Editing Misconceptions about HIV/AIDS

{{short description|Misinformation about the HIV/AIDS and its spread}}
The spread of [[HIV/AIDS]] has affected millions of people worldwide; AIDS is considered a [[pandemic]].<ref name=Kallings>{{Cite journal|journal= Journal of Internal Medicine |year=2008 |volume=263 |issue=3 |pages=218–43 |title= The first postmodern pandemic: 25 years of HIV/AIDS |author= Kallings LO |doi=10.1111/j.1365-2796.2007.01910.x |pmid=18205765 |doi-access=free }}</ref>  The [[World Health Organization]] (WHO) estimated that in 2016 there were 36.7&nbsp;million people worldwide living with HIV/AIDS, with 1.8&nbsp;million new [[HIV]] infections per year and 1&nbsp;million deaths due to AIDS.<ref name=WHO2009>{{cite web|title=AIDS epidemic update |url=http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/report/2009/jc1700_epi_update_2009_en.pdf|publisher=World Health Organization|access-date=29 July 2011}}</ref>  '''Misconceptions about HIV and AIDS''' arise from several different sources, from simple ignorance and misunderstandings about scientific knowledge regarding HIV infections and the cause of AIDS to misinformation propagated by individuals and groups with ideological stances that [[AIDS denialism|deny]] a causative relationship between HIV infection and the development of AIDS. Below is a list and explanations of some common misconceptions and their rebuttals.
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==The relationship between HIV and AIDS==

===HIV is the same as AIDS===
HIV is an acronym for [[human immunodeficiency virus]], which is the virus that causes AIDS ([[acquired immunodeficiency syndrome]]). Contracting HIV can lead to the development of AIDS or stage 3 HIV, which causes serious damage to the immune system.{{medical citation needed|date=July 2023}} While this virus is the underlying cause of AIDS,<ref name="NIAID, 1994-2003"/> not all HIV-positive individuals have AIDS, as HIV can remain [[AIDS#Clinical latency|in a latent state]] for many years.{{medical citation needed|date=July 2023}} If undiagnosed or left untreated, HIV usually progresses to AIDS, defined as possessing a CD4+ lymphocyte count under 200 cells/μL or HIV infection plus co-infection with an AIDS-defining opportunistic infection. HIV cannot be cured, but it can be treated, and its transmission can be halted. Treating HIV [[Treatment as prevention|can prevent new infections]], which is the key to ultimately defeating AIDS.<ref>{{Cite web|url=https://www.unicef.org/aids/index_fight.html|title=Children and HIV and AIDS – What is the relationship between HIV and AIDS and emergencies?|website=UNICEF|access-date=2018-09-30|archive-date=2017-09-21|archive-url=https://web.archive.org/web/20170921080320/https://www.unicef.org/aids/index_fight.html|url-status=dead}}</ref>

==Treatment==

===Cure===
{{see also|HIV/AIDS#Management|Management of HIV/AIDS}}
[[File:Stribild bottle Dutch labeling.jpg|thumb|A bottle containing Stribild tablets (medication used to treat HIV). Stribild is a combination drug containing [[tenofovir disoproxil fumarate]], [[emtricitabine]], [[elvitegravir]] and [[cobicistat]].]]
[[Highly active anti-retroviral therapy]] (HAART) in many cases allows the stabilization of the patient's symptoms, partial recovery of CD4+ [[T-cell]] levels, and reduction in [[viremia]] (the level of virus in the blood) to low or near-undetectable levels. Disease-specific drugs can also alleviate symptoms of AIDS and even cure specific AIDS-defining conditions in some cases. Medical treatment can reduce HIV infection in many cases to a survivable chronic condition. However, these advances do not constitute a cure, since current treatment regimens cannot eradicate latent HIV from the body.{{cn|date=January 2021}}

High levels of HIV-1 (often HAART-resistant) develop if treatment is stopped, if compliance with treatment is inconsistent, or if the virus spontaneously develops resistance to an individual's regimen.<ref name ="Becker, 2002">{{cite journal | last1 = Becker | first1 = S. | last2 = Dezii | first2 = C.M. | last3 = Burtcel | first3 = B. | last4 = Kawabata | first4 = H. | last5 = Hodder | first5 = S. | year = 2002 | title = Young HIV-infected adults are at greater risk for medication nonadherence | journal = Medscape General Medicine | volume = 4 | issue = 3| page = 21 | pmid = 12466764 }}</ref> [[Antiretroviral treatment]] known as [[post-exposure prophylaxis]] reduces the chance of acquiring an HIV infection when administered within 72 hours of exposure to HIV.<ref name=Fan>{{Cite book |year=2005 |title=AIDS: science and society |editor=Fan, H. |editor2=Conner, R.F. |editor3=Villarreal, L.P. |edition=4th |publisher=Jones and Bartlett Publishers |location=Boston |isbn=978-0-7637-0086-7 |url-access=registration |url=https://archive.org/details/aidssciencesocie00fanh }}</ref> 
However, an overwhelming body of clinical evidence has demonstrated the U=U rule - if someone's viral load is undetectable (<200 viral copies per mL) they are untransmissible. Essentially this means if a person living with HIV is well controlled on medications with a viral load less than 200, they cannot transmit HIV to their partners via sexual contact. <ref>{{cite web | url=https://www.niaid.nih.gov/diseases-conditions/treatment-prevention | title=HIV Undetectable=Untransmittable (U=U), or Treatment as Prevention &#124; NIH: National Institute of Allergy and Infectious Diseases | date=21 May 2019 }}</ref>
The landmark study that first established this was the HPTN052 study, which looked at over 2000 couples over 10 years, where one partner was HIV positive, and the other partner was HIV negative. <ref>{{cite journal | pmid=28385131 | pmc=5633001 | doi=10.1080/15284336.2017.1311056 | title=Virologic outcomes in early antiretroviral treatment: HPTN 052 | journal=HIV Clinical Trials | date=May 2017 | volume=18 | issue=3 | pages=100–109 | last1=Eshleman | first1=Susan H. | last2=Wilson | first2=Ethan A. | last3=Zhang | first3=Xinyi C. | last4=Ou | first4=San-San | last5=Piwowar-Manning | first5=Estelle | last6=Eron | first6=Joseph J. | last7=McCauley | first7=Marybeth | last8=Gamble | first8=Theresa | last9=Gallant | first9=Joel E. | last10=Hosseinipour | first10=Mina C. | last11=Kumarasamy | first11=Nagalingeswaran | last12=Hakim | first12=James G. | last13=Kalonga | first13=Ben | last14=Pilotto | first14=Jose H. | last15=Grinsztejn | first15=Beatriz | last16=Godbole | first16=Sheela V. | last17=Chotirosniramit | first17=Nuntisa | last18=Santos | first18=Breno Riegel | last19=Shava | first19=Emily | last20=Mills | first20=Lisa A. | last21=Panchia | first21=Ravindre | last22=Mwelase | first22=Noluthando | last23=Mayer | first23=Kenneth H. | last24=Chen | first24=Ying Q. | last25=Cohen | first25=Myron S. | last26=Fogel | first26=Jessica M. }}</ref>

===Sexual intercourse with a virgin will cure AIDS===
{{See also|Virgin cleansing myth}}
The myth that sex with a virgin will cure AIDS is prevalent in South Africa.<ref name=babyrape>{{cite news |first=Jane |last=Flanagan |title=South African men rape babies as 'cure' for Aids |work=Telegraph |url=https://www.telegraph.co.uk/news/worldnews/africaandindianocean/southafrica/1362134/South-African-men-rape-babies-as-%27cure%27-for-Aids.html |archive-url=https://web.archive.org/web/20080612061053/http://www.telegraph.co.uk/news/worldnews/africaandindianocean/southafrica/1362134/South-African-men-rape-babies-as-%27cure%27-for-Aids.html |url-status=dead |archive-date=2008-06-12 |access-date=2009-03-25 |date=2001-11-11 |location=London}}</ref><ref name="Meel, 2003">{{cite journal | doi = 10.1258/rsmmsl.43.1.85 | last1 = Meel | first1 = B.L. | year = 2003 | title = 1. The myth of child rape as a cure for HIV/AIDS in Transkei: a case report | journal = Med. Sci. Law | volume = 43 | issue = 1| pages = 85–88 | pmid = 12627683 | s2cid = 2706882 }}</ref><ref name="Groce, 2004">{{cite journal | doi = 10.1016/S0140-6736(04)16288-0 | last1 = Groce | first1 = N.E. | last2 = Trasi | first2 = R. | year = 2004 | title = Rape of individuals with disability: AIDS and the folk belief of virgin cleansing | journal = Lancet | volume = 363 | issue = 9422| pages = 1663–64 | pmid = 15158626 | s2cid = 34857351 }}</ref> Sex with an uninfected virgin does not cure an [[HIV]]-infected person, and such contact will expose the uninfected individual to HIV, potentially further spreading the disease. This myth has gained considerable notoriety as the perceived reason for certain [[sexual abuse]] and [[child sexual abuse|child molestation]] occurrences, including the rape of infants, in [[South Africa]].<ref name=babyrape /><ref name="Meel, 2003"/>

===Sexual intercourse with an animal will avoid or cure AIDS===
In 2002, the National Council of [[Society for the Prevention of Cruelty to Animals|Societies for the Prevention of Cruelty to Animals]] (NSPCA) in [[Johannesburg]], [[South Africa]], recorded beliefs amongst youths that [[zoophilia|sex with animals]] is a means to avoid AIDS or cure it if infected.<ref>[http://www.news24.com/News24/South_Africa/Aids_Focus/0,,2-7-659_1161152,00.html "Bestiality new Aids myth – SPCA"] {{webarchive|url=https://web.archive.org/web/20081219070401/http://www.news24.com/News24/South_Africa/Aids_Focus/0,,2-7-659_1161152,00.html |date=2008-12-19 }}, March 25, 2002; retrieved February 22, 2007</ref> As with "virgin cure" beliefs, there is no scientific evidence suggesting a sexual act can actually cure AIDS, and no plausible mechanism by which it could do so has ever been proposed. While the risk of contracting HIV via sex with animals is likely much lower than with humans due to HIV's inability to infect animals, the practice of bestiality still has the ability to infect humans with other fatal [[zoonotic diseases]].{{cn|date=January 2021}}

===HIV antibody testing is unreliable===
[[Medical diagnosis|Diagnosis]] of [[infection]] using [[ELISA|antibody testing]] is a well-established technique in [[medicine]]. HIV [[antibody]] tests exceed the performance of most other infectious disease tests in both sensitivity (the ability of the screening test to give a positive finding when the person tested truly has the disease) and specificity (the ability of the test to give a negative finding when the subjects tested are free of the disease under study). Many current HIV antibody tests have sensitivity and specificity in excess of 96% and are therefore extremely reliable.<ref>[https://www.who.int/diagnostics_laboratory/publications/en/HIV_Report15.pdf "HIV Assays: Operational Characteristics", World Health Organization, 2004]</ref> While most patients with HIV show an antibody response after six weeks, window periods vary and may occasionally be as long as three months.<ref name=GilbertKrajden10>{{cite journal|last1=Gilbert|first1=Mark|last2=Krajden|first2=Mel|title=Don't wait to test for HIV|journal=BC Medical Journal|date=July–August 2010|volume=52|issue=6|page=308}}</ref>

Progress in testing methodology has enabled detection of viral genetic material, antigens, and the virus itself in bodily fluids and cells. While not widely used for routine testing due to high cost and requirements in laboratory equipment, these direct testing techniques have confirmed the validity of the antibody tests.<ref name="Jackson, 1990">{{cite journal | last1 = Jackson | first1 = J.B. | last2 = Kwok | first2 = S.Y. | last3 = Sninsky | first3 = J.J. | last4 = Hopsicker | first4 = J.S. | last5 = Sannerud | first5 = K.J. | last6 = Rhame | first6 = F.S. | last7 = Henry | first7 = K. | last8 = Simpson | first8 = M. | last9 = Balfour | first9 = H.H. Jr |display-authors=etal | year = 1990 | title = Human immunodeficiency virus type 1 detected in all seropositive symptomatic and asymptomatic individuals | journal = J. Clin. Microbiol. | volume = 28 | issue = 1| pages = 16–19 | doi = 10.1128/JCM.28.1.16-19.1990 | pmid = 2298875 | pmc = 269529  }}</ref><ref name="Busch, 1991">{{cite journal | doi = 10.1056/NEJM199107043250101 | last1 = Busch | first1 = M.P. | last2 = Eble | first2 = B.E. | last3 = Khayam-Bashi | first3 = H. | last4 = Heilbron | first4 = D. | last5 = Murphy | first5 = E.L. | last6 = Kwok | first6 = S. | last7 = Sninsky | first7 = J. | last8 = Perkins | first8 = H.A. | last9 = Vyas | first9 = G.N. |display-authors=etal | year = 1991 | title = Evaluation of screened blood donations for human immunodeficiency virus type 1 infection by culture and DNA amplification of pooled cells | journal = N. Engl. J. Med. | volume = 325 | issue = 1| pages = 1–5 | pmid = 2046708  | doi-access = free }}</ref><ref name="Silvester, 1995">{{cite journal | last1 = Silvester | first1 = C. | last2 = Healey | first2 = D.S. | last3 = Cunningham | first3 = P. | last4 = Dax | first4 = E.M. | year = 1995 | title = Multisite evaluation of four anti-HIV-1/HIV-2 enzyme immunoassays. Australian HIV Test Evaluation Group | journal = J Acquir Immune Defic Syndr Hum Retrovirol | volume = 8 | issue = 4| pages = 411–19 | pmid = 7882108 | doi=10.1097/00042560-199504000-00014}}</ref><ref name="Urassa, 1999">{{cite journal | doi = 10.1016/S1386-6532(99)00043-8 | last1 = Urassa | first1 = W. | last2 = Godoy | first2 = K. | last3 = Killewo | first3 = J. | last4 = Kwesigabo | first4 = G. | last5 = Mbakileki | first5 = A. | last6 = Mhalu | first6 = F. | last7 = Biberfeld | first7 = G. | year = 1999 | title = The accuracy of an alternative confirmatory strategy for detection of antibodies to HIV-1: experience from a regional laboratory in Kagera, Tanzania | journal = J. Clin. Virol. | volume = 14 | issue = 1| pages = 25–29 | pmid = 10548127 }}</ref><ref name="Nkengasong, 1999">{{cite journal|last1=Nkengasong|first1=J.N.|author-link=John Nkengasong|last2=Maurice|first2=C.|last3=Koblavi|first3=S.|last4=Kalou|first4=M.|last5=Yavo|first5=D.|last6=Maran|first6=M.|last7=Bile|first7=C.|last8=N'guessan|first8=K.|last9=Kouadio|first9=J.|last10=Bony|first10=Séka|last11=Wiktor|first11=Stefan Z.|display-authors=9|year=1999|title=Evaluation of HIV serial and parallel serologic testing algorithms in Abidjan, Cote d'Ivoire|journal=AIDS|volume=13|issue=1|pages=109–17|doi=10.1097/00002030-199901140-00015|pmid=10207552|first12=Alan E.|last12=Greenberg|doi-access=free}}</ref><ref name="Samdal, 1996">{{cite journal | doi = 10.1016/S0928-0197(96)00244-9 | last1 = Samdal | first1 = H.H. | last2 = Gutigard | first2 = B.G. | last3 = Labay | first3 = D. | last4 = Wiik | first4 = S.I. | last5 = Skaug | first5 = K. | last6 = Skar | first6 = A.G. | year = 1996 | title = Comparison of the sensitivity of four rapid assays for the detection of antibodies to HIV-1/HIV-2 during seroconversion | journal = Clin. Diagn. Virol | volume = 7 | issue = 1| pages = 55–61 | pmid = 9077430 }}</ref>{{citation overkill|date=January 2021}}

Positive HIV antibody tests are usually followed up by retests and tests for [[antigen]]s, viral genetic material and the virus itself, providing confirmation of actual infection.{{cn|date=January 2021}}

==HIV infection==
[[File:Symptoms of acute HIV infection.svg|thumb|Symptoms of acute HIV infection ]]

===HIV can be spread through casual contact with an HIV infected individual===
[[File:Symptoms of AIDS.svg|thumb|Symptoms of AIDS]]
One cannot become infected with HIV through normal contact in social settings, schools, or in the workplace. Other examples of casual contact in which HIV infection will not occur include shaking someone's hand, hugging or "dry" kissing someone, using the same [[toilet]] or drinking from the same glass as an HIV-infected person, and being exposed to [[coughing]] or [[sneezing]] by an infected person.<ref name="Madhok, 1986">{{cite journal | last1 = Madhok | first1 = R. | last2 = Gracie | first2 = J.A. | last3 = Lowe | first3 = G.D. | last4 = Forbes | first4 = C.D. | year = 1986 | title = Lack of HIV transmission by casual contact | journal = Lancet | volume = 328 | issue = 8511| page = 863 | doi=10.1016/S0140-6736(86)92898-9 | pmid = 2876307 | s2cid = 28722212 }}</ref><ref name="Courville, 1998">{{cite journal | doi = 10.1177/000992289803700303 | last1 = Courville | first1 = T.M. | last2 = Caldwell | first2 = B. | last3 = Brunell | first3 = P.A. | year = 1998 | title = Lack of evidence of transmission of HIV-1 to family contacts of HIV-1 infected children | journal = Clin. Pediatr. | volume = 37 | issue = 3| pages = 175–78 | pmid = 9545605 | s2cid = 30065399 }}</ref> [[Saliva]] carries a negligible viral load, so even open-mouthed kissing is considered a low risk. However, if the infected partner or both of the performers have blood in their mouth due to cuts, open sores, or [[gum disease]], the risk increases. The [[Centers for Disease Control and Prevention]] (CDC) has only recorded one case of possible HIV transmission through kissing (involving an HIV-infected man with significant gum disease and a sexual partner also with significant gum disease),<ref name= "Kissing and HIV">[http://www.thebody.com/content/art2287.html "Kissing and HIV"]</ref> and the [[Terence Higgins Trust]] says that this is essentially a no-risk situation.<ref name="THT">{{Cite web |url=http://www.tht.org.uk/informationresources/hivandaids/howhivistransmitted/wayshivisnottransmitted/ |title=THT: "Ways HIV is not passed on" |access-date=2007-10-10 |archive-url=https://web.archive.org/web/20150601202401/http://www.tht.org.uk/informationresources/hivandaids/howhivistransmitted/wayshivisnottransmitted/ |archive-date=2015-06-01 |url-status=dead }}</ref>

Other interactions that could ''theoretically'' result in person-to-person transmission include caring for [[nose bleed]]s and home health care procedures, yet there are very few recorded incidents of transmission occurring in these ways. A handful of cases of transmission via [[biting]] have occurred, though this is extremely rare.<ref>{{cite journal|last1=Bartholomew|first1=Courtenay F|last2=Jones|first2=Avion M|title=Human bites: a rare risk factor for HIV transmission|journal=[[AIDS (journal)|AIDS]]|volume=20|issue=4|pages=631–32|doi=10.1097/01.aids.0000210621.13825.75|pmid=16470132|year=2006|doi-access=free}}</ref>

===HIV-positive individuals can be detected by their appearance===
Due to media images of the effects of AIDS, many people believe that individuals infected with HIV always appear a certain way, or at least appear different from an uninfected, healthy person. In fact, disease progression can occur over a long period of time before the onset of symptoms, and as such, HIV infections cannot be detected based on appearance.<ref>{{cite web|author=Piya Sorcar|title=Teaching Taboo Topics Without Talking About Them: An Epistemic Study of a New Approach to HIV/AIDS Prevention Education in India|url=http://teachaids.org/download/dissertation-teaching-taboo-topics.pdf|publisher=[[Stanford University]], [[TeachAids]]|date=March 2009|author-link=Piya Sorcar}}</ref>

===HIV cannot be transmitted through oral sex===
Contracting HIV through [[oral sex]] is possible, but it is much less likely than from [[anal sex]] and [[human reproduction#copulation|penile–vaginal intercourse]].<ref>{{cite journal|last=Yu|first=M|author2=Vajdy, M|title=Mucosal HIV transmission and vaccination strategies through oral compared with vaginal and rectal routes|journal=Expert Opinion on Biological Therapy|date=August 2010|volume=10|issue=8|pages=1181–95|pmid=20624114|doi=10.1517/14712598.2010.496776|pmc=2904634}}</ref> No cases of such a transmission were observed in a sample of 8965 people performing receptive oral sex.<ref>{{Cite journal|last1=Patel|first1=Pragna|last2=Borkowf|first2=Craig B.|last3=Brooks|first3=John T.|last4=Lasry|first4=Arielle|last5=Lansky|first5=Amy|last6=Mermin|first6=Jonathan|date=2014-06-19|title=Estimating per-act HIV transmission risk: a systematic review|url= |journal=AIDS|language=en-US|volume=28|issue=10|pages=1509–1519|doi=10.1097/QAD.0000000000000298|pmid=24809629|issn=0269-9370|pmc=6195215}}</ref>

===HIV is transmitted by mosquitoes===
When [[mosquito]]es bite a person, they do not inject the blood of a previous victim into the person they bite next. Mosquitoes do, however, inject their [[saliva]] into their victims, which may carry diseases such as [[dengue fever]], [[malaria]], [[yellow fever]], or [[West Nile virus]] and can infect a bitten person with these diseases. HIV is not transmitted in this manner.<ref name="Webb, 1989">{{cite journal | last1 = Webb | first1 = P.A. | last2 = Happ | first2 = C.M. | last3 = Maupin | first3 = G.O. | last4 = Johnson | first4 = B.J. | last5 = Ou | first5 = C.Y. | last6 = Monath | first6 = T.P. | year = 1989 | title = Potential for insect transmission of HIV: experimental exposure of Cimex hemipterus and Toxorhynchites amboinensis to human immunodeficiency virus | journal = J. Infect. Dis. | volume = 160 | issue = 6| pages = 970–77 | pmid = 2479697 | doi = 10.1093/infdis/160.6.970 }}</ref> On the other hand, a mosquito may have HIV-infected blood in its gut, and if swatted on the skin of a human who then scratches it, transmission is hypothetically possible,<ref name="Siemens, 1987">{{cite journal | last1 = Siemens | first1 = D.F. | year = 1987 | title = AIDS Transmission and Insects | journal = Science | volume = 238 | issue = 4824| page = 143 | pmid = 2889266| doi=10.1126/science.2889266 | bibcode=1987Sci...238..143S}}</ref> though this risk is extremely small, and no cases have yet been identified through this route.

===HIV survives for only a short time outside the body===
HIV can survive at room temperature outside the body for hours if dry (provided that initial concentrations are high),<ref name="Resnick, 1986">{{cite journal | doi = 10.1001/jama.255.14.1887 | last1 = Resnick | first1 = L. | last2 = Veren | first2 = K. | last3 = Salahuddin | first3 = S.Z. | last4 = Tondreau | first4 = S. | last5 = Markham | first5 = P.D. | year = 1986 | title = Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments | journal = JAMA | volume = 255 | issue = 14| pages = 1887–91 | pmid = 2419594 }}</ref> and for weeks if wet (in used syringes/needles).<ref name="Heimer, 2000">{{cite journal | last1 = Heimer | first1 = R. | last2 = Abdala | first2 = N. | year = 2000 | title = Viability of HIV-1 in syringes: implications for interventions among injection drug users | journal = AIDS Reader | volume = 10 | issue = 7| pages = 410–17 | pmid = 10932845 }}</ref> However, the amounts typically present in bodily fluids do not survive nearly as long outside the body—generally no more than a few minutes if dry.<ref name="Kissing and HIV"/>

===HIV can infect only homosexual men and drug users===
{{see also|Gay-related immune deficiency|Anal sex#Health risks|History of HIV/AIDS#Unsterile injections}}
HIV can transmit from one person to another if an engaging partner is HIV positive. In the United States, the main route of infection is via homosexual [[anal sex]], while for women transmission is primarily through heterosexual contact.<ref name=CDC>{{cite web|title=HIV Surveillance –Epidemiology of HIV Infection (through 2008)|url=https://www.cdc.gov/hiv/topics/surveillance/resources/slides/general/|publisher=Center for Disease Control|access-date=1 March 2011|url-status=dead|archive-url=https://web.archive.org/web/20110304014448/http://www.cdc.gov/hiv/topics/surveillance/resources/slides/general/|archive-date=4 March 2011}}</ref> It is true that anal sex (regardless of the sex of the receptive partner) carries a higher risk of infection than most sex acts, but most penetrative sex acts between any individuals carry some risk. Properly used [[condom]]s can reduce this risk.<ref name="Condoms">{{cite web | title = Condoms and STDs: Fact Sheet for Public Health Personnel | publisher = [[Centers for Disease Control and Prevention]] | date= 10 February 2010 | url = https://www.cdc.gov/condomeffectiveness/latex.htm | access-date = 5 January 2011 }}</ref>

===An HIV-infected person cannot have children===
HIV-infected women remain fertile, although in late stages of HIV disease a pregnant woman may have a higher risk of [[miscarriage]]. Normally, the risk of transmitting HIV to the unborn child is between 15 and 30%. However, this may be reduced to just 2–3% if patients carefully follow medical guidelines.<ref name="Groginsky, 1998">{{cite journal | last1 = Groginsky | first1 = E. | last2 = Bowdler | first2 = N. | last3 = Yankowitz | first3 = J. | year = 1998 | title = Update on vertical HIV transmission | journal = J Reprod Med | volume = 43 | issue = 8| pages = 637–46 | pmid = 9749412 }}</ref><ref name="WHO, 2005">[https://web.archive.org/web/20060321195253/http://www.who.int/reproductive-health/stis/index.htm WHO, 2005]</ref>

===HIV cannot be the cause of AIDS because the body develops a vigorous antibody response to the virus===
This reasoning ignores numerous examples of [[virus]]es other than HIV that can be [[pathogenic]] after evidence of [[immunity (medical)|immunity]] appears. [[Measles]] virus may persist for years in [[brain]] cells, eventually causing a chronic neurologic disease despite the presence of [[antibodies]]. Viruses such as ''[[Cytomegalovirus]]'', [[Herpes simplex virus|''Herpes simplex'' virus]], and ''[[Varicella zoster]]'' may be activated after years of latency even in the presence of abundant antibodies. In other animals, viral relatives of HIV with long and variable latency periods, such as [[visna virus]] in [[sheep]], cause [[central nervous system]] damage even after the production of antibodies.<ref name="NIAID, 1995">"Disease Progression Despite Antibodies", "The Relationship Between the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome", [[National Institute of Allergy and Infectious Diseases]], September, 1995</ref>

HIV has a well-recognized capacity to [[mutate]] to evade the ongoing immune response of the host.<ref name="Levy, 1993">{{cite journal | last1 = Levy | first1 = J.A. | year = 1993 | title = Pathogenesis of human immunodeficiency virus infection | journal = Microbiol. Rev. | volume = 57 | issue = 1| pages = 183–289 | pmid = 8464405 | pmc = 372905 | bibcode = 1989NYASA.567...58L | doi = 10.1111/j.1749-6632.1989.tb16459.x }}</ref>

===Only a small number of CD4+ T-cells are infected by HIV, not enough to damage the immune system===
Although the fraction of CD4+ T-cells that is infected with HIV at any given time is never high (only a small subset of activated cells serve as ideal targets of infection), several groups have shown that rapid cycles of death of infected cells and infection of new target cells occur throughout the course of the disease.<ref name="Richman, 2000">{{cite journal | doi = 10.1172/JCI9478 | last1 = Richman | first1 = D.D. | year = 2000 | title = Normal physiology and HIV pathophysiology of human T-cell dynamics | journal = J. Clin. Invest. | volume = 105 | issue = 5| pages = 565–66 | pmid = 10712427 | pmc = 292457 }}</ref>  [[Macrophage]]s and other cell types are also infected with HIV and serve as reservoirs for the virus.{{cn|date=January 2021}}

Furthermore, like other viruses, HIV is able to suppress the immune system by secreting proteins that interfere with it. For example, HIV's [[Capsid|coat protein]], [[gp120]], sheds from viral particles and binds to the [[CD4]] receptors of otherwise healthy T-cells; this interferes with the normal function of these signalling receptors. Another HIV protein, [[HIV structure and genome#Genome organization|Tat]], has been demonstrated to suppress T cell activity.{{cn|date=January 2021}}

Infected lymphocytes express the [[Fas ligand]], a cell-surface protein that triggers the death of neighboring uninfected T-cells expressing the [[Fas receptor]].<ref name="Xu, 1999">{{cite journal | doi = 10.1084/jem.189.9.1489 | last1 = Xu | first1 = X.N. | last2 = Laffert | first2 = B. | last3 = Screaton | first3 = G.R. | last4 = Kraft | first4 = M. | last5 = Wolf | first5 = D. | last6 = Kolanus | first6 = W. | last7 = Mongkolsapay | first7 = J. | last8 = McMichael | first8 = A.J. | last9 = Baur | first9 = A.S. |display-authors=etal | year = 1999 | title = Induction of Fas ligand expression by HIV involves the interaction of Nef with the T cell receptor zeta chain | journal = J. Exp. Med. | volume = 189 | issue = 9| pages = 1489–96 | pmid = 10224289 | pmc = 2193060  }}</ref> This "bystander killing" effect shows that great harm can be caused to the immune system even with a limited number of infected cells.{{cn|date=January 2021}}

==History of HIV/AIDS==
{{Main|Origin of AIDS}}
[[File:Mmwr-aids-July1981-report-101.png|thumb|The cover page of MMWR on July 3, 1981. The first major public info regarding (what later became known as) AIDS/HIV.]]
The current consensus is that HIV was introduced to North America by a Haitian immigrant who contracted it while working in the [[Democratic Republic of the Congo]] in the early 1960s, or from another person who worked there during that time.<ref>{{cite news |url=http://news.bbc.co.uk/2/hi/health/7068574.stm |work=BBC News |title=Key HIV strain 'came from Haiti' |date=2007-10-30 |access-date=2010-05-04}}</ref> In 1981 on June 5, the U.S. Centers for Disease Control and Prevention (CDC) published a ''Morbidity and Mortality Weekly Report'' (MMWR) describing cases of a rare lung infection, Pneumocystis carinii pneumonia (PCP), in five healthy [[gay men]] in Los Angeles. This edition would later become ''MMWR's'' first official reporting of the AIDS epidemic in North America.<ref name=":0">{{Cite web|url=https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline|title=A Timeline of HIV and AIDS|website=HIV.gov|language=en|access-date=2018-09-30|date=2016-05-11}} {{PD-notice}}</ref> By year-end, a cumulative total of 337 cases of severe immune deficiency had been reported, and 130 out of the 337 reported cases had died.<ref name=":0" /> On September 24, 1982, the CDC used the term "AIDS" (acquired immune deficiency syndrome) for the first time, and released the first case definition of AIDS: "a disease at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known case for diminished resistance to that disease."<ref name=":0" /> The March 4, 1983 edition of the ''Morbidity and Mortality Weekly Report'' (MMWR) noted that most cases of AIDS had been reported among homosexual men with multiple sexual partners, injection drug users, Haitians, and hemophiliacs. The report suggested that AIDS may be caused by an infectious agent that is transmitted sexually or through exposure to blood or blood products, and issued recommendations for preventing transmission.<ref name=":0" /> Although most cases of HIV/AIDS were discovered in gay men, on January 7, 1983, the CDC reported cases of AIDS in female sexual partners of males with AIDS.<ref name=":0" /> In 1984, scientists identified the virus that causes AIDS, which was first named after the T-cells affected by the strain and is now called HIV or human immunodeficiency virus.<ref name=":1">{{Cite news|url=https://www.cnn.com/2013/03/04/health/timeline-hiv-aids-moments/index.html|title=Timeline: AIDS moments to remember|last=Wilson |first=Jacque Wilson|work=CNN|access-date=2018-10-01}}</ref>

===Origin of AIDS through human–monkey sexual intercourse===
{{See also|HIV/AIDS#Origins}}
While HIV is most likely a mutated form of [[simian immunodeficiency virus]] (SIV), a disease present only in chimpanzees and [[Old World monkey|African monkeys]], highly plausible explanations for the transfer of the disease between species ([[zoonosis]]) exist not involving [[bestiality|sexual intercourse]].<ref name=Locatelli2012>{{cite journal|last=Locatelli|first=S|author2=Peeters, M|title=Cross-species transmission of simian retroviruses: how and why they could lead to the emergence of new diseases in the human population|journal=AIDS  |date=Mar 27, 2012|volume=26|issue=6|pages=659–73|pmid=22441170|doi=10.1097/QAD.0b013e328350fb68|s2cid=38760788|doi-access=free}}</ref>  In particular, the African chimpanzees and monkeys which carry SIV are often [[hunting|hunted]] for food, and epidemiologists theorize that the disease may have appeared in humans after hunters came into blood-contact with monkeys infected with SIV that they had killed.<ref name=Sharp2011>{{cite journal|last=Sharp|first=PM|author2=Hahn, BH|title=Origins of HIV and the AIDS Pandemic|journal=Cold Spring Harbor Perspectives in Medicine|date=September 2011|volume=1|issue=1|pages=a006841|pmid=22229120|doi=10.1101/cshperspect.a006841|pmc=3234451}}</ref> The first known instance of HIV in a human was found in a person who died in the [[Democratic Republic of the Congo]] in 1959,<ref name="Zhu, 1998">{{cite journal | doi = 10.1038/35400 | last1 = Zhu | first1 = T. | last2 = Korber | first2 = B.T. | last3 = Nahmias | first3 = A.J. | last4 = Hooper | first4 = E. | last5 = Sharp | first5 = P.M. | last6 = Ho | first6 = D.D. | year = 1998 | title = An African HIV-1 sequence from 1959 and implications for the origin of the epidemic | journal = Nature | volume = 391 | issue = 6667| pages = 594–97 | pmid = 9468138 |bibcode = 1998Natur.391..594Z | s2cid = 4416837 | doi-access = free }}</ref> and a recent study dates the last common ancestor of HIV and SIV to between 1884 and 1914 by using a [[molecular clock]] approach.<ref name="nature07390">{{cite journal |last1=Worobey |first1=Michael |date=2 October 2008 |title=Direct evidence of extensive diversity of HIV-1 in Kinshasa by 1960 |journal=[[Nature (journal)|Nature]] |volume=455 |issue=7293 |pages=661–64 |doi=10.1038/nature07390  |pmid=18833279 |first2=Marlea |last2=Gemmel |first3=3=Dirk E. |last3=Teuwen |display-authors=2 |last4=Haselkorn |first4=Tamara |last5=Kunstman |first5=Kevin |last6=Bunce |first6=Michael |last7=Muyembe |first7=Jean-Jacques |last8=Kabongo |first8=Jean-Marie M. |last9=Kalengayi |first9=Raphaël M.|last10=Van Marck |first10=Eric |last11=Gilbert |first11=M. Thomas P. |last12=Wolinsky |first12=Steven M. |bibcode = 2008Natur.455..661W |pmc=3682493|url=http://researchrepository.murdoch.edu.au/id/eprint/5121/ }}</ref>

[[Tennessee Senate|Tennessee State Senator]] [[Stacey Campfield]] was the subject of controversy in 2012 after stating that AIDS was the result of a human having sexual intercourse with a monkey.<ref name=huff0126>{{Cite news|url=http://www.huffingtonpost.com/2012/01/26/stacey-campfield-tennessee-senator-dont-say-gay-bill_n_1233697.html |title=Stacey Campfield, Tennessee Senator Behind 'Don't Say Gay' Bill, On Bullying, AIDS And Homosexual 'Glorification' |work=The Huffington Post |date=2012-01-26 |access-date=2012-01-30|last1=Signorile |first1=Michelangelo }}</ref><ref>{{cite news|title=Knoxville Republican says AIDS came from man having sex with a monkey then with other men|url=http://www.politifact.com/tennessee/statements/2012/feb/03/stacey-campfield/knoxville-republican-says-aids-came-man-having-sex/|access-date=16 April 2018|work=Politifact|language=en}}</ref>

===Gaëtan Dugas as "patient zero"===
{{Main|Gaëtan Dugas}}
The Canadian flight attendant Gaëtan Dugas has been referred to as "[[Index case|patient zero]]" of the HIV/AIDS epidemic, meaning the first case of HIV/AIDS in the United States. In fact, the "patient zero" moniker originated from a misinterpretation of a 1984 study<ref name="Auerbach1984">{{cite journal |last1=Auerbach |first1=D.M. |author2=W.W. Darrow |author3=H.W. Jaffe |author4=J.W. Curran |title=Cluster of cases of the acquired immune deficiency syndrome. Patients linked by sexual contact |journal=[[The American Journal of Medicine]] |volume=76 |issue=3 |pages=487–92 |year=1984 |doi=10.1016/0002-9343(84)90668-5 |pmid=6608269 }}</ref> that referred to Dugas as "patient O", where the O stood for "out of California".<ref name="Macleans">{{cite news |last1=Johnson |first1=Brian D. |title=How a typo created a scapegoat for the AIDS epidemic |url=https://www.macleans.ca/culture/movies/how-a-typo-created-a-scapegoat-for-the-aids-epidemic/ |access-date=20 April 2019 |publisher=Maclean's |date=17 April 2019}}</ref><ref name="npr.org">{{cite web|url=https://www.npr.org/sections/health-shots/2016/10/26/498876985/mystery-solved-how-hiv-came-to-the-u-s|title=Researchers Clear 'Patient Zero' From AIDS Origin Story|website=NPR.org }}</ref> A 2016 study published in ''[[Nature (journal)|Nature]]'' found "neither biological nor historical evidence that [Dugas] was the primary case in the US or for subtype B as a whole."<ref name=Nature>{{cite journal |title=1970s and 'Patient 0' HIV-1 genomes illuminate early HIV/AIDS history in North America |first1=Michael |last1=Worobey |author2=Thomas D. Watts |author3=Richard A. McKay |author4=Marc A. Suchard |author5=Timothy Granade |author6=Dirk E. Teuwen |author7=Beryl A. Koblin |author8=Walid Heneine |author9=Philippe Lemey |author10=Harold W. Jaffe |display-authors=2 |journal=[[Nature (journal)|Nature]] |volume=539 |issue=7627 |pages=98–101 |date=October 26, 2016 |doi=10.1038/nature19827 |pmid=27783600 |pmc=5257289 |bibcode=2016Natur.539...98W }}</ref>

==AIDS denialism==
{{Main|AIDS conspiracy theories|AIDS denialism}}

===There is no AIDS in Africa, as AIDS is nothing more than a new name for old diseases===
The diseases that have come to be associated with [[AIDS in Africa]], such as [[cachexia]], diarrheal diseases and [[tuberculosis]] have long been severe burdens there. However, high rates of [[death|mortality]] from these diseases, formerly confined to the elderly and [[malnourish]]ed, are now common among HIV-infected young and [[middle-age]]d people, including well-educated members of the [[middle class]].<ref name="UNAIDS, 2000">UNAIDS, 2000</ref>

For example, in a study in [[Côte d'Ivoire]], HIV-[[seropositive]] individuals with [[pulmonary tuberculosis]] were 17 times more likely to die within six months than HIV-seronegative individuals with pulmonary tuberculosis.<ref name="Ackah, 1995">{{cite journal | doi = 10.1016/S0140-6736(95)90519-7 | last1 = Ackah | first1 = A.N. | last2 = Coulibaly | first2 = D. | last3 = Digbeu | first3 = H. | last4 = Diallo | first4 = K. | last5 = Vetter | first5 = K.M. | last6 = Coulibaly | first6 = I.M. | last7 = Greenberg | first7 = A.E. | last8 = De Cock | first8 = K.M. | year = 1995 | title = Response to treatment, mortality, and CD4 lymphocyte counts in HIV-infected persons with tuberculosis in Abidjan, Cote d'Ivoire | journal = Lancet | volume = 345 | issue = 8950| pages = 607–10 | pmid = 7898177 | s2cid = 19384981 }}</ref> In [[Malawi]], mortality over three years among children who had received recommended childhood [[immunization]]s and who survived the first year of life was 9.5 times higher among HIV-seropositive children than among HIV-seronegative children. The leading causes of death were wasting and respiratory conditions.<ref name="Taha, 1999">{{cite journal | doi = 10.1097/00006454-199908000-00007 | last1 = Taha | first1 = T.E. | last2 = Kumwenda | first2 = N.I. | last3 = Broadhead | first3 = R.L. | last4 = Hoover | first4 = D.R. | last5 = Graham | first5 = S.M. | last6 = Van Der | first6 = Hoven L. | last7 = Markakis | first7 = D. | last8 = Liomba | first8 = G.N. | last9 = Chiphangwi | first9 = J.D. | last10 = Miotti | first10 = Paolo G. | year = 1999 | title = Mortality after the first year of life among human immunodeficiency virus type 1-infected and uninfected children | journal = Pediatr. Infect. Dis. J. | volume = 18 | issue = 8| pages = 689–94 | pmid = 10462337 | display-authors = 9 }}</ref> Elsewhere in Africa, findings are similar.

===HIV is not the cause of AIDS===
{{Main|AIDS denialism}}
There is broad [[scientific consensus]] that HIV is the cause of AIDS, but some individuals reject this consensus, including biologist [[Peter Duesberg]], biochemist [[David Rasnick]], journalist/activist [[Celia Farber]], conservative writer [[Tom Bethell]], and [[intelligent design]] advocate [[Phillip E. Johnson]]. (Some one-time skeptics have since rejected AIDS denialism, including physiologist [[Robert Root-Bernstein]], and physician and AIDS researcher [[Joseph Sonnabend]].){{cn|date=January 2021}}

A great deal is known about the [[pathogenesis]] of HIV disease, even though important details remain to be elucidated. However, a complete understanding of the pathogenesis of a disease is not a prerequisite to knowing its cause. Most infectious agents have been associated with the disease they cause long before their pathogenic mechanisms have been discovered. Because research in pathogenesis is difficult when precise animal models are unavailable, the disease-causing mechanisms in many diseases, including [[tuberculosis]] and [[hepatitis B]], are poorly understood, but the pathogens responsible are very well established.<ref name="NIAID, 1994-2003">{{cite web |url=https://www.niaid.nih.gov/topics/HIVAIDS/Understanding/howHIVCausesAIDS/Pages/HIVcausesAIDS.aspx |title=The Evidence that HIV Causes AIDS |date=4 September 2009|publisher=[[National Institute of Allergy and Infectious Disease]] |access-date=29 May 2015}}</ref>

====AZT and other antiretroviral drugs, not HIV, cause AIDS====
{{Main|Duesberg hypothesis}}
The vast majority of people with AIDS never received antiretroviral drugs, including those in developed countries prior to the licensure of [[Zidovudine|AZT]] in 1987. Even today, very few individuals in developing countries have access to these medications.<ref name="UNAIDS, 2003">[http://www.unaids.org/html/pub/publications/fact-sheets04/fs_treatment_en_pdf.pdf UNAIDS, 2003] {{webarchive|url=https://web.archive.org/web/20070614103019/http://www.unaids.org/html/pub/publications/fact-sheets04/fs_treatment_en_pdf.pdf |date=2007-06-14 }}</ref>

In the 1980s, [[clinical trial]]s enrolling patients with AIDS found that AZT given as single-drug therapy conferred a survival advantage compared to [[placebo]], albeit modest and short-lived. Among HIV-infected patients who had not yet developed AIDS, placebo-controlled trials found that AZT given as a single-drug therapy delayed, for a year or two, the onset of AIDS-related illnesses. The lack of excess AIDS cases and death in the AZT arms of these placebo-controlled trials effectively counters the argument that AZT causes AIDS.<ref name="NIAID, 1995"/>

Subsequent clinical trials found that patients receiving two-drug combinations had up to 50% increases in time to progression to AIDS and in survival when compared to people receiving single-drug therapy. In more recent years, three-drug combination therapies have produced another 50–80% improvements in progression to AIDS and in survival when compared to two-drug regimens in clinical trials.<ref name="HHS, 2005">{{Cite web |url=http://www.hivatis.org/guidelines/adult/AA_040705.pdf |title=HHS, 2005 |access-date=2005-08-23 |archive-url=https://web.archive.org/web/20171004135919/http://www.hivatis.org/guidelines/adult/AA_040705.pdf |archive-date=2017-10-04 |url-status=dead }}</ref> Use of potent anti-HIV combination therapies has contributed to dramatic reductions in the incidence of AIDS and AIDS-related deaths in populations where these drugs are widely available, an effect which would be unlikely if antiretroviral drugs ''caused'' AIDS.<ref name="Palella, 1998">{{cite journal | doi = 10.1056/NEJM199803263381301 | last1 = Palella | first1 = F.J. Jr | last2 = Delaney | first2 = K.M. | last3 = Moorman | first3 = A.C. | last4 = Loveless | first4 = M.O. | last5 = Fuhrer | first5 = J. | last6 = Satten | first6 = G.A. | last7 = Aschman | first7 = D.J. | last8 = Holmberg | first8 = S.D. | year = 1998 | title = Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators | journal = N. Engl. J. Med. | volume = 338 | issue = 13| pages = 853–60 | pmid = 9516219 | doi-access = free }}</ref><ref name="Mocroft, 1998">{{cite journal | doi = 10.1016/S0140-6736(98)03201-2 | last1 = Mocroft | first1 = A. | last2 = Vella | first2 = S. | last3 = Benfield | first3 = T.L. | last4 = Chiesi | first4 = A. | last5 = Miller | first5 = V. | last6 = Gargalianos | first6 = P. | last7 = Arminio Monforte | first7 = A. | last8 = Yust | first8 = I. | last9 = Bruun | first9 = J.N. | last10 = Phillips | first10 = AN | last11 = Lundgren | first11 = JD | year = 1998 | title = Changing patterns of mortality across Europe in patients infected with HIV-1. EuroSIDA Study Group | journal = Lancet | volume = 352 | issue = 9142| pages = 1725–30 | pmid = 9848347 | s2cid = 32223916 | display-authors = 9 }}</ref><ref name="Mocroft, 2000">{{cite journal | doi = 10.1016/S0140-6736(00)02504-6 | last1 = Mocroft | first1 = A. | last2 = Katlama | first2 = C. | last3 = Johnson | first3 = A.M. | last4 = Pradier | first4 = C. | last5 = Antunes | first5 = F. | last6 = Mulcahy | first6 = F. | last7 = Chiesi | first7 = A. | last8 = Phillips | first8 = A.N. | last9 = Kirk | first9 = O. | last10 = Lundgren | first10 = JD | year = 2000 | title = AIDS across Europe, 1994–98: the EuroSIDA study | journal = Lancet | volume = 356 | issue = 9226| pages = 291–96 | pmid = 11071184 | s2cid = 8167162 | display-authors = 9 }}</ref><ref name="Vittinghoff, 1999">{{cite journal | doi = 10.1086/314623 | last1 = Vittinghoff | first1 = E. | last2 = Scheer | first2 = S. | last3 = O'Malley | first3 = P. | last4 = Colfax | first4 = G. | last5 = Holmberg | first5 = S.D. | last6 = Buchbinder | first6 = S.P. | year = 1999 | title = Combination antiretroviral therapy and recent declines in AIDS incidence and mortality | journal = J. Infect. Dis. | volume = 179 | issue = 3| pages = 717–20 | pmid = 9952385 | doi-access = free }}</ref><ref name="Detels, 1998">{{cite journal | doi = 10.1001/jama.280.17.1497 | last1 = Detels | first1 = R. | last2 = Munoz | first2 = A. | last3 = McFarlane | first3 = G. | last4 = Kingsley | first4 = L.A. | last5 = Margolick | first5 = J.B. | last6 = Giorgi | first6 = J. | last7 = Schrager | first7 = L.K. | last8 = Phair | first8 = J.P. | year = 1998 | title = Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators | journal = JAMA | volume = 280 | issue = 17| pages = 1497–503 | pmid = 9809730 | doi-access = free }}</ref><ref name="de Martino, 2000">{{cite journal | last1 = De Martino | first1 = M | last2 = Tovo | first2 = PA | last3 = Balducci | first3 = M | last4 = Galli | first4 = L | last5 = Gabiano | first5 = C | last6 = Rezza | first6 = G | last7 = Pezzotti | first7 = P | title = Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection. Italian Register for HIV Infection in Children and the Italian National AIDS Registry | journal = JAMA | volume = 284 | issue = 2 | pages = 190–97 | year = 2000 | pmid = 10889592 | doi=10.1001/jama.284.2.190| doi-access = free }}</ref><ref name="Hogg, 1999">{{cite journal | last1 = Hogg | first1 = R.S. | last2 = Yip | first2 = B. | last3 = Kully | first3 = C. | last4 = Craib | first4 = K.J. | last5 = O'Shaughnessy | first5 = M.V. | last6 = Schechter | first6 = M.T. | last7 = Montaner | first7 = J.S. | year = 1999 | title = Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens | journal = CMAJ | volume = 160 | issue = 5| pages = 659–65 | pmid = 10102000 | pmc = 1230111 }}</ref><ref name="Schwarcz, 2000">{{cite journal | doi = 10.1093/aje/152.2.178 | last1 = Schwarcz | first1 = S.K. | last2 = Hsu | first2 = L.C. | last3 = Vittinghoff | first3 = E. | last4 = Katz | first4 = M.H. | year = 2000 | title = Impact of protease inhibitors and other antiretroviral treatments on acquired immunodeficiency syndrome survival in San Francisco, California, 1987–1996 | journal = Am. J. Epidemiol. | volume = 152 | issue = 2| pages = 178–85 | pmid = 10909955 | doi-access = free }}</ref><ref name="Kaplan, 2000">{{cite journal | last1 = Kaplan | first1 = JE | last2 = Hanson | first2 = D | last3 = Dworkin | first3 = MS | last4 = Frederick | first4 = T | last5 = Bertolli | first5 = J | last6 = Lindegren | first6 = ML | last7 = Holmberg | first7 = S | last8 = Jones | first8 = JL | title = Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy | journal = Clinical Infectious Diseases | volume = 30 | pages = S5–S14 | year = 2000 | issue = Suppl 1 | pmid = 10770911 | doi = 10.1086/313843 | doi-access = free }}</ref><ref name="McNaghten, 1999">{{cite journal | doi = 10.1097/00002030-199909100-00012 | last1 = McNaghten | first1 = A.D. | last2 = Hanson | first2 = D.L. | last3 = Jones | first3 = J.L. | last4 = Dworkin | first4 = M.S. | last5 = Ward | first5 = J.W. | last6 = The Adultadolescent Spectrum Of Disease Group +/ | year = 1999 | title = Effects of antiretroviral therapy and opportunistic illness primary chemoprophylaxis on survival after AIDS diagnosis. Adult/Adolescent Spectrum of Disease Group | journal = AIDS | volume = 13 | issue = 13| pages = 1687–95 | pmid = 10509570 | doi-access = free }}</ref>{{citation overkill|date=January 2021}}

====Behavioral factors such as recreational drug use and multiple sexual partners—not HIV—account for AIDS====
The proposed behavioral causes of AIDS, such as multiple sexual partners and long-term [[recreational drug use]], have existed for many years. The epidemic of AIDS, characterized by the occurrence of formerly rare opportunistic infections such as ''[[Pneumocystis carinii]]'' pneumonia (PCP), did not occur in the United States until a previously unknown human [[retrovirus]]—HIV—spread through certain communities.<ref>{{Cite web |url=https://www.niaid.nih.gov/publications/hivaids/21.htm |title=NIAID }}</ref>

Compelling evidence against the hypothesis that behavioral factors cause AIDS comes from recent studies that have followed cohorts of [[homosexual]] men for long periods of time and found that only HIV-seropositive men develop AIDS. For example, in a prospectively studied cohort in [[Vancouver, British Columbia]], 715 homosexual men were followed for a median of 8.6 years. Among 365 HIV-positive individuals, 136 developed AIDS. No AIDS-defining illnesses occurred among 350 seronegative men, despite the fact that these men reported appreciable use of [[nitrite inhalants]] ("poppers") and other recreational drugs, and frequent receptive [[anal intercourse]] (Schechter et al., 1993).<ref name="Schechter, 1993">{{cite journal | doi = 10.1016/0140-6736(93)90421-C | last1 = Schechter | first1 = M.T. | last2 = Craib | first2 = K.J. | last3 = Gelmon | first3 = K.A. | last4 = Montaner | first4 = J.S. | last5 = Le | first5 = T.N. | last6 = O'Shaughnessy | first6 = M.V. | year = 1993 | title = HIV-1 and the aetiology of AIDS | journal = Lancet | volume = 341 | issue = 8846| pages = 658–59 | pmid = 8095571 | last7 = Schechter | first7 = M.T. | last8 = Gelmon | first8 = K.A. | last9 = Montaner | first9 = J.S.G.  | s2cid = 23141531 }}</ref>

Other studies show that among homosexual men and injection-drug users, the specific immune deficit that leads to AIDS—a progressive and sustained loss of [[CD4]]+ [[T-cell]]s—is extremely rare in the absence of other immunosuppressive conditions. For example, in the [[Multicenter AIDS Cohort Study]], more than 22,000 T-cell determinations in 2,713 HIV-seronegative homosexual men revealed only one individual with a CD4+ T-cell count persistently lower than 300 cells/μL of blood, and this individual was receiving [[immunosuppressive therapy]].<ref name="Vermund, 1993">{{cite journal | last1 = Vermund | first1 = S.H. | last2 = Hoover | first2 = D.R. | last3 = Chen | first3 = K. | year = 1993 | title = CD4+ counts in seronegative homosexual men. The Multicenter AIDS Cohort Study | journal = N. Engl. J. Med. | volume = 328 | issue = 6| page = 442 | pmid = 8093639 | doi = 10.1056/NEJM199302113280615 | doi-access = free }}</ref>

In a survey of 229 HIV-seronegative injection-drug users in [[New York City]], mean CD4+ T-cell counts of the group were consistently more than 1000 cells/μL of blood. Only two individuals had two CD4+ T-cell measurements of less than 300/μL of blood, one of whom died with cardiac disease and [[non-Hodgkin's lymphoma]] listed as the cause of death.<ref name="Des Jarlais, 1993">{{cite journal | last1 = Des Jarlais | first1 = D.C. | last2 = Friedman | first2 = S.R. | last3 = Marmor | first3 = M. | last4 = Mildvan | first4 = D. | last5 = Yancovitz | first5 = S. | last6 = Sotheran | first6 = J.L. | last7 = Wenston | first7 = J. | last8 = Beatrice | first8 = S. | year = 1993 | title = CD4 lymphocytopenia among injecting drug users in New York City | journal = J. Acquir. Immune Defic. Syndr. | volume = 6 | issue = 7| pages = 820–22 | pmid = 8099613 }}</ref>

====AIDS among transfusion recipients is due to underlying diseases that necessitated the transfusion, rather than to HIV====
This notion is contradicted by a report by the Transfusion Safety Study Group (TSSG), which compared HIV-negative and HIV-positive blood recipients who had been given [[blood transfusions]] for similar diseases. Approximately 3 years following blood transfusion, the mean CD4+ T-cell count in 64 HIV-negative recipients was 850/μL of blood, while 111 HIV-seropositive individuals had average CD4+ T-cell counts of 375/μL of blood. By 1993, there were 37 cases of AIDS in the HIV-infected group, but not a single AIDS-defining illness in the HIV-seronegative transfusion recipients.<ref name="Donegan, 1990">{{cite journal | last1 = Donegan | first1 = E. | last2 = Stuart | first2 = M. | last3 = Niland | first3 = J.C. | last4 = Sacks | first4 = H.S. | last5 = Azen | first5 = S.P. | last6 = Dietrich | first6 = S.L. | last7 = Faucett | first7 = C. | last8 = Fletcher | first8 = M.A. | last9 = Kleinman | first9 = S.H. |display-authors=etal | year = 1990 | title = Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations | journal = Annals of Internal Medicine | volume = 113 | issue = 10| pages = 733–39 | pmid = 2240875  | doi=10.7326/0003-4819-113-10-733}}</ref><ref name="Cohen, 1994">{{cite journal | doi = 10.1126/science.7992044 | last1 = Cohen | first1 = J. | year = 1994 | title = Duesberg and critics agree: hemophilia is the best test | journal = Science | volume = 266 | issue = 5191| pages = 1645–46 | pmid = 7992044 | bibcode=1994Sci...266.1645C}}</ref>

====High usage of clotting factor concentrate, not HIV, leads to CD4+ T-cell depletion and AIDS in hemophiliacs====
This view is contradicted by many studies. For example, among HIV-seronegative patients with [[hemophilia A]] enrolled in the Transfusion Safety Study, no significant differences in CD4+ T-cell counts were noted between 79 patients with no or minimal factor treatment and 52 with the largest amount of lifetime treatments. Patients in both groups had CD4+ T-cell-counts within the normal range.<ref name="Hasset, 1993">{{cite journal | last1 = Hassett | first1 = J. | last2 = Gjerset | first2 = G.F. | last3 = Mosley | first3 = J.W. | last4 = Fletcher | first4 = M.A. | last5 = Donegan | first5 = E. | last6 = Parker | first6 = J.W. | last7 = Counts | first7 = R.B. | last8 = Aledort | first8 = L.M. | last9 = Lee | first9 = H. |display-authors=etal | year = 1993 | title = Effect on lymphocyte subsets of clotting factor therapy in human immunodeficiency virus-1-negative congenital clotting disorders. The Transfusion Safety Study Group | journal = Blood | volume = 82 | issue = 4| pages = 1351–57 | pmid = 8353293  | doi = 10.1182/blood.V82.4.1351.1351 | doi-access = free }}</ref> In another report from the Transfusion Safety Study, no instances of AIDS-defining illnesses were seen among 402 HIV-seronegative hemophiliacs who had received factortherapy.<ref name="Aledort, 1993">{{cite journal | last1 = Aledort | first1 = L.M. | last2 = Operskalski | first2 = E.A. | last3 = Dietrich | first3 = S.L. | last4 = Koerper | first4 = M.A. | last5 = Gjerset | first5 = G.F. | last6 = Lusher | first6 = J.M. | last7 = Lian | first7 = E.C. | last8 = Mosley | first8 = J.W. | year = 1993 | title = Low CD4+ counts in a study of transfusion safety. The Transfusion Safety Study Group | journal = N. Engl. J. Med. | volume = 328 | issue = 6| pages = 441–42 | pmid = 8093638 | doi = 10.1056/NEJM199302113280614 | doi-access = free }}</ref>

In a cohort in the [[United Kingdom]], researchers matched 17 HIV-seropositive [[hemophiliac]]s with 17 HIV-seronegative hemophiliacs with regard to clotting factor concentrate usage over a ten-year period. During this time, 16 AIDS-defining clinical events occurred in 9 patients, all of whom were HIV-seropositive. No AIDS-defining illnesses occurred among the HIV-negative patients. In each pair, the mean CD4+ T-cell count during follow-up was, on average, 500 cells/μL lower in the HIV-seropositive patient.<ref name="Sabin, 1996">{{cite journal | last1 = Sabin | first1 = C.A. | last2 = Pasi | first2 = K.J. | last3 = Phillips | first3 = A.N. | last4 = Lilley | first4 = P. | last5 = Bofill | first5 = M. | last6 = Lee | first6 = C.A. | year = 1996 | title = Comparison of immunodeficiency and AIDS defining conditions in HIV negative and HIV positive men with haemophilia A | journal = BMJ | volume = 312 | issue = 7025| pages = 207–10 | pmid = 8563582 | pmc = 2349998 | doi=10.1136/bmj.312.7025.207}}</ref>

Among HIV-infected hemophiliacs, Transfusion Safety Study investigators found that neither the purity nor the amount of factor VIII therapy had a deleterious effect on CD4+ T-cell counts.<ref name="Gjerset, 1994">{{cite journal | last1 = Gjerset | first1 = G.F. | last2 = Pike | first2 = M.C. | last3 = Mosley | first3 = J.W. | last4 = Hassett | first4 = J. | last5 = Fletcher | first5 = M.A. | last6 = Donegan | first6 = E. | last7 = Parker | first7 = J.W. | last8 = Counts | first8 = R.B. | last9 = Zhou | first9 = Y. |display-authors=etal | year = 1994 | title = Effect of low- and intermediate-purity clotting factor therapy on progression of human immunodeficiency virus infection in congenital clotting disorders. Transfusion Safety Study Group | journal = Blood | volume = 84 | issue = 5| pages = 1666–71 | pmid = 7915149  | doi = 10.1182/blood.V84.5.1666.1666 | doi-access = free }}</ref> Similarly, the Multicenter Hemophilia Cohort Study found no association between the cumulative dose of plasma concentrate and incidence of AIDS among HIV-infected hemophiliacs.<ref name="Goedert, 1989">{{cite journal | last1 = Goedert | first1 = JJ | last2 = Kessler | first2 = CM | last3 = Aledort | first3 = LM | last4 = Biggar | first4 = RJ | last5 = Andes | first5 = WA | last6 = White Gc | first6 = 2nd | last7 = Drummond | first7 = JE | last8 = Vaidya | first8 = K | last9 = Mann | first9 = DL | last10 = Eyster | first10 = M. Elaine | last11 = Ragni | first11 = Margaret V. | last12 = Lederman | first12 = Michael M. | last13 = Cohen | first13 = Alan R. | last14 = Bray | first14 = Gordon L. | last15 = Rosenberg | first15 = Philip S. | last16 = Friedman | first16 = Robert M. | last17 = Hilgartner | first17 = Margaret W. | last18 = Blattner | first18 = William A. | last19 = Kroner | first19 = Barbara | last20 = Gail | first20 = Mitchell H. | title = A prospective study of human immunodeficiency virus type 1 infection and the development of AIDS in subjects with hemophilia | journal = The New England Journal of Medicine | volume = 321 | issue = 17 | pages = 1141–48 | year = 1989 | pmid = 2477702 | doi = 10.1056/NEJM198910263211701 | display-authors = 8 }}</ref>

====The distribution of AIDS cases casts doubt on HIV as the cause. Viruses are not gender-specific, yet only a small proportion of AIDS cases are among women====
The distribution of AIDS cases, whether in the United States or elsewhere in the world, invariably mirrors the prevalence of HIV in a population. In the United States, HIV first appeared in populations of [[injection-drug]] users (a majority of whom are male) and [[gay]] men. HIV is spread primarily through unprotected sex, the exchange of HIV-contaminated needles, or cross-contamination of the drug solution and infected blood during intravenous drug use. Because these behaviors show a gender skew—Western men are more likely to take illegal drugs intravenously than Western women, and men are more likely to report higher levels of the riskiest sexual behaviors, such as unprotected [[anal intercourse]]—it is not surprising that a majority of U.S. AIDS cases have occurred in men.<ref>{{Cite web |url=https://www.census.gov/population/international/ |title=U.S. Census Bureau }}</ref>

Women in the United States, however, are increasingly becoming HIV-infected, usually through the exchange of HIV-contaminated needles or sex with an HIV-infected male. The [[Centers for Disease Control and Prevention|CDC]] estimates that 30 percent of new HIV infections in the United States in 1998 were in women. As the number of HIV-infected women has risen, so too has the number of female AIDS patients in the United States. Approximately 23% of U.S. adult/adolescent AIDS cases reported to the CDC in 1998 were among women. In 1998, AIDS was the fifth leading cause of death among women aged 25 to 44 in the United States, and the third leading cause of death among African-American women in that age group.<ref>{{Cite web |url=https://www.niaid.nih.gov/factsheets/aidsstat.htm |title=AIDS/HIV Statics }}</ref>

In Africa, HIV was first recognized in sexually active [[heterosexual]]s, and AIDS cases in Africa have occurred at least as frequently in women as in men. Overall, the worldwide distribution of HIV infection and AIDS between men and women is approximately 1 to 1.<ref>{{Cite web |url=https://www.census.gov/population/international/ |title=U.S. Bureau Census }}</ref> In [[sub-Saharan Africa]], 57% of adults with HIV are women, and young women aged 15 to 24 are more than three times as likely to be infected as young men.<ref name="UNAIDS, 2005">{{Cite web |url=http://www.unfpa.org/upload/lib_pub_file/308_filename_women_aids1.pdf |title=UNAIDS, 2005 |access-date=2005-08-24 |archive-date=2013-12-02 |archive-url=https://web.archive.org/web/20131202144406/http://www.unfpa.org/upload/lib_pub_file/308_filename_women_aids1.pdf |url-status=dead }}</ref>

====HIV is not the cause of AIDS because many individuals with HIV have not developed AIDS====
HIV infections have a prolonged and variable course. The median period of time between infection with HIV and the onset of clinically apparent disease is approximately 10 years in [[industrialized countries]], according to prospective studies of homosexual men in which dates of [[seroconversion]] are known. Similar estimates of asymptomatic periods have been made for HIV-infected blood-transfusion recipients, injection-drug users and adult hemophiliacs.<ref name="Alcabes, 1993">{{cite journal | last1 = Alcabes | first1 = P. | last2 = Munoz | first2 = A. | last3 = Vlahov | first3 = D. | last4 = Friedland | first4 = G.H. | year = 1993 | title = Incubation period of human immunodeficiency virus | journal = Epidemiol. Rev. | volume = 15 | issue = 2| pages = 303–18 | pmid = 8174659 | doi = 10.1093/oxfordjournals.epirev.a036122 }}</ref>

As with many diseases, a number of factors can influence the course of HIV disease. Factors such as age or genetic differences between individuals, the level of virulence of the individual strain of virus, as well as exogenous influences such as co-infection with other microbes may determine the rate and severity of HIV disease expression. Similarly, some people infected with [[hepatitis B]], for example, show no symptoms or only [[jaundice]] and clear their infection, while others suffer disease ranging from chronic [[liver]] inflammation to [[cirrhosis]] and hepatocellular carcinoma. Co-factors probably also determine why some smokers develop [[lung cancer]] while others do not.<ref name="Levy, 1993"/><ref name="Evans, 1982">{{cite journal | last1 = Evans | first1 = A.S. | year = 1982 | title = The clinical illness promotion factor: a third ingredient | journal = Yale J. Biol. Med. | volume = 55 | issue = 3–4| pages = 193–99 | pmid = 6295003 | pmc = 2596440 }}</ref><ref name="Fauci, 1996">{{cite journal | doi = 10.1038/384529a0 | last1 = Fauci | first1 = A.S. | year = 1996 | title = Host factors and the pathogenesis of HIV-induced disease | url = https://zenodo.org/record/1233194| journal = Nature | volume = 384 | issue = 6609| pages = 529–34 | pmid = 8955267 |bibcode = 1996Natur.384..529F | s2cid = 4370482 }}</ref>

====HIV is not the cause of AIDS because some people have symptoms associated with AIDS but are not infected with HIV====
Most AIDS symptoms result from the development of [[opportunistic infection]]s and [[cancer]]s associated with severe [[immunosuppression]] secondary to HIV.{{cn|date=January 2021}}

However, immunosuppression has many other potential causes. Individuals who take [[glucocorticoid]]s or immunosuppressive drugs to prevent [[organ transplant|transplant]] rejection or to treat [[autoimmune disease]]s can have increased susceptibility to unusual infections, as do individuals with certain [[genetics|genetic]] conditions, severe [[malnutrition]] and certain kinds of cancers. There is no evidence suggesting that the numbers of such cases have risen, while abundant [[epidemiologic]] evidence shows a very large rise in cases of immunosuppression among individuals who share one characteristic: HIV infection.<ref name="NIAID, 1995"/><ref name="UNAIDS, 2000"/>

====The spectrum of AIDS-related infections seen in different populations proves that AIDS is actually many diseases not caused by HIV====
[[File:Pneumocystis jiroveci infection (3833203709).jpg|thumb|[[Pneumocystis jiroveci pneumonia|''Pneumocystis jiroveci'' pneumonia]] ]]
[[File:Bacteria on Warthin–Starry stain.jpg|thumb|[[Mycobacterium avium complex|''Mycobacterium avium'' complex]] ]]
The diseases associated with AIDS, such as [[Pneumocystis jiroveci pneumonia|''Pneumocystis jiroveci'' pneumonia]] (PCP) and [[Mycobacterium avium complex|''Mycobacterium avium'' complex]] (MAC), are not caused by HIV, but rather result from the immunosuppression caused by HIV disease. As the immune system of an HIV-infected individual weakens, he or she becomes susceptible to the particular [[virus|viral]], [[fungus|fungal]], and [[bacteria]]l infections common in the community. For example, HIV-infected people in the [[Midwestern United States]] are much more likely than people in [[New York City]] to develop [[histoplasmosis]], which is caused by a fungus. A person in Africa is exposed to pathogens different from individuals in an American city. Children may be exposed to different infectious agents compared to adults.<ref>{{Cite web |url=http://hivatis.org/guidelines/op_infections/OI_112801.html |title=USPHS/IDSA }}</ref>

HIV is the underlying cause of the condition named AIDS, but the additional conditions that may affect an AIDS patient are dependent upon the [[endemic (epidemiology)|endemic]] [[pathogens]] to which the patient may be exposed.{{cn|date=January 2021}}

===AIDS can be prevented with complementary or alternative medicine===
Many HIV-infected people turn to complementary and [[alternative medicine]], such as traditional medicine, especially in areas where conventional therapies are less widespread.<ref>{{cite journal|last1=Littlewood|first1=RA|last2=Vanable|first2=PA|title=A global perspective on complementary and alternative medicine use among people living with HIV/AIDS in the era of antiretroviral treatment|journal=Curr. HIV/AIDS Rep.|date=8 Dec 2011|volume=8|issue=4|pages=257–68|doi=10.1007/s11904-011-0090-8|pmid=21822625|s2cid=20186700}}</ref> However, the overwhelming majority of scientifically rigorous research indicates little or negative effect on patient outcomes such as HIV-symptom severity and disease duration, and mixed outcomes on psychological well-being.<ref>{{cite journal|last1=Mills|first1=Edward|last2=Wu|first2=Ping|last3=Ernst|first3=Edzard|title=Complementary therapies for the treatment of HIV: in search of the evidence|journal=International Journal of STD & AIDS|date=June 2005|volume=16|issue=6|pages=395–403|pmid=15969772|ref=Mills (2005)|doi=10.1258/0956462054093962|s2cid=7411052}}</ref><ref>{{cite journal|last1=Littlewood|first1=Rae A|last2=Vandable|first2=Peter A|title=Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care|journal=AIDS Care|date=June 2002|volume=20|issue=8|pages=1002–18|doi=10.1080/09540120701767216|pmid=18608078|ref=Littlewood (2002)|pmc=2570227}}</ref> It is important that patients notify their healthcare provider prior to beginning any treatment, as certain alternative therapies may interfere with conventional treatment.<ref>{{cite journal|last1=Piscitelli|first1=Stephen C|last2=Burstein|first2=Aaron H|last3=Chaitt|first3=Doreen|last4=Alfaro|first4=Raul|last5=Falloon|first5=Judith|title=Indinavir concentrations and St John's wort|journal=The Lancet|date=14 April 2001|volume=355|issue=9203|pages=547–48|pmid=10683007|ref=Piscitelli (2000)|doi=10.1016/S0140-6736(99)05712-8|s2cid=7339081}}</ref><ref>{{cite journal|last1=Piscitelli|first1=Stephen|last2=Burstein|first2=Aaron H.|last3=Weldon|first3=Nada|last4=Gallicano|first4=Keith D.|last5=Falloon|first5=Judith|title=The Effect of Garlic Supplements on the Pharmacokinetics of Saquinavir|journal=Clinical Infectious Diseases|date=Jan 2002|volume=34|issue=2|pages=234–38|pmid=11740713|ref=Piscitelli (2002)|doi=10.1086/324351|doi-access=free}}</ref>

==See also==
* [[International AIDS Society]]
* [[Safe sex]]
* [[Contaminated haemophilia blood products]]
* [[Prevention of HIV/AIDS]]

==References==
{{Reflist}}

==External links==
* [https://www.hiv.gov/ HIV.gov – The U.S. Federal Domestic HIV/AIDS Resource]
* [https://www.cdc.gov/hiv/basics/index.html HIV Basics] at [[Centers for Disease Control and Prevention]]

{{AIDS}}

{{DEFAULTSORT:Hiv And Aids Misconceptions}}
[[Category:Misconceptions|HIV and AIDS]]
[[Category:HIV/AIDS]]
[[Category:HIV/AIDS denialism]]