The year 2008 marked 25 years of acquired immunodeficiency syndrome (AIDS) research since the discovery of the human immunodeficiency virus (HIV) in 1993. It also marked the year that the discovery of HIV was recognised with a Nobel Prize for Physiology or Medicine. Despite rapid advancements in the past decades, with the development of anti-retroviral drugs meaning HIV is no longer a death sentence, and new vaccine technologies providing hope for the developing world, it appears the Catholic Church remains in the dark.

This week, the church once again demonstrated their detachment from science and reality when Pope Benedict proclaimed that the “use of condoms could actually increase the HIV epidemic”. The Pope initially told reporters flying with him to Cameroon that AIDS was “a tragedy that cannot be overcome by money alone, and that cannot be overcome through the distribution of condoms, which even aggravates the problem”.

imagesHowever, Benedict holds the dubious honour of not being the first Pope to spread such misinformation. As early as 1990, Pope John Paul described condoms as “a sin in any circumstances”, comments which have since been attributed to the worsening of the AIDS epidemic in Africa. As a solution to tackle the AIDS epidemic, he offered marital fidelity and sexual abstinence, the position continued by the Catholic church to this day.

For many, statements made by Pope John that day in 1990 in Tanzania, sentenced millions of Africans to death. Unabashed, he repeated the same message time and again as he moved on to neighbouring Rwanda and Burundi, countries then suffering an even higher HIV infection rate.

An epidemic of exponential proportions.

After the papal visit of 1990, the HIV pandemic gathered pace. By 2010, it is estimated, there will be 50 million orphaned children in sub-Saharan Africa, 18 million of whose parents will have died from AIDS or AIDS-related illnesses. Today, more than 28 per cent of African children have lost one or both parents to AIDS. In 1990, at the time of the Pope’s visit to Tanzania, the figure was 2 per cent.

Since HIV was first photographed by a group of French researchers back in 1993, 22 million people have died and 40 million are HIV-infected – the vast majority in Africa. In 2007, 2.7 million individuals became newly infected with HIV-1, and 2 million AIDS deaths occurred. Regrettably, half of all people who are infected with HIV acquire the infection before the age of 25 years, and are killed by AIDS before they turn 35. More than 95 per cent of new HIV-1 infections arise in low and middle income nations, populations least likely to have access to anti-retroviral therapy.

Condoms are 98-99 % effective against the transmission of HIV.

Regardless of what the Catholic Church has to say on the issue, science tells us that condoms are a very effective way of preventing HIV infection.

The WHO advises; “Condoms can prevent sexually transmitted infections including HIV in 98-99 per cent of cases, when consistently and correctly used. Therefore, it is the most effective strategy available to protect from HIV…With consistent condom use, the HIV infection rate among uninfected partners in families where one partner is infected with HIV and the other is not, can be reduced to less than 1 percent per year.”

Luc Montagnier, Françoise Barré-Sinoussi and Harald zur Hausen after delivering their Nobel Lectures at Karolinska Institutet in Stockholm, 7 December 2008.

Luc Montagnier, Françoise Barré-Sinoussi and Harald zur Hausen after delivering their Nobel Lectures at Karolinska Institutet in Stockholm, 7 December 2008.

In December 2008, the Nobel Prize for Physiology or Medicine was awarded for two discoveries, half for the human papilloma virus which causes cervical cancer, and the other for the discovery of the virus which causes AIDS, HIV. For the isolated and identification of the HIV virus, the Nobel was given to the French team of Luc Montagnier and Françoise Barré-Sinoussi from the Pasteur Institute in Paris.

Notably overlooked, were the American scientists also involved in the discovery, headed by Robert Gallo. To some observers, it is no surprise that Gallo and his team were overlooked for the prestigious prize. Allegations of fraud, lies and misconduct surround the path to one of the biggest scientific discoveries of this century.

Controversy surrounding the discovery of HIV.

The story begins in June 1981, when physicians in New York and California reported unusual clusters of rare diseases in previously healthy gay men, notably Pneumocystis carinii pneumonia and a rare form of cancer called Kaposi’s sarcoma. The first cases of AIDS were described in homosexual men in the US in 1981 [1]. The syndrome was first known as the “4Hs” for homosexuals, Haitians, hemophiliacs and heroin users as a way of describing high risk groups.

For nearly two years, the cause of AIDS remained elusive; the scientific community was largely baffled, lacking good leads for developing therapies or even a diagnostic test.

To be able to identify the virus, scientists had to be able to grow it in culture dishes. Several years earlier, a research group at the National Cancer Institute in Bethesda, Maryland, lead by the respected cancer researcher, Robert C. Gallo had developed a method for growing T-helper cells in culture, the immune cells targeted and killed by HIV. Even so, Gallo’s group and a rival group in France at the Pasteur Institute, lead by Luc Montagnier were having problems getting enough material from their cultures to identify the virus. Each group had isolated tissue from an AIDS patient; the French group from the lymph nodes of Frederic Brugiere, a French fashion designer with AIDS. Gallo’s team had their own virus samples, but failed to get it to replicate sufficiently, so Gallo asked Montagnier’s for some of his virus to which Montagnier agreed. It is not uncommon for scientists to “gift” cells and other biological material for the benefit of advancing research.

The virus which causes AIDS was originally named LAV and HTLV-III.

In 1983, Montagnier’s team finally isolated the virus we now call HIV-1 and called it lymphadenopathy associated virus (LAV). On 20 May

HIV paticles bud from a T-helper cell. Image: CDC.

HIV paticles bud from a T-helper cell. Image: CDC.

1983, the discovery was published in Science. The resp0nse from the scientific community was underwhelming.

That was, until a year later, on 4 May 1984, when Gallo’s team reported that they too had discovered the virus that causes AIDS, again in Science. His team called its virus HTLV-III, the acronym for human T-cell leukaemia/lymphoma virus type III.

With the publication of Gallo’s paper, suddenly people began to take notice. Whilst both teams knew they were looking for a retrovirus, indicated by the presence of the enzyme, known as reverse transcriptase, necessary for the replication of these viruses, Gallo was convinced he would find a particular type of retrovirus similar to the HTLVs he had previously discovered. Now we know of many types of retroviruses, but in 1982, only one was known to infect humans and that was HTLV.

But Gallo made a crucial mistake; HTLV-1 has been associated with a rare form of cancer and caused T-cells to grow out of control (for a review of this and HTLV-II, see a review by Robert Gallo here). This new virus, which was leading to AIDS did the polar opposite, it was destroying T-cells. However, Gallo was a charismatic and high profile researcher with a spotless reputation, so when Montagnier announced the virus associated with AIDS was an as yet, unseen type of retrovirus, nobody took much notice.

A critical year of research wasted.

An entire year lapsed between the publication of the French team’s discovery and recognition by the scientific community that the cause of AIDS had been found, which was heralded with Gallo’s publication in Science. An entire year in which a diagnostic test could have been developed, potentially preventing the infection with HIV of thousands of hemopheliacs and blood transfusion patients.

So, the race was now on to develop a diagnostic test to detect HIV in blood and blood products. By this time, scientists around the world were extracting tissue from AIDS patients and growing plenty of virus – they had got better at the technique. It became clear that viruses extracted from individual patients varied greatly in their sequence, or series of nucleotides.

HIV is a single stranded RNA virus and is replicated by an enzyme known as reverse transcriptase. This enzyme makes many mistakes when copying HIV leading to great variability between copies. Scientists had learned to expect between 10 and 20 per cent variability between viruses, even from within the same patient. So, it came as a surprise to many in the scientific community, that when Gallo announced the discovery of “his” virus, 12 months after Montagnier, it only differed by approximately 2 per cent. This lead to the possibility that Gallo had either deliberately used the French virus in his studies since it had been growing well (although he denies this) or that the French virus had somehow contaminated his own cultures.

Was the American virus really the French virus?

But now there were also issues of money and patents coming from a test for HIV developed and patented by Gallo’s team on the back of the HTLV-III discovery. Although this was settled out of court in March 1987, the question arises whether in the light of the viruses having originated from France, the Pasteur Institute deserved to have profited exclusively from the test (not least since the French team had applied for a patent on the test in the US four months before Gallo).

The out-of-court agreement, announced jointly by French prime minister Jacques Chirac and US president Ronald Reagan, stipulated that each of the two parties had equal rights to claim priority concerning detection and isolation of the virus, and Gallo and Montagnier would henceforth be recognised as the “co-discoverers” of HIV – a stipulation also included in a Chronology of AIDS research co-authored by the two in Nature on 2 April 1987.

Who really discovered the HIV virus?

In 1989, the Pulitzer Prize winning writer, John Crewdson published an investigative report in the Chicago Tribune which questioned whether Gallo’s laboratory had deliberately used the French virus rather than growing their own. This led to National Institutes of Health (NIH) and Congressional investigations that ultimately cleared Gallo’s group from any wrongdoing. However, years and many rumours later, in June 1991, Gallo finally admitted that the AIDS virus he had “discovered” in 1984 really came from the Pasteur Institute. In a letter to the journal Nature in 1991 admitting that the crucial sample had come from France, Gallo said that it appeared to have come from contamination of his cultures by the French virus.

The human tragedy is, that during the period of court cases and government intervention, many good research hours which could have been spent on developing a diagnostic test and hence saving the lives of thousands of haemopheliacs and blood transfusion patients, were wasted.

Many accounts have been written describing the conduct of Robert Gallo during this time and they do not make for flattering reading. Whilst there is no doubt that he did, and continues to do good virology science, his conduct surrounding the discovery, obviously had a big effect on him being overlooked in December for the prize. Some say Robert Gallo was robbed of the Noel Prize. Whilst The Nobel citation mentions Gallo’s contributions, it settles the dispute once and for all by declaring the French duo to be the true discoverers of the virus.

This is not to detract from the hard work continued by Robert Gallo, now the director of the Institute of Human Virology.

Meanwhile scientifiic endeavour, no matter how competitive, and the Catholic Church seem to pass like ships in the night.

—–

The story surrounding the discovery of the HIV virus reads like a espionage novel (See the story dramatised in the 1993 film “And the Band Played On”, starring Alan Alda and Patrick Bucheau or the book of the same name by Randy Shilts).

John Crewdson’s account has also been published as a book entitled Science Fictions: A Scientific Mystery, A Massive Cover-Up, and the Dark Legacy of Robert Gallo.

Listen to an interview with HIV researcher Professor Quentin Sattentau from the William Dunn School of Pathology in the UK. Interviewed by Robin Williams from the ABC Science Show here

[1] Gottlieb MS, Schroff R, Schanker HM, Weisman JD, Fan PT, Wolf RA, Saxon A. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. N Engl J Med. 1981;305:1425–1431.


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  • A Fan

    Hi Dr. Rachie,

    Big fan of the Zone and the previous TANK podcast, and I love your weekly science-based medical segment. It sounds like you’re getting positive results, in that Australian legislation appears to be doing something about this, given today’s show.

    While it’s not nearly as glamorous or important as quackery like homeopathy, and doesn’t have a genuine death toll like Darth Ratzinger or the 3-continent-wide anti-vax “movement”, I was wondering if you’d consider doing a segment on the various hair-loss treatments making the rounds for decades. It’s especially difficult to find genuine information about these treatments without a medical journal subscription, due to the countless half-baked studies, testimonials, marketing, etc. Right now google gives:

    Results 1 – 10 of about 17,700,000 for hair loss treatment. (0.17 seconds)

    Sorting the wheat from the chaff with regards to minoxidil, provillus, ad nauseum is difficult for a layman, even with yours, Steve Novella’s, and Ben Goldacre’s advice regarding testimonials, etc.

    I’ve hunted around, and haven’t really found a comprehensive overview of these treatments on any of the various shows, so it sounds ripe material for coverage 🙂 With pattern baldness affecting umpteen millions of people, something evidence-based to direct people to would be spectacular!

    Regardless, thanks millions to you, Richard, and the other Zoners for the podcast, and keep up the good work!

  • zombiwulF

    When the Catholic church reverses its current status *against* biological evolution – back to supporting it … then they may get to participate in public debate on world health without being mocked and ridiculed!

    As for abstinence and morality – they are hardly models in that department!

    Get in the naughty corner your holiness!!

  • Nice Read

    Regards
    genis

  • seantheblogonaut

    Abstinence is 99.99% effective, look at any study you want, but common sense tells you that.

    Actually its 100% effective against contracting HIV sexually if both partners are “clear”. The trouble is that achieving 100% abstinence is unrealistic, common sense tells you that.

    Secondly, morality has worked in Uganda. Also, it has made a major difference DC area schools where it is used compared to areas where condems and sex education is used.

    This is an area of contention, care to provide some studies that I might be able to look at? Uganda ran the ABC program, the C being for Condom. So the indication is that a combined educational approach works best at least in Uganda. Uganda was also unique in the level of government support and the success cannot be attributed soley to the ABC program.

    It pioneered approaches towards reducing stigma, discussing sexual behavior openly, involved HIV-infected people in public education, persuaded individuals and couples to be tested and counseled, improved the status of women, involved religious organizations, enlisted traditional healers,etc.

    Read The Guttmacher Report on Public Policy

    There are scholars and scientists on both sides of this debate, but what both scientists would agree with is that abstinence is more effective than condems, even if it is more difficult for people.

    Abstinence as a behavior is bloody successful where condoms are 87-99% dependent on quality. But we are talking about public policy we are taking about trying to get people to conform to behaviors. There are people who no matter how sensible it might be, no matter how much guilt or fear you instill in them, no matter how much you try and control them, will not remain abstinent, so the only approach that makes any sense is broad spectrum one.

    There are studies that show condem use and sex education DO promote promiscuity. Polls and studies seem to indicate both. The best we can do is be moral.

    Provide please. Correlation does not equal causation

    The healthy, morally responsible choice is abstinence.

    The only responsible choice is the one that works.

  • podblack

    HAAAAAAAAAAA!!!!!! Doug M you are PRICELESS!! Absolutely contradicted the paper as well and all the sci research and showed no support for your argument whatsoever, well done! 😀

  • Doug M

    Hahaha… and I almost fell for it! April fools to you too! Any more wacky ravings? Nice one!

  • Doug M

    Abstinence is 99.99% effective, look at any study you want, but common sense tells you that.

    Secondly, morality has worked in Uganda. Also, it has made a major difference DC area schools where it is used compared to areas where condems and sex education is used.

    There are scholars and scientists on both sides of this debate, but what both scientists would agree with is that abstinence is more effective than condems, even if it is more difficult for people.

    This same line of reasoning (which is science is either amoral or more important than morals) has been used in abortion, stem cell research, gay rights, and euthanasia which has meant the death of millions.

    We cannot use “good science” when it is teaches immortality. When it does it is “bad science”.

    There are studies that show condem use and sex education DO promote promiscuity. Polls and studies seem to indicate both. The best we can do is be moral.

    The healthy, morally responsible choice is abstinence.

  • Have a good long read of this, dominic sanchez falar:
    http://www.adolescenthealth.org/PositionPaper_Abstinence_only_edu_policies_and_programs.pdf

    and let us know if you’re going to say any more unsupported nonsense in return. Or maybe just realise that there is no ‘immorality and irresponsibility’ in comparison to unsafe sex which these teens are going to have anyway.

  • Not really dominic as I fail to see how condoms breed immorality and irresponsibility. If you’re going to make the claim that they encourage pre-marital sex then you’re greatly mistaken.

    Almost every (if not every) study which has been conducted on teens in regards to pre-marital sex shows that the rate of those having sex is exactly the same no matter whether the teens are taught abstinence only sex education or safe sex education. In fact, the only numbers that differ are those of sexually transmitted disease and teen pregnancy, both of which greatly favour the safe sex education.

    The facts are against you dominic. I suggest you actually open your eyes and look at the studies, facts and that little thing known as evidence.

    Fight aids by doing things that actually work (medicine, safe sex, condoms), not by doing things that encourage it.

  • Hi Dominic,

    I think you’ll find that attempting the “cure AIDS with morality” angle has well and truly failed. As my blog points out, since Pope John Paul visited Africa in 1990, preaching for marital fidelity and sexual abstinence, the epidemic has grown exponentially.

    “By 2010, it is estimated, there will be 50 million orphaned children in sub-Saharan Africa, 18 million of whose parents will have died from AIDS or AIDS-related illnesses. Today, more than 28 per cent of African children have lost one or both parents to AIDS. In 1990, at the time of the pope’s visit to Tanzania, the figure was 2 per cent”.

    These figures make it clear that this strategy alone is not working. When it comes to a human disaster of this scale, we need to do everything we can. And if religion can’t prevent the death of thousands of innocent children then we will turn to science. Which it has been demonstrated, is a very successful way of preventing the transmission of HIV.

    Cheers

    Rachael.

  • fight aids by fighting immorality, instead.

  • Hi,

    What solution does science offer you that you cannot use against man? Condom prevents aids but it also breeds immorality and irresponsibility. see my point?