Harvard School of Public Health AIDS Initiative and Department of Immunology and Infectious Diseases, Harvard School of Public Health, FXB 402, 651 Huntington Ave, Boston, MA 02115, USA.
AIDS Behav. 2010 Apr;14(2):237-47. doi: 10.1007/s10461-009-9654-7.
In this paper, we respond to AIDS denialist arguments that HIV does not cause AIDS, that antiretroviral drugs are not useful, and that there is no evidence of large-scale deaths from AIDS, and discuss the key implications of the relationship between AIDS denialism and public health practice. We provide a brief history of how the cause of AIDS was investigated, of how HIV fulfills Koch's postulates and Sir Bradford Hil's criteria for causation, and of the inconsistencies in alternatives offered by denialists. We highlight clinical trials as the standard for assessing efficacy of drugs, rather than anecdotal cases or discussions of mechanism of action, and show the unanimous data demonstrating antiretroviral drug efficacy. We then show how statistics on mortality and indices such as crude death rate, life expectancy, child mortality, and population growth are consistent with the high mortality from AIDS, and expose the weakness of statistics from death notification, quoted by denialists. Last we emphasize that when denialism influences public health practice as in South Africa, the consequences are disastrous. We argue for accountability for the loss of hundreds of thousands of lives, the need to reform public health practice to include standards and accountability, and the particular need for honesty and peer review in situations that impact public health policy.
在本文中，我们回应了艾滋病否认论者的论点，即 HIV 不会导致艾滋病，抗逆转录病毒药物没有用处，而且没有大规模死于艾滋病的证据，并讨论了艾滋病否认论与公共卫生实践之间关系的关键含义。我们简要回顾了艾滋病病因的研究过程，HIV 如何满足科赫的假设和布拉德福德·希尔的因果关系标准，以及否认论者提供的替代方案的不一致性。我们强调临床试验是评估药物疗效的标准，而不是轶事案例或作用机制的讨论，并展示了一致的数据表明抗逆转录病毒药物的疗效。然后，我们展示了死亡率统计数据和粗死亡率、预期寿命、儿童死亡率和人口增长率等指标如何与艾滋病的高死亡率相一致，并揭示了否认论者引用的死亡通知统计数据的弱点。最后，我们强调了当否认论影响公共卫生实践时，如在南非，后果是灾难性的。我们认为应该对数十万人的生命损失负责，需要改革公共卫生实践，包括标准和问责制，并且在影响公共卫生政策的情况下特别需要诚实和同行评审。
