Horizontal Transmission ? 5 March 2004
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James E Parker,
Retired Paediatrician
289 Mc Calllum Rd Abbotsford B.C Canada V2S 8A1

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Re: Horizontal Transmission ?

'The politics of AIDS in South Africa: beyond the controversies' by Fassin and Schneider (BMJ March 1 2003) has provided a most important and valuable forum for discussion on HIV/AIDS. In stimulating discussion it poses as many questions as it answers. How does one prove the infectivity of budding virus particles on electron microscopy for instance ?. It's a bit like counting angels on the head of a pin !.

HIV as an infectious agent is questioned by the Perth Group. Indeed doubt has been expressed concerning the very existence of exogenous retroviruses. And yet we have been this route before. Thirty years ago similar doubt was entertained that the retrovirus FeLv (cat leukaemia virus) was horizontally transmitted in field situations (Schneider R; Status report: feline leukemia (C) J Am Vet Assoc 164 1070, 1974 ). Two years later Hardy and associates (Nature 263 326 1976 ), in a test and removal program, demonstrated that removal of infected cats reduced the subsequent incidence of disease in multiple cat households. This did not occur in control households where infected cats were not removed.

While a 'test and removal' program in HIV/AIDS has been deemd unethical, it has been carried out in one country (Cuba) with fairly dramatic results. (Schepper-Hughes N , Lancet: 1993 342 965-067). It is of interest that the successful and impressive 'ABC -program' of HIV prevention in Uganda according to it's president had it's genesis in Cuban advice. Whatever the mode (and opinion of the Perth group ), it does appear that AIDS is transmissable. The dangers of 'denialism' of this fact cannot be over emphasised.

James E Parker

Competing interests: None declared