohort is either dishonest or grossly
incompetent. On balance of probabilities it is dishonest. Researchers with
the skill and tenacity to find an incidental HIV transmission rate figure
buried in a not very well known article are unlikely to have missed the
sentence "Follow-up of the cohort was interrupted by the events of the
Rwandan civil war." More than likely, Turner and at least one of Fiala et
al. realised this fact would negate the point they were making and
deliberately left it out. This is dishonesty.

Or perhaps the AIDS denialists also deny the Rwandan genocide took place?

We accuse Turner and at least one of Fiala et al. of dishonesty for this
misrepresentation. We are prepared to accept that not all of them
intentionally omitted the relevant fact. When co-authoring an article, one
depends on one's co-authors' integrity; it is seldom possible to check
everything the others contribute. So if Fiala et al. indicate who among them
was responsible for this dishonesty, we will relieve the remaining authors
from the accusation of dishonesty on this particular point. Valendar Turner,
however, has no excuse. He was the sole author of the letter to Nature that
first misrepresented the research. He looked for and found an article with a
figure-12%-that, if he dishonestly concealed the intervening genocide that
prevented follow-up, would allow him to make his case.

1 http://www.nature.com/nature/journal/v441/n7092/full/441406c.html. Last
accessed 3 June 2006.
2 See http://www.tac.org.za/newsletter/2006/ns09_05_2006.html#Citizen. Last
accessed 3 June 2006.
3 http://www.nature.com/nature/journal/v434/n7030/full/434137a.html. Last
accessed 3 June 2006.
4 This study tested a short-course of the antiretroviral nevirapine for
mother-to-child transmission prevention of HIV. It found that administering
a single dose of nevirapine to mother and a single dose to child "lowers the
risk of HIV-1 transmission by nearly 50% during the first 14-16 weeks of
life in breast-fed infants". Guay LA et al., Intrapartum and neonatal
single-dose nevirapine compared with zidovudine for prevention of
mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012
randomised trial. Lancet 1999 Sep 4;354(9181):795-802.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=1
0485720&Dopt=Citation.
Last accessed 4 June 2006.

5 http://www.aegis.org/files/tac/2006/errorsinfarberarticle.html. Last
accessed 3 June 2006.
6 http://www.aidstruth.org/Harpers_Out-of-Control-Article_March-2006.pdf.
Last accessed 3 June 2006.
7 http://rethinkaids.info/GalloRebuttal/Farber-Gallo-29.html. Last accessed
3 June 2006.
8 http://rethinkaids.info/GalloRebuttal/Farber-Gallo-30.html. Last accessed
3 June 2006.
9  http://www.nature.com/doifinder/10.1038/4341067a. Last accessed 3 June
2006.
10 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed. Last
accessed 3 June 2006.
11 The Ladner et al article's abstract gives the numbers of HIV-positive
women enrolled as 286 and HIV-negative women enrolled as 275. This is a
reversal of the numbers provided elsewhere in the text, including in the
statistical charts. We therefore assume the error is in the abstract.

[END OF ACCUSATION OF DISHONESTY]

Nature 441, 406 (25 May 2006) | doi:10.1038/441406c; Published online 24 May
2006
HIV denialists ignore large gap in the study they cite

Nathan Geffen1, Nicoli Nattrass2 and Glenda Gray3

 1.. Treatment Action Campaign, 34 Main Road, Muizenberg 7945, South Africa
 2.. AIDS and Society Research Unit, University of Cape Town, Private Bag,
Rondebosch 7701, Cape Town, South Africa
 3.. Perinatal HIV Research Unit, University of Witwatersrand, PO Box 114,
Diepkloof 1864, South Africa
Sir:

Valendar Turner, in Correspondence ("HIV drug remains unproven without
placebo trial" Nature 435, 137; 2005), argues that there is no evidence for
antiretrovirals reducing the transmission of HIV from mother to child. He
points out that HIV transmission in people taking the antiretroviral drug
nevirapine was 13.1% in the HIVNET 012 study in Uganda, whereas only 12% of
women in a Rwandan study were found to have transmitted HIV to their babies
in the absence of antiretroviral treatment.

Despite a rebuttal in Correspondence by the authors of the Ugandan study,
Brooks Jackson and Thomas Fleming ("A drug is effective if better than a
harmless control" Nature 434, 1067; 2005), Turner's letter continues to be
cited by AIDS denialists (for example, C. Farber Harper's Magazine 37-52;
March 2006).

The Rwandan study referred to by Turner enrolled 561 pregnant women, of whom
286 were HIV-positive. Of the children born to HIV-positive mothers, 158
were tested for HIV and 19 (12%, as Turner states) were found to be
HIV-positive. Why were only 158 children assessed? The answer, conveniently
ignored by the denialists, is that follow-up was interrupted by the events
of the Rwandan civil war (J. Ladner et al. J. Acquir. Immun. Def. Syndr.
Hum. Retrovirol. 18, 293-298; 1998). Given that this interruption was
sufficiently lengthy for many HIV-positive children and their mothers to die
of AIDS in the interim, the surviving sample of the initial cohort cannot be
regarded as representative. The actual figure for HIV transmission was
almost certainly much higher. Failing to acknowledge this important caveat
to the study appears to us to be inconsistent with accepted academic
standards.

[END OF NATURE LETTER