While deniers rigidly believe that HIV is nonexistent or incidental, they have yet to articulate a coherent explanation for its nearly universal presence in people with AIDS. Nor have they explained the documented efficacy of drugs that specifically suppress HIV in prolonging AIDS patients' lives and preventing infection in newborns of HIV-infected women. Furthermore, in the face of such data, they have not articulated a moral defense for their advice against anti-retroviral treatments that actually work to save human lives. At best, their position is surreal; at worst, it is blatantly immoral.

Deniers also believe that AIDS researchers are somehow organized into a conspiracy that profits in its singular and rigid focus on HIV as the cause of AIDS. Those of us who actually do research find this humorous. Like their hero, Duesberg, we tend to be a fiercely independent and competitive lot who keep our research secret from colleagues, hoping to be the one to find the new truth and debunk the old one. Any "mainstream" scientist would love to discover another cause of AIDS. The rush of excitement and notoriety that such a discovery would bring are what researchers strive for during their repetitive, dreary work in crowded and underfunded labs. Still, no one so far, including Duesberg, has found another cause for AIDS.

Interestingly, there exists much agreement between deniers and AIDS researchers. For example, both camps concur that poor nutrition, poverty, homelessness, drug abuse and infections can accelerate or promote the development of AIDS. Similarly, they agree that anti-retrovirals are toxic therapies. How these mutually accepted views have been misrepresented as disagreements by the deniers is mysterious -- the tactic has the feel of a very thin line drawn in sand. Meanwhile, a war of rhetoric rages, threatening to blur the basic and irrevocable facts: So far deniers have found no cures for AIDS, and they are doing absolutely nothing to diminish contributing factors like poverty and malnutrition. AIDS researchers and activists, in contrast, are moving forward in search of less toxic ARTs.

Before the deniers caught Mbeki's favor, the scientific community could afford to view them as deluded voices screaming in the wind. After all, as long as the scientists shared an overwhelming consensus that the deniers had got it wrong, their anti-retroviral campaign could go only so far. But with the dissidents' growing public platform on the world stage, researchers have stepped up to the front lines. In anticipation of the AIDS conference in Durban, South Africa, more than 5,000 global AIDS scientists signed the "Durban Declaration." Published in the prestigious scientific journal Nature, the declaration was a sharp rebuke to Mbeki's refusal to acknowledge that HIV causes AIDS. The declaration states that the link between HIV and AIDS is "clear-cut, exhaustive and unambiguous ... HIV causes AIDS. It is unfortunate that a few vocal people continue to deny the evidence. This position will cost countless lives."

At the AIDS conference, more than 10,000 attendees heard Winnie Mandela, head of the African National Congress' Women's League, angrily proclaim, "Let me start by asserting what appears to have become less obvious in South Africa. AIDS exists! HIV causes AIDS. It is roaming the world, attacking the poor and marginalized. In our beloved Africa, it is swallowing up families and communities and villages."

At the closing ceremony, South Africa's former president, Nelson Mandela, joined the conference and offered what could only be taken as an attempt to reconcile both sides and thereby sidestep the maelstrom of controversy. "The ordinary people of the world -- particularly the poor who are on our continent who will again carry a disproportionate burden of the scourge -- would wish that the dispute about the primacy of politics or science be put on the back burner and that we proceed to address the needs and concerns of those suffering and dying," he said. "And this can only be done in partnership. The challenge is to move from rhetoric to action, and action at an unprecedented intensity and scale."

But for many researchers, such conciliatory gestures could not elide the potential dangers of the deniers' position. Like many AIDS doctors I know, Paul Volberding, a UC-San Francisco professor of medicine who directs the Positive Health Program at San Francisco General Hospital, refrained from attending the AIDS conference, partly in response to Mbeki's stand. "In the midst of a raging epidemic that threatens the survival of his country, we expect the strongest and most direct leadership from the highest levels," he explained. "The sad situation in South Africa, and the encouragement of President Mbeki's distraction from the task at hand by American AIDS denialists, underscore the need for clarity. HIV causes AIDS, and the continued devastation of the epidemic can only be limited by programs that help inform people of all lands how HIV transmission can be prevented. It's time to get to work."

Indeed, many AIDS scientists and activists worry that if Mbeki promotes the view that AIDS is neither infectious nor caused by HIV, South Africans will ignore effective behavioral strategies (like safer sex) that prevent HIV transmission. Reportedly, one in 10 of South Africa's 43 million people are already HIV infected. If they fail to engage in safer sex and reject anti-retrovirals, the National Health Research Development Program of Health Canada projects that South Africa will witness 2.3 million new AIDS cases between 2000 and 2005, and that the country's life expectancy will decrease to 46.5 years.

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