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BOOK REVIEW

AIDS denialism is not the same as pseudoscience, proselytizing techniques and political strategies
AIDS dissent make for genuinely interesting reading, as do the sections on
how to get out of AIDS denialism using the power of critical
Denying AIDS: Conspiracy Theories, Pseudoscience thinking – in my view, always easier recommended than
and Human Tragedy done. That AIDS denialism may be more of a generic than
specific turn of mind is suggested by his pointing out that
Seth C Kalichman
AIDS denialists also frequently subscribe to irrational, even
ISBN-13: 978-0-387-79475-4, 201 pp
paranoid (especially conspiratorial), points of view in other
(eISBN-13: 978-0-387-79476-1)
fields of inquiry. Kalichman refrains from imputing evil
Berlin: Springer Science þ Business Media LLC, 2009
motives to denialists. From what is presented, readers will
US$ 25.00. Hard cover
have problems deciding whether, with denialism, one is
dealing with a heart of darkness or a mind of darkness or both.
The singular exception to Kalichman’s otherwise objective
‘Generally, the theories we believe we call facts, and the facts assessment of AIDS denialism is his inclusion of two research-
we disbelieve we call theories.’ ers (with whom I have published many papers) who should
Felix Cohen properly be classified as AIDS dissenters. Denying the evidence
is not the same as interrogating it and Kalichman clearly con-
Denialists of any kind are irritating. AIDS denialists are doubly fuses the two when reporting on the probing scholarship of
irritating, since AIDS is an inherently contentious issue. A Drs David Gisselquist and Stuart Brody. A careful and open-
common antidenialist response is anger. Hence, writing about minded assessment of their publications will show that the
AIDS denialism presents a daunting challenge to any research- basis for their questioning what is driving HIV transmission
er’s wish to be dispassionately objective. Seth Kalichman’s in sub-Saharan Africa is grounded in epistemology (quality
assessment of AIDS denialism in his new book relies mostly and validity of evidence issues);1 on solid bench science find-
on the cerebral, rather than adrenal, cortex. But for one ings (healthy genital tract tissue in women could not become
notable exception, Kalichman succeeds in objectively describing infected by application of huge quantities of HIV);2,3 and on
and analysing the history, principal actors, scripts, arguments empiric evidence that contradicts the mainstream view.1,4 – 6
and shortcomings of what I dub the AIDS Denialism School. Each of these evidentiary avenues leads, especially in light of
Kalichman, a clinical psychologist and professor of social the many observed anomalies,7 to the legitimate questioning
psychology at the University of Connecticut in the USA, who of whether ‘heterosexual sex’ (an inherently fuzzy concept)
is also the editor of the behavioural science research journal can account for the virtually 10 times greater efficiency of
AIDS and Behavior, stumbled upon the AIDS Denialism HIV transmission in Africa than elsewhere. Rather than being
School by visiting one of its websites, confessing: ‘My reaction inappropriately subsumed under the ‘Pseudo-epidemiology’
was one of absolute outrage. I mean I was really angry. I was in section, Gisselquist and Brody should be classified, in
an emotional upheaval. I surprised everyone around me, Kalichman’s own words, as ‘Legitimate dissidents in AIDS
including myself, by my seemingly irrational reaction’. Prior science [who] should also have greater visibility’.
to this encounter Kalichman had, like nearly all other AIDS Kalichman, whose professional paradigm is clinical rather
scientists, ignored it, admitting that: ‘I was in denial about deni- than epidemiologic, accepts the received wisdom about what
alism. I knew it was out there, but I pushed it to the back of my is driving the HIV epidemics in Africa without according reco-
mind’. To Kalichman the central tenet of the AIDS Denialism gnition to the existence of the considerable evidence undermin-
School – that HIV does not cause AIDS – is not only an ing it and of its serious methodological shortcomings. He seems
affront to the depth and breadth of the empiric evidence that not to know (recognize?) that the fundamental weakness of
HIV does indeed cause AIDS but, far more importantly, has mainstream epidemiologic studies in sub-Saharan Africa has
potentially serious health consequences for HIV-infected been its 20-year track record of dismissing non-sexual modes
patients who believe it. Such an erroneous belief can cause of transmission as being insignificant, in the absence of
at-risk persons not to be tested for HIV infection or, if tested, studies comprehensively assessing the contribution to HIV inci-
to ignore a positive HIV test result; to reject scientifically mon- dence of skin puncturing (blood) exposures. He also uncriti-
itored therapies in favour of vitamin and nutritional sup- cally accepts the current mantra that a special form of sexual
plement regimens of unproven or much lesser efficacy; and concurrency in heterosexual African populations accounts for
to facilitate downstream HIV transmission if denialists were much of the observed HIV transmission when, in fact, the
to dispense with safer-sex cautions. To Kalichman, AIDS deni- empiric evidence for this idea is virtually non-existent.8 Not
alism is ultimately destructive because it corrodes trust in scien- automatically believing what the experts say when rational
tific medicine and public health. methodological and empiric evidence undermines their view
He describes, in substantial detail, the birth of the denialist is sound science, not pseudo-epidemiology or denialism. Au
movement a quarter century ago, its chief protagonist, the contraire.
distinguished scientist Peter Duesberg and, in lesser detail, In summary, Kalichman’s treatment of AIDS denialism is a
disciples and congeners; Appendix B consists of nearly 20 bio- good, if somewhat partisan, review. I also suspect that if he
graphical vignettes of what could be called The Rogue Gallery carefully considered the arguments and evidence of legitimate
of Principal AIDS Denialists. He devotes much space to probing AIDS dissenters such as Gisselquist and Brody, rather than
why denialists propagate ‘myths, misconceptions, and misin- indefensibly dismissing their work as pseudo-epidemiology,
formation to distort and refute reality’. His sections on denialist Kalichman might well change his mind. From my

International Journal of STD & AIDS 2009; 20: 515 –516


516 International Journal of STD & AIDS Volume 20 July 2009
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understanding of this book, I doubt AIDS denialists would, 2 Greenhead P, Hayes P, Watts PS, Laing KG, Griffin GE, Shattock RJ. Parameters
which makes its reading all the more important for those inter- of human immunodeficiency virus infection of human cervical tissue and
inhibition by vaginal virucides. J Virol 2000;74:5577–86
ested in countering the denialists’ baleful influence. 3 Dezutti CS, Guenther PC, Cummins JE Jr., et al., Cervical and prostate epithelial
cells are not productively infected but sequester human immunodeficiency
virus type 1. J Infect Dis 2001;183:1204 –13
J J Potterat
4 St Lawrence JS, Klaskula W, Kankasa C, West JT, Mitchell CD, Wood C. Factors
Colorado Springs, CO 80909-1020, USA associated with HIV prevalence in a prepartum cohort of Zambian women. Int
Email: jjpotterat@earthlink.net J STD AIDS 2006;17:607 –13
DOI: 10.1258/ijsa.2009.009138 5 Brewer DD, Potterat JJ, Roberts JM Jr., Brody S. Male and female circumcision
associated with prevalent HIV infection in virgins and adolescents in Kenya,
Lesotho, and Tanzania. Ann Epidemiol 2007;17:217 –26
6 Deuchert E, Brody S. The role of health care in the spread of HIV/AIDS in
REFERENCES sub-Saharan Africa: evidence from Kenya. Int J STD AIDS 2006;17:749 –52
7 Brewer DD, Brody S, Drucker E, et al. Mounting anomalies in the epidemiology
1 Gisselquist D. Points to Consider: Responses to HIV/AIDS in Africa, Asia, and the of AIDS in Africa: cry the beloved paradigm. Int J STD AIDS 2003;14:144 –7
Caribbean. London: Adonis & Abbey Publishers Ltd, 2008 8 Potterat JJ. Attractive theory is not enough. Int J STD AIDS 2007;18:645– 6