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The HIV vaccine effort is fraught not only with political and economic hurdles, but also with per... more The HIV vaccine effort is fraught not only with political and economic hurdles, but also with perplexing scientific anomalies, ones that cast further doubt on the precise relationship between HIV and AIDS. No vaccine has ever been made against a human retrovirus — the genre of virus to which HIV belongs. One of the main challenges facing researchers is the highly variable nature of HIV, which can mutate into different strains, making the prospects for the development of a single vaccine uncertain.

The biggest news to come out ot the 8th international onference on AIDS is the discovery of a num... more The biggest news to come out ot the 8th international onference on AIDS is the discovery of a number of people with AIDS who show no trace of HIV whatsoever, spotlighting the growing uncertainty in the scientific community about the precise role of HIV in AIDS. Despite billions of dollars worth of research over the last decade, scientists are still in the dark about exactly how the virus destroys the immune system.

The man considered one of the longest living persons with AIDS, and an inspiration to thousands, ... more The man considered one of the longest living persons with AIDS, and an inspiration to thousands, passed away December 27 in Los Angeles after his own 12-year struggle with the illness. Michael Callen, a multi-talented musician. prolific author, scientific heretic and tireless activist was a symbol of hope - and a thorn in the side of the AIDS establishment.

The controversial debate over what causes AIDS has taken on a new significance now that the origi... more The controversial debate over what causes AIDS has taken on a new significance now that the original discoverer of human immunodeficiency virus (HIV) admits that HIV alone can't explain the destruction of the immune system associated with AIDS.

After years spent wading through the minutiae of AIDS science, I now find myself very close to be... more After years spent wading through the minutiae of AIDS science, I now find myself very close to believing the truly astounding — that the virus known as HIV, which has sucked up billions of our research dollars and tied up laboratories the world over, does not exist. This possibility — devastating in its implications — came to me here in London, courtesy of a number of mind-blowing interviews with renegade scientists who believe that HIV is not really a microbiological entity, but merely a collection of signals caused by stresses on the immune system. If this is true, every assumption about AIDS testing and treatment gets thrown to the wind.

The drug AZT. once the brightest hope in the quest for a treatment tor AIDS, now faces an uncerta... more The drug AZT. once the brightest hope in the quest for a treatment tor AIDS, now faces an uncertain future in light of results from the longest and largest study of the drug released last week. British and French researchers reported that HIV-positive people who had not yet developed symptoms and who took AZT progressed to full-blown AIDS at the same rate as those taking a placebo.

Triumphant U.S. health officials told the world 10 years ago they had found the cause of AIDS and... more Triumphant U.S. health officials told the world 10 years ago they had found the cause of AIDS and a vaccine was two years away. But AIDS research is in a state of disarray. The U.S. has put its vaccine trials on hold (Canada has none), amid disappointing preliminary data and uncertain economic prospects for any biotechnology firm that does manage to develop a vaccine. "The state of confusion is absolutely astonishing," says vaccine pioneer Jonas Salk, the man behind the needles that protect us from polio.

In an unprecedented display of journalistic backstabbing, a bitter feud has broken out between th... more In an unprecedented display of journalistic backstabbing, a bitter feud has broken out between the world's top scientific journal and one of Britain's leading news papers over the true cause of AIDS. The journal Nature has embarked on a campaign lo discredit the coverage of the Sunday Times of London, which has questioned whether HIV is truly the culprit behind the deadly disease.

The battle lines in the scientific debate over the cause of AIDS have now become even more firmly... more The battle lines in the scientific debate over the cause of AIDS have now become even more firmly drawn with the publication of two papers in the British journal Nature, papers that claim to prove that HIV — and nothing else — is the culprit in AIDS. To many in the field, the papers represent the final blow to criticisms of the HIV-equals-AIDS theory by people like professor Peter Duesberg. the controversial molecular biologist from the University of California at Berkeley who has argued that the virus is not the cause of the syndrome. He's even gone a step further, claiming that AIDS itself is not an infectious, transmissible condition, and that safe-sex practices will do nothing to halt the epidemic — a radical position that most other critics of the HIV-based approach don't share. HIV researchers, however, don't usually distinguish between these two separate issues, and see the latest findings as a vindication for HIV-based research and a source of ridicule for "...

AIDS has already cramped our sexual styles, throwing a latex fortress around sexual intercourse a... more AIDS has already cramped our sexual styles, throwing a latex fortress around sexual intercourse and dulling the delights of the flesh. But there was always the direct skin-to-skin magic of oral sex — the much-lauded "safer" alternative. Now an unsettling new development is calling into question long-held assumptions about safe-sex education — an increasing number of gay men in Toronto and Vancouver are claiming to have become infected with HIV after engaging in fellatio. So far, the numbers are small enough — fewer than 20 known cases across the country — that they might be dismissed as freak occurrences. But a growing number of people believe this may be the bell-weather of an entirely new AIDS paradigm. The reports of oral transmission come as some doctors question the possible role of another far more infectious sexually transmitted disease — syphilis — and the inability of standard tests to consistently identify the presence of the syphilis bacterium in the human body....

On a cold December afternoon, a select group of 30 AIDS activists, scientists, physicians and jou... more On a cold December afternoon, a select group of 30 AIDS activists, scientists, physicians and journalists, armed with stacks of scientific papers and medical text-books, gathers in the plush board-room of a Manhattan ad agency. They've come to discuss some highly controversial findings that threaten to alter fundamentally the direction of AIDS research. These dedicated investigators have uncovered disturbing evidence suggesting a chronic form of syphilis may be ravaging — undetected and untreated — the same populations affected by AIDS.

When medical historians look back at the AIDS era. they are likely to point to a curious anomaly ... more When medical historians look back at the AIDS era. they are likely to point to a curious anomaly — the the growing movement of grass roots scientists who are surpassing traditional researchers in the race to understand and treat the alarming illness. Like a new cottage industry, this new breed of medical monitors is posing serious challenges to conventional medical wisdom.

Tomorrow (Friday, January 15), the Canadian Red Cross, government officials and leading hemophili... more Tomorrow (Friday, January 15), the Canadian Red Cross, government officials and leading hemophilia specialists will meet in Ottawa to discuss a recently licensed, highly purified blood product that — if approved for distribution — could revolutionize the treatment of hemophilia. Moreover, growing evidence indicates that administering this product, or other existing high purity preparations, may prevent most HIV-positive hemophiliacs from ever developing AIDS. During the past year, major hemophilia researchers and groups in the U.S. and Europe have issued calls recommending that HIV-positive hemophiliacs be switched over to these new types of ultra-pure products. But their counterparts in Canada are only now beginning to talk with the government about introducing them, a delay that some observers see as another tragic example of the kind of bureaucratic-bungling that led to hundreds of Canadians becoming HIV-positive from contaminated transfusions in 1985.

Four months ago, Michael Steeler was a very sick man. He and his doctor both thought the end was ... more Four months ago, Michael Steeler was a very sick man. He and his doctor both thought the end was near. "I had bargained on it," Steeler tells me. "I had geared my finances and everything else to dying within the year.'" Before his AIDS diagnosis in 1990, Steeler had led a distinguished career as a banker, ship broker and publisher of trade magazines. After years of trying almost every experimental treatment that came along, he was losing weight last and his body was overtaken by chronic diarrhea. Then, in an eerie scenario now being re-played throughout North America and Europe, Steeler began taking one of the newly available pharmaceutical compounds recently licensed to fight HIV. His symptoms quickly disappeared and he began gaining weight, yet another tentative success story in what may prove to be the most dramatic treatment advance so far in this public health calamity. Just when it was beginning to look like the struggle to come up with a useful AIDS tr...

A new AIDS patient advocacy group that's not the least bit interested in those much-lauded co... more A new AIDS patient advocacy group that's not the least bit interested in those much-lauded combination therapies has sprouted up in the city. The most recently formed chapter of an international "AIDS dissident" organization called HEAL (Health AIDS Education Liaison), is encouraging people with HIV to question not only the safety and effectiveness of the drug "cocktails,"' but also whether the virus is really what's making them sick. Having spent a decade covering scientific controversies surrounding AIDS, I find it refreshing to see new voices enter this critical debate over causes and treatments. But the group's rehashing of old, tired arguments about how AIDS itself isn't sexually transmitted but simply the result of too much drug use of one sort or another — coupled with more recent quibbling over the existence of HIV itself — has me wondering how much constructive dialogue this new arrival will really foster.

Africa has always been a continent of mystery for North Americans. In a more innocent time, it wa... more Africa has always been a continent of mystery for North Americans. In a more innocent time, it was Tarzan. Lately, it's been war and famine. But in the near future, the panic over a seemingly overwhelming menace — AIDS — will overshadow those other images. As the syndrome recedes as a source of public concern in Canada and the United States, it's becoming the focus of more and more news about Africa. It was the subject of the first meeting of the UN Security Council not concerned with war and peace. Disease is now the main security issue in Africa. Later this year, the traveling media medical road show heads to Durban, South Africa, for the once-every-two-years international conference on AIDS. No doubt there will be more nightmare statistics about the numbers of people infected with the ticking time bomb of HIV, and the need to send in AIDS drugs ASAP. But these scribes may find there are things happening in Africa that don't fit into the AIDS-is-rampant. give-us-AZT-qu...

Local AIDS rebels are positively rejoicing following last Sunday's appearance by Nobel laurea... more Local AIDS rebels are positively rejoicing following last Sunday's appearance by Nobel laureate Kary Mullis, whose animated lecture critiquing the HIV theory of AIDS drew coverage in all three newspapers. Indeed, I was enjoying the spectacle of headlines like Danger In HIV Theory myself, given that I've authored articles bearing similar banners tor nearly a decade. Alas, HEAL (an international coalition of AIDS dissidents), the group that invited Mullis, while obviously banking on the glitz of his Nobel, got the wrong man for the job.

It's a jungle out there in the scientific world, where the big story this week is the discove... more It's a jungle out there in the scientific world, where the big story this week is the discovery that every single HIV particle in the world today stems from a small population of West African chimps. The world's science reporters gobbled up this journalistic snack that fell off the tree at the annual conference on retroviruses and opportunistic infections in Chicago, hailing it as the latest breakthrough in AIDS research. But far away from the action in the Windy City, it was easy to find naysayers who met the latest AIDS discovery with raised eyebrows. Maybe instead of chimps passing HIV to humans, it was the other way around. And maybe it happened hundreds of years ago, not 40. And if HIV came from chimps, then why haven't our furry friends got sick from it?

In an old church used centuries ago as a haven for religious heretics fleeing persecution from or... more In an old church used centuries ago as a haven for religious heretics fleeing persecution from orthodox Protestants, about 150 people gather fora small three-day symposium on AIDS. As it turns out. the site has been aptly chosen, since this is no ordinary AIDS meeting. In contrast to the official annual AIDS conference taking place here in July. this is the first ever organized gathering of AIDS 'dissidents' — a group of scientists, doctors and researchers who have called into question one of the fundamental tenets on which current AIDS research is based, namely that the virus HIV is the primary cause of AIDS. But while they all share the view that more than HIV is involved, they tend to disagree — at times bitterly — on what the actual cause, or causes, of AIDS really is.

BMJ, 2002

Professor Davidoff is quite right to point out that great harm is often done by inappropriate tre... more Professor Davidoff is quite right to point out that great harm is often done by inappropriate treatments whose safety and efficacy were established as often by anecdotal evidence than by rigorous review. We are now learning, for instance, that the coxibs that selectively inhibit inducible prostaglandins also inhibit a physiologically important pathway. Parts of the COX-2 pathway are physiologic-especially for kidney and heart function-and therefore not only pathologic. This has led to ongoing changes in the guidelines for selective COX inhibitors. With respect to harm, some of the earlier hypoglycemic drugs may be similar to the triple-drug anti-HIV therapies now used in the developed world to treat AIDS. In fact, the harm from HIV treatment may turn out to be a much bigger tragedy than that from older hypoglycemic drugs, selective COX inhibitors, or for that matter, treatments like outpatient anti-arrhythmics and all the teratogens. AIDS physicians spend far too much of their time managing the often horrific side effects of the current anti-retroviral regimens, such as dislipidaemia, hypertension, lipodistrophy, heart attack, stroke, kidney failure, cytochrome P-450 interference/liver failure, fatigue, anaemia, depression, etc.

BMJ, 2002

"Objectives: To ascertain if syphilis screening reliably detects latent disease, including in the... more "Objectives: To ascertain if syphilis screening reliably detects latent disease, including in the HIV context, by comparing standard syphilis testing with newly-developed techniques, using either recombinant antigen based treponemal serology or direct detection by DNA amplification.

Methods: (1) 500 patients at a downtown Toronto HIV clinic were screened from 1988-1992 with both RPR and quantified treponemal tests, including MHA-Tp (TPHA). (2) Serum aliquots from a further 250 patients from the University of Toronto's AIDS Epi-Study were similarly tested in 1992. (3) 557 patients from another downtown HIV/STD clinic were screened in 2000 as above, and also monitored with the Trep-Chek, a more sensitive, FDA-approved, recombinant ag-based EIA test. (4) Recently, 183 patients from two dermatology clinics in Budapest were tested for T. pallidum DNA with a nested PCR.

Results: (1) None of 500 patients were RPR(+), while 60/500 were TPHA (+), 11 of whom had no syphilis history. Six with a syphilis history were TPHA (-) with CD4 < 80/ul. (2) Of 125/250 Epi-Study patients with HIV, 24 had dropping treponemal titres during B-cell polyclonal activation, while only one HIV(-) case lost treponemal antibody selectively in this way. (3) Of 557 clinic patients, none were RPR(+), while 27 had evidence of syphilis by Trep-Chek, 24 of whom were WB (+) or equivocal. Nine were TPHA(+). Only 4/27 had ever been followed up. (4) 13/183 of the Budapest group were syphilis PCR(+), while only four had ever been treated. These four were the only TPHA (+) persons in the group.

Conclusions: Diagnostically, early acute syphilis is one thing and latent syphilis is quite another. RPR(+) findings were extremely rare among these nearly 1500 high-risk patients. Screening for syphilis with anti-lipoidal tests, based on a 1906 concept, is inappropriate. The persistence of treponemal antibody may indicate ongoing syphilis infection despite therapy, and such patients may need re-treatment and follow-up using gene amplification. Some patients with latent syphilis seem to have little or no treponemal antibody. It is therefore unclear to what extent undetected latent syphilis overlaps with HIV, and HIV/AIDS."

Novel PCR screening on whole blood has found T. pallidum DNA in erythrocytes of young gay men in ... more Novel PCR screening on whole blood has found T. pallidum DNA in erythrocytes of young gay men in Budapest who are repeatedly negative in all other standard syphilis tests, including treponemal antibody screening (TPHA). This follows on historical evidence suggesting syphilis has been under-diagnosed ever since screening with non-specific anti-lipoidal antigens began in 1906.

The first half of the 20th century saw the development of complement fixation and precipitation/flocculation assays, which were often used together to increase sensitivity and specificity, because many cases proved difficult. Syphilis sequelae often occurred despite lifelong negative anti-lipoidal serology.

The arrival of treponemal tests (TPI in 1949) further increased the sensitivity, and also excluded many false positives, although this class of test lacked sensitivity in primary syphilis. Vienna's teaching hospitals have also confirmed over many years that the TPHA finds nearly twice as many undetected cases as the VDRL. The avidity/affinity index as a surrogate for IgM antibody (Boltzmann Institute for Serodiagnosis, Vienna) found many active cases with no VDRL reactions. Despite these refinements, Ontario's Public Health Laboratory has documented the selective loss of treponemal antibody among HIV antibody(+) gay men, making it difficult - if not impossible - to assess the prevalence of syphilis.

Since the early 1990s, recombinant antigens have provided even greater sensitivity, confirmed again in Toronto by reactive immunoblots - both IgG and IgM - among men at high risk for syphilis. Yet these VDRL(-) and often TPHA(-) persons remain undiagnosed. Using the PCR in South Africa, the CDC's Multiplex assay has proven that the VDRL misses most primary syphilis when the DNA of other ulcerative STDs is present.

The increased sensitivity of newer tools will allow a better assessment of the true morbidity and mortality caused by syphilis, and suggests the gold standard for screening select populations will ultimately require gene amplification.

Objective: To assess whether the culture technique recently developed to isolate Borrelia burgdor... more Objective: To assess whether the culture technique recently developed to isolate Borrelia burgdorferi from patients with chronic lyme disease would improve the sensitivity of the diagnosis of syphilis, especially in HIV infected individuals at high risk for re-exposure to Treponema pallidum.

Methods: A review of the historical literature on cell-wall deficient forms of various spirochetes, especially T. pallidum, was undertaken in an attempt to trace parallels between the apparent insensitivity of serologic and gene amplification techniques used in lyme and what may be a similar insensitivity in syphilis diagnosis.

Results: The sensitivity of non-treponemal tests in the diagnosis of syphilis has historically been questioned. Many pre-1970 authors repeatedly stated that latent syphilis was most likely maintained in part by a spirochetal life cycle distinct from the easily demonstrated binary fission of T. pallidum. This research was abandoned in light of the efficacy of penicillin. The culture of B. burgdorferi from treated lyme patients, however, suggests the existence of sero-negative chronic lyme disease, and re-opens the old question of a life cycle for T. pallidum.

Conclusion: Syphilis and HIV may interact at levels that cannot be presently measured with standard syphilis serology, especially non-treponemal tests. If serology and direct detection by gene amplification are as insensitive for latent syphilis as they seem to be for late lyme, then it may be useful for syphilis researchers to attempt to parallel the B. burgdorferi culture technique with the venereal treponematoses (keeping in mind that T. pallidum loses virulence quickly in culture), in order to establish a new gold standard in this field as well.

Most successful human pathogens induce a spectrum of immune responses in their hosts, ranging fro... more Most successful human pathogens induce a spectrum of immune responses in their hosts, ranging from the protective DTH Th1 (cellular) type, to the predominantly humoural and sometimes ineffective Th2 type. This latter response, coupled with the other down-regulation of Th1 DTH, is associated with chronic active infections, especially viruses and other intracellular organisms, including HIV and T. pallidum.

Strong, seemingly protective, HIV-specific Th1 type responses - and even virus isolation - have been documented in many individuals who do not subsequently seroconvert. The global phylogenetics of HIV-1 suggest that the virus has been in human populations for centuries, perhaps millennia. It is therefore possible that most people exposed to HIV develop effective Th1 type responses and will not develop chronic active disease in the absence of co-factors intrinsic to their AIDS risk group.

Venereal treponematoses may be one of these co-factors. Infection with T. pallidum results in somewhat effective Th1 type responses in early syphilis, while immune deviation away from protective cellular immunity is the norm in late disease. Syphilis remains conspicuously absent as an opportunistic complication in AIDS, despite millions of untreated or inadequately treated cases worldwide prior to the current epidemic. Furthermore, many persons with HIV-associated B-cell polyclonal activation have been found to selectively switch off some or all clones making antibodies to T. pallidum, while antibodies to other infections remain, raising questions over the reliability of current syphilis diagnosis.

Supplemental diagnostic tools, such as PCR and DFA on tissue, may be needed to reliably exclude ongoing syphilis in persons with sexually-acquired HIV disease. The immunoregulation of repeated treponemal infections should be reassessed in an animal model.

NOW Magazine, Nov 16, 2000

The Globe and Mail, Mar 18, 2000

Medical researchers preparing for this summer's AIDS 2000 conference in Durban, South Africa are ... more Medical researchers preparing for this summer's AIDS 2000 conference in Durban, South Africa are under ever-increasing pressure, as the threat posed by the global pandemic inevitably inches its way into the agendas of the world's powerful institutions.

AIDS is no longer simply seen as a public-health problem, with the UN Security Council designating it a danger to international security, and Al Gore leading the fight with a $150 million initiative for vaccines and education campaigns. Meanwhile, activists continue to press pharmaceutical firms for better and cheaper drugs to save the millions of infected - and supposedly doomed - people around the globe.

The generally accepted culprit decimating the developing world, of course, is the deadly virus named HIV. The announcement of this virus as the cause of AIDS in 1984 swept aside other suggested candidates at the time, including other venereal diseases, esoteric viruses, even tanning salons.

HIV's quick rise to prominence in medical thinking - despite other, equally plausible explanations for this peculiar syndrome - is given a critical examination in this latest offering by former Montreal Gazette reporter Nicholas Regush. Now an online medical columnist for ABC News, Regush is one of the few journalists still willing to raise what has become a taboo question in AIDS circles: is HIV really the sole factor responsible for this seemingly new plague?

He notes that the question was first pursued with great vigour by University of California molecular biologist Peter Duesberg, a renowned expert on retroviruses (the family of viruses to which HIV belongs), and once a colleague of Dr. Robert Gallo, the U.S. researcher credited with the HIV thesis. Readers are treated to a faithful chronology of Duesberg's decade-long battle with medical orthodoxy, along with that of other HIV skeptics, including Greenwich Village physician Joe Sonnabend and a team of scientists from Perth, Australia.

But if not HIV, then what else could possible bring the downfall of the normally robust network of cells and chemicals that protect us from infections and cancers?

Duesberg's answer is simple, albeit somewhat extreme: he dismisses the notion of AIDS as a transmissible condition altogether, blaming the condition instead on recreational and pharmaceutical drugs, including the very medicines used to attack HIV, calling condoms and safe sex "irrelevant" to the spread of AIDS. This view of AIDS as non-infectious, shared by most "AIDS dissidents", has been held up by media and science alike as "the" alternative view, effectively obscuring those advocating other, possibly microbial, causes.

That's why it's refreshing to see Regush bring infectious agents back in the AIDS co-factor spotlight, in this case a member of the human herpes virus family known as HHV-6, which he says may play a role in not only AIDS, but a variety of other illnesses as well, from chronic fatigue to multiple sclerosis. He traces the careers of two obscure Wisconsin scientists on the hunt for HHV-6, illustrating his narrative with dramatic, at times disquieting, clinical case descriptions.

Regush acknowledges the missing gaps in assigning a role for HHV-6 in AIDS, especially the fact that 90% of the world's people have been exposed to this organism, making it unclear why it should play a central role in the syndrome. Many infections become reactivated in people with immune dysfunction, and HHV-6 is no different in this regard.

Interestingly, neither is HIV: Mounting evidence suggests people can resist the supposedly deadly virus with strong immune responses, at least in the absence of other contributing co-factors.

One of these co-factors - completely ignored by Regush - may well be inadequately treated syphilis which, unlike HHV-6 or other postulated AIDS co-factors, remains conspicuously absent as an opportunistic complication in AIDS. Odd, given the once deadly disease ran rampant and unchecked at epidemic levels in both the gay men in the West and heterosexuals in Africa at the onset of the AIDS era, while doctors placed their trust in cheap, outdated blood tests now acknowledged to be inadequate for detecting re-infection.

Experts acknowledge millions of untreated syphilis cases on the loose by the early 1980s, especially in Africa, yet the classical later presentations of the disease seem to have mysteriously vanished - among the very same populations that later went on to develop AIDS in large numbers.

In contrast to the widely distributed HHV-6, syphilis is concentrated mostly among gay men in the West, and there's an overwhelming statistical association between having had a past history of syphilis and subsequently turning HIV-positive.

The usual explanation for the correlation is that the open sores of early syphilis allow HIV to penetrate the body more easily. But some European STD experts suggest chronic syphilis infection - compounded by undetected re-exposures - may well hasten the development of AIDS itself.

While Regush sidesteps these fundamental questions about the possible hidden role of syphilis in AIDS - a glaring omission, in my mind - he still performs a valuable service by noting HIV is only one of several equally plausible candidates worthy of scrutiny by AIDS researchers. While he may have erred in his choice of alternative theory, his persistent refusal to accept easy answers to this complex health problem is one reporters descending en masse at the Durban conference would do well to take a cue from.

Colman Jones's 1996 radio documentary, Déjà Vu: AIDS in Historical Perspective, won a Science in Society Journalism Award from the Canadian Science Writers Association. Jones writes for Toronto's NOW Magazine.

The Globe and Mail, Aug 2, 1997

"Although AIDS has come to represent the most deadly disease ever spread through sex, syphilis wa... more "Although AIDS has come to represent the most deadly disease ever spread through sex, syphilis was once capable of evoking the exact same fear and dread, thanks to its ability to lie dormant, undetected, producing hideous and often life-threatening symptoms years later, just like its modern-day counterpart. When penicillin made its debut in the 1940s, the drug's miraculous ability to cure syphilis - at least in its early stages - promised to eradicate the infection, as the rate of reported new cases plummeted to an all-time low.

But the miracle didn't last: By the early 1960s, the incidence of syphilis had shot up again, especially among gay men in the throes of a then-blossoming sexual liberation. The resurgence of the disease had nothing to do with any shortcomings of the drug, however, but instead to the "ecological" aspects of disease - those in which host, parasite, and a range of social and environmental factors all interact to produce the breeding ground for an epidemic. In this case, the explosion of bathhouses and other venues for repeated anonymous sexual encounters provided the spiral-shaped syphilis bacteria a unique opportunity to spread through a vulnerable population, leading to record levels of the disease in gay men by the late 1970s.

It's this analysis of sexual ecology that Rotello, a gay New York journalist and long-time activist, brings to bear on the AIDS epidemic. It's a courageous and long overdue analysis that is sure to inflame the politically correct forces that have constructed AIDS as an "equal opportunity" disease. In his book, Rotello seeks to dismantle this and other cherished myths surrounding AIDS, myths he contends actually hinder the job of bringing this plague to an end. For example, by promoting condoms as the main AIDS prevention strategy, Rotello argues, educators are failing to address a host of other larger factors in gay culture that help propagate the epidemic, from sex clubs to other sexually transmitted diseases to substance abuse.

His treatise will win him few friends, especially among sexual libertarians, who will undoubtedly argue that Rotello is simply adopting the sex-negative morality that gay men have fought so long to overturn, and thereby feeding into the hands of the religious right. But the book is far more than just a simple backlash against sexual excess: As a long time gay activist, Rotello displays a unique understanding of the forces in society that led to the development of modern gay culture. In fact, his main desire is to recreate what he calls a "sustainable gay culture", in which gay men are both sexual and healthy. This will only come about, he argues, if the community squarely faces its own role in providing the fertile soil for the epidemic to take root.

Having spent years researching AIDS from a historical perspective, I found this latest entry in the field both inspiring and at the same time incredibly frustrating: inspiring for its thoughtful overview of the origins of AIDS and its implications for the gay community; frustrating for its pronounced blind spots in the area of science, especially immunology. While Rotello correctly points out that neither AIDS nor HIV are strictly new, he still slavishly adheres to the mainstream assumption that nothing else besides HIV matters, scientifically speaking. In doing so, he sweeps aside huge unanswered questions about possible microbial co-factors, questions that have profound implications for future research - a surprising omission, given his exhaustive review of the various behavioural and sociological factors contributing to the epidemic.

For example, while Rotello argues convincingly that the virus has been present in human populations for centuries, he clings to the commonly-accepted idea that it hid away in small pockets before spreading insidiously across the globe, wreaking havoc along its path. In doing so, he ignores the considerable body of evidence suggesting billions of people may have always carried the virus in a latent, harmless state, without ever falling ill, nor even making the tell-tale antibodies associated with a "positive" HIV test. Indeed, researchers are finding more and more people who can fight the virus off with the same strong cell-based immune response known to provide protective immunity against a variety of viral and bacterial infections.

This finding of widespread "seronegative" exposure and immunity to HIV - which may well constitute the norm - raises fundamental questions about whether the virus is sufficient, in and of itself, to bring about the syndrome, or whether other agents (which may vary between the different risk groups) are needed to set the AIDS process into motion. In fact, it's not clear whether the subsequent immune chaos following activation is caused by HIV itself, or the factor (or factors) that set it off.

In the sexually acquired form of AIDS, one of these factors may be syphilis, ironically enough, a disease to which hundreds of thousands of gay men became repeatedly exposed throughout the 1970s and early 1980s. Rotello notes this frightening statistic, but seems unaware of the major questions being raised over the reliability of the existing methods for diagnosing re-exposure to syphilis. Also unclear is to what extent such syphilitic re-infection itself devastates the immune system (and may always have), perhaps waking up an otherwise inactive HIV in the process.

These questions, of course, are absent from almost all AIDS writings, which reflect a "new virus-new disease" paradigm. Still, it's refreshing to see Rotello point out AIDS is actually a centuries-old syndrome brought into focus by changes in social mores and improved diagnostic tools. He has made an important contribution in setting the current prevention strategies in a broader context and reminding his peers of the dangers of focusing solely on medical solutions while ignoring behavioural aspects. The question now is whether anyone will heed his warning call.

Colman Jones' 1996 radio documentary, Déja Vu: AIDS in Historical Perspective, won a Science in Society Journalism Award from the Canadian Science Writers Association. Jones writes for Toronto's NOW Magazine."

"A mysterious epidemic, hitherto unknown, which had struck terror into all hearts by the rapidity... more "A mysterious epidemic, hitherto unknown, which had struck terror into all hearts by the rapidity of its spread, the ravages it made, and the apparent helplessness of the physicians to cure it." A quote about AIDS? No. It's about the appearance of syphilis in the early sixteenth century. Writer Colman Jones finds the two diseases share issues, from science and public health to civil liberties and sexuality.

This two-part radio program places the current responses to AIDS, from both socio-cultural and medical standpoints, in historical perspective. Using interviews with historians and scientists, archival public health films, radio broadcasts, and readings from classical texts, the series traces the history of venereal diseases from the 1600s to the present, and shows how many of today's concerns have clear precedents in past epidemics. The programs underline how a whole series of biological, psychological and social factors shape the public's perception of disease, and society's response to it. The strengths and limits of past approaches to detecting sexually transmitted diseases are explored, in order to shed light on approaches that could be used to control AIDS today.

Déja Vu: AIDS in Historical Perspective is divided into two 1-hour episodes:

Part 1, "The Social Construction of Disease", compares the public reaction to AIDS with past reactions to other sexually transmitted diseases, especially syphilis. We hear about the medical approaches - then and now - which used toxic and ineffective drugs, about blaming the victims, about contact tracing and laws designed to regulate sexual conduct, and about the education campaigns - then and now - which were reluctant to focus on the real risk groups, or to give straightforward advice on self-protection, for fear of offending public taste.

Part 2, "New Questions About an Old Killer", explores the wealth of medical and scientific evidence from the history of sexually transmitted diseases, evidence that sheds considerable light on AIDS today. It suggests we may be living through an extraordinary episode of déja vu, not only as far as the social, cultural, and political responses to AIDS are concerned, but in terms of the actual medical syndrome itself: the program examines evidence that AIDS, as we understand it today, has been around for a long time, and examines the growing questions being raised over the possible hidden role of syphilis in sexually-acquired AIDS.

Over a dozen experts in the fields of infectious diseases, immunology, epidemiology, and medical history were interviewed during the preparation of these programs, including:

-Edward Shorter, Professor of the History of Medicine at the University of Toronto
-Jay Cassel, Professor of History at Toronto's York University, author of "The Secret Plague: VD in Canada 1838-1939"
-Robert Root-Bernstein, Associate Professor of Physiology at Michigan State University, author of "Rethinking AIDS: The Tragic Cost of Premature Consensus"
-Allan Brandt, Kass Professor of the History of Medicine and Medical Ethics at Harvard University, author of "No Magic Bullet", a study of the history of sexually transmitted diseases in the United States in the 20th century
-Daniel Musher, Head of Infectious Diseases at the Baylor College of Medicine and the Veterans Affairs Medical Centre in Houston, Texas
-Jadwiga Podwiñska, Associate Professor at the Institute of Immunology and Experimental Therapy of the Polish Academy of Sciences in Wroclaw, Poland
-István Horváth, Doctor of Science, Department Head for syphilis serology, National Center for Dermatology and Venereology, Budapest, Hungary
-Bruno Schmidt, Laboratory Chief at the Ludwig Boltzmann Institute for Dermato-venerological Sero-diagnosis in Vienna, Austria
-Justin Radolf, Director, Center for Microbial Pathogenesis, and Professor of Microbiology at the University of Connecticut Health Center
-Konstantin Borisenko, General Director of Moscow's Association Against Sexually Transmitted Diseases (SANAM), and a top Russian syphilis expert
-Robert Rolfs, former medical epidemiologist with the U.S. Centers for Disease Control and Prevention (CDCP), now Director of the Bureau of Surveillance and Analysis, Utah Department of Health
-Nikolai Chaika, Director of Information for the Ukraine's Pasteur Institute in St. Petersburg
-Nils Strandber Pedersen, Director of the Statens Serum Institute in Copenhagen, covering all syphilis diagnostic services in Denmark.
-Barbara Romanowski, Director of Sexually Transmitted Disease Services for the province of Alberta, and also Professor of Infectious Disease at the University of Alberta
-Stephen Caiazza, (now deceased) New York physician who treated his AIDS patients with penicillin, suspecting they were dying from syphilis.
-John Scythes, independent investigator and owner of Glad Day Bookshop in Toronto.

For more information, visit the extensive web site created to accompany the program, an archive of which is available at http://web.archive.org/web/20030228013741/http://cbc.ca/ideas/features/Aids/index.html

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