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06 July 2000

Nature 406, 15 - 16 (2000); doi:10.1038/35017662

The Durban Declaration

HIV causes AIDS. Curbing the spread of this virus must remain the first step towards eliminating this devastating disease.

 

Future orphans? The death toll from AIDS in Africa will be enormous unless action is taken now.

Seventeen years after the discovery of the human immunodeficiency virus (HIV), thousands of individuals from around the world are gathering in Durban, South Africa, to attend the XIII International AIDS Conference, which starts next week (9 July). At the turn of the millennium, figures released last week reveal that an estimated 34.3 million people worldwide are living with HIV or AIDS, 24.5 million of them in sub-Saharan Africa¹. Last year alone, 2.8 million people died of AIDS, the highest rate since the start of the epidemic. If current trends continue, southern and Southeast Asia, South America and regions of the former Soviet Union will also bear a heavy burden in the next two decades.

 

AIDS spreads by infection, like many other diseases, such as tuberculosis and malaria, that cause illness and death particularly in underprivileged and impoverished communities. HIV-1, which is responsible for the AIDS pandemic, is a retrovirus closely related to a simian immunodeficiency virus (SIV) that infects chimpanzees. HIV-2, which is prevalent in West Africa and has spread to Europe and India, is almost indistinguishable from an SIV that infects sooty mangabey monkeys. Although HIV-1 and HIV-2 first arose as zoonoses² — infections transmitted from animals to humans — both now spread among humans through sexual contact; from mother to infant; and via contaminated blood.

An animal source for an infection is not unique to HIV. The plague came from rodents and influenza from birds. The new Nipah virus in Southeast Asia reached humans via pigs. Variant Creutzfeldt–Jakob disease in the United Kingdom is identical to 'mad cow' disease. Once HIV became established in humans, it soon followed human habits and movements. Like many other viruses, HIV recognizes no social, political or geographic boundaries (see figure).

 

 

Figure 1 Adults and children estimated to be living with HIV/AIDS, together with the proportion of adults infected by HIV across the world (UNAIDS, June 2000).   Full legend   High resolution image and legend (37k)

 

The evidence that AIDS is caused by HIV-1 or HIV-2 is clear-cut, exhaustive and unambiguous, meeting the highest standards of science^3-7. The data fulfil exactly the same criteria as for other viral diseases, such as polio, measles and smallpox:

• Patients with acquired immune deficiency syndrome, regardless of where they live, are infected with HIV^3-7.
• If not treated, most people with HIV infection show signs of AIDS within 5–10 years^{6, 7}. HIV infection is identified in blood by detecting antibodies, gene sequences or viral isolation. These tests are as reliable as any used for detecting other virus infections.
• People who receive HIV-contaminated blood or blood products develop AIDS, whereas those who receive untainted or screened blood do not⁶.
• Most children who develop AIDS are born to HIV-infected mothers. The higher the viral load in the mother, the greater the risk of the child becoming infected⁸.
• In the laboratory, HIV infects the exact type of white blood cell (CD4 lymphocytes) that becomes depleted in people with AIDS^3-5.
• Drugs that block HIV replication in the test tube also reduce virus load in people and delay progression to AIDS. Where available, treatment has reduced AIDS mortality by more than 80% (ref. 9).
• Monkeys inoculated with cloned SIV DNA become infected and develop AIDS¹⁰.

 

Further compelling data are available⁴. HIV causes AIDS⁵. It is unfortunate that a few vocal people continue to deny the evidence. This position will cost countless lives.

In different regions of the world, HIV/AIDS can show altered patterns of spread and symptoms. In Africa, for example, people infected with HIV are 11 times more likely to die within five years⁷, and more than 100 times more likely than uninfected people to develop Kaposi's sarcoma, a cancer linked to yet another virus¹¹.

As with any other chronic infection, various factors have a role in determining the risk of disease. People who are malnourished, who already suffer other infections or who are older, tend to be more susceptible to the rapid development of AIDS following HIV infection. However, none of these factors weakens the scientific evidence that HIV is the sole cause of the AIDS epidemic.

In this global emergency, prevention of HIV infection must be our greatest worldwide public-health priority. The knowledge and tools to prevent infection are available. The sexual spread of HIV can be stopped by mutual monogamy, abstinence or by using condoms. Blood transmission can be prevented by screening blood products and by not reusing needles. Mother-to-child transmission can be reduced by half or more by short courses of antiviral drugs^{12, 13}.

Limited resources and the crushing burden of poverty in many parts of the world constitute formidable challenges to the control of HIV infection. People already infected can be helped by treatment with life-saving drugs, but the high cost of these drugs puts these treatments out of reach for most of the world. It is crucial to develop new antiviral drugs that are easier to take, have fewer side effects and are much less expensive, so that millions more can benefit from them.

There are many ways of communicating the vital information on HIV/AIDS, and what works best in one country may not be appropriate in another. But to tackle the disease, everyone must first understand that HIV is the enemy. Research, not myths, will lead to the development of more effective and cheaper treatments, and, it is hoped, a vaccine. But for now, emphasis must be placed on preventing sexual transmission.

There is no end in sight to the AIDS pandemic. But, by working together, we have the power to reverse its tide. Science will one day triumph over AIDS, just as it did over smallpox. Curbing the spread of HIV will be the first step. Until then, reason, solidarity, political will and courage must be our partners.

Supplementary information accompanies this paper.

References

Nature © Macmillan Publishers Ltd 2000 Registered No. 785998 England.

Letter to the Department of Health and Human Services

-- 02/05/2001

February 5, 2001

Mr. Edgar M. Swindell
Associate General Counsel
Department of Health and Human Services
Office of the General Counsel, Ethics Division
700-E Humphrey Building
200 Independence Avenue, S.W.
Washington, DC 20201

Dear Mr. Swindell:

It is my understanding that the Ethics Division of the Department of Health and Human Services investigates ethics matters relating to officials in all component agencies of the Department. It is also my understanding that your office provides advice to employees in matters relating to federal criminal conflict of interest statutes, the Standards of Ethical Conduct regulations, and the financial disclosure provisions of the Ethics in Government Act.

Federal regulations require that Executive branch employees must not use their public office for their own or another’s private gain; that they are not to use their position, title or any authority associated with their office to coerce or induce a benefit for themselves or others; that they are not to use or allow the improper use of nonpublic information to further a private interest, either their own or another’s; and, that they may not use Government property for other than authorized purposes. Government property includes office supplies, telephones, computers, copiers and any other property purchased with Government funds. Employees may not misuse official time and it is my understanding that this includes the employee’s own time as well as the time of a subordinate.

I refer to 5 C.F.R. § 2635.702:
“An employee shall not use his public office for his own private gain, for the endorsement of any product, service or enterprise, or for the private gain of friends, relatives, or persons with whom the employee is affiliated in a nongovernmental capacity, including nonprofit organizations of which the employee is an officer or member, and persons with whom the employee has or seeks employment or business relations. The specific prohibitions set forth in paragraphs (a) through (d) of this section apply this general standard, but are not intended to be exclusive or to limit the application of this section. ”

Specifically paragraph (b):
"(b) Appearance of governmental sanction. Except as otherwise provided in this part, an employee shall not use or permit the use of his Government position or title or any authority associated with his public office in a manner that could reasonably be construed to imply that his agency or the Government sanctions or endorses his personal activities or those of another. When teaching, speaking, or writing in a personal capacity, he may refer to his official title or position only as permitted by § 2635.807(b). He may sign a letter of recommendation using his official title only in response to a request for an employment recommendation or character reference based upon personal knowledge of the ability or character of an individual with whom he has dealt in the course of Federal employment or whom he is recommending for Federal employment.

And § 2635.807 Teaching, speaking and writing:

“(b) Reference to official position. An employee who is engaged in teaching, speaking or writing as outside employment or as an outside activity shall not use or permit the use of his official title or position to identify him in connection with his teaching, speaking or writing activity or to promote any book, seminar, course, program or similar undertaking, except that:

(1) An employee may include or permit the inclusion of his title or position as one of several biographical details when such information is given to identify him in connection with his teaching, speaking or writing, provided that his title or position is given no more prominence than other significant biographical details;

(2) An employee may use, or permit the use of, his title or position in connection with an article published in a scientific or professional journal, provided that the title or position is accompanied by a reasonably prominent disclaimer satisfactory to the agency stating that the views expressed in the article do not necessarily represent the views of the agency of the United States; and

(3) An employee who is ordinarily addressed using a general term of address, such as "The Honorable," or a rank, such as a military or ambassadorial rank, may use or permit the use of that term of address or rank in connection with his teaching, speaking or writing."
********************************************************************************
Prior to the XIII International Conference on AIDS, Anthony Fauci, MD, Director, NIAID, was identified by name and official title as a signatory of a document now known as the Durban Declaration, a document that was printed in the journal Nature and posted on the Internet (www.durbandeclaration.org). No indication or disclaimer was provided indicating the individual involved was expressing their personal opinion.

One of the intentions of the Durban Declaration is to declare that “HIV is the sole cause of AIDS,” in response to controversial comments to the contrary made by a political leader and several scientists. Efforts to end full, free, and open scientific debate are dangerous, particularly when so many unanswered questions exist about the nature and course of AIDS. When government officials from agencies that provide for research funding and/or licensure of pharmaceuticals and diagnostic products participate in such declarations, there is a serious danger of government sanctions and/or the creation of fear that government sanction will be the consequence of legitimate scientific debate.

Therefore, I am requesting an explanation from the Department as to whether the opinion expressed by Dr. Fauci is the official opinion of the Department. If the opinion expressed is not the official opinion of the Department, I am requesting a full investigation into the facts and circumstances surrounding Dr. Fauci's becoming a signatory of this document and an explanation as to what corrective actions will be taken to prevent the recurrence of similar conduct by Department of Health and Human Service employees.

The adherence to ethical standards by federal employees is critical if we as a nation are to maintain true scientific freedom without fear of government sanctions.

Howard B. Urnovitz, Ph.D.
Science Director
Chronic Illness Research Foundation

CC: The Honorable Tommy G. Thompson
Secretary
Department of Health and Human Services
200 Independence Ave., S.W.
Room 615-F
Washington, DC 20201