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The X Factor

AIDS researchers have struggled to find a cure for the disease for thirty years. But what if they have it all wrong?

JOHN SCYTHES is a 61-year-old with grey bushy hair, pursed lips and a tendency to punctuate his quickly issued sentences with bursts of cackling laughter. He’s never spent a day in medical school, but his knowledge of human illness seems encyclopedic. This is odd given that he earns his living as the owner of Toronto’s Glad Day Bookshop, a small, dusty gay and lesbian bookstore stacked with novels, calendars, posters and steamy Tom of Finland erotica.

A remarkable autodidact, Scythes co-authors papers for medical journals, is on a first-name basis with some of the world’s leading disease researchers, and has travelled the world to sit in their offices, attend and present papers at their conferences. He’s even given lectures before doctors at Johns Hopkins Bloomberg School of Public Health, at the US Centers for Disease Control and Prevention, and at university teaching hospitals in Europe. “I have stood in front of hundreds of doctors a couple of times in my lifetime and you don’t get there by accident,” he once boasted to me.

All of this is in aid of a single-minded purpose: to prove a radically alternative theory for the cause of Acquired Immunodeficiency Syndrome (AIDS). Scythes agrees that the Human Immunodeficiency Virus (HIV) exists and is found in most people who develop AIDS. He’s just not persuaded this particular retrovirus is responsible for destroying the immune system, and causing the infected to become progressively more vulnerable to viruses, parasites and bacteria before dying.

The sorts of questions Scythes has raised about the ongoing failure to find a cure or vaccine for AIDS are met with fierce and often emotional dissension in medical circles. As AIDS scientist John Moore defined it in 1996, HIV “denialism” implies that “tens of thousands of health care professionals and research scientists are either too stupid to realize that HIV is not the cause of AIDS, or too venal to do anything about it for fear of losing income from the government or drug companies.” The debate continues to be waged even as AIDS has fallen off the radar in North America. In Canada, about fifty-eight thousand people live with HIV, with up to 4,500 new infections every year. Since the epidemic exploded in the early 1980s, there have been nearly twenty-one thousand AIDS diagnoses in Canada, with 15,556 deaths in total (averaging about 580 deaths a year). Compare this with the thirty-seven thousand fatalities caused by smoking in Canada every year and it’s not hard to see why—unless you’re a gay or bisexual guy having lots of unprotected sex—HIV/AIDS might not crowd your worries.

Globally speaking, however, the numbers are more sobering. The World Health Organization (WHO) estimates that thirty-three million people live with HIV/AIDS, and that an estimated two million die a year from the syndrome, with more than 25 million having succumbed since 1981. It’s also a disease that attracts huge sums of money: every year up to $24 billion US is spent on AIDS prevention and treatment around the world. Over $3,000 US is spent on AIDS research for every death caused by the syndrome, compared to only $37 US per death from cardiovascular disease.

Despite these vast expenses, HIV research has made little progress. During an interview with a CBC producer in 2004, French virologist Luc Montagnier, who last year won the Nobel Prize for his role in the discovery of HIV, said that “we know the virus, we know everything very well of the virus—we know the chemical science of the disease, but we still don’t know how the virus causes the disease.”

The latest setback was announced in October 2007 when two field tests for an HIV vaccine, considered the most promising contender in two decades, failed spectacularly. Called STEP and Phambili, and overseen by the pharmaceutical giant Merck & Co., the studies were halted not only because they didn’t work but also because they actually increased people’s chances of getting infected with HIV. “This is on the same level of catastrophe as the Challenger [shuttle] disaster,” Dr. Robert Gallo, head of the Institute of Human Virology in Baltimore, and the AIDS scientist most responsible for promoting the HIV link, told the Washington Post last March. Other AIDS scientists were equally dumbfounded. “We simply do not know at the present time how to design a vaccine that will be effective against HIV,” admitted Ronald C. Desrosiers, a molecular geneticist at Harvard University.

Yet this “disaster” is one of more than two dozen attempted and ongoing vaccine trials that have so far come up short. A situation that, for many HIV skeptics, seems to strengthen the contention that there’s more to AIDS than just HIV. As Scythes observes: “If HIV were panning out the way you and I think it should, these vaccines should be working a little bit.”

Scythes instead believes that what medical science is probably overlooking in the AIDS equation—the X factor, in other words—is an ancient and nasty bug often referred to as “The Great Masquerader.” In a word, syphilis. To make his case, Scythes has spent years building a vast library on syphilis literature and learning more about this almost-forgotten disease than just about anyone alive. “He is the most knowledgeable person I have ever known on the history of syphilis and its treatment,” says Dr. Lynn Margulis, one of America’s leading biologists and a member of the National Academy of Sciences.

Unsurprisingly, the suggestion that HIV is not the main or sole cause of AIDS is deeply unpopular within the medical science establishment. Critics of HIV are derided as “the lunatic fringe,” irresponsible and dangerous denialists and conspiracy theorists who embrace “pseudoscience.” Even Luc Montagnier, who has raised eyebrows by positing AIDS as a complex disease helped by a panoply of unknown infectious factors, doesn’t buy it. “I am not on the side of a few people saying AIDS is not caused by HIV,” he has said, “because there is no doubt that HIV is the main cause. HIV is causing AIDS and without HIV we don’t see an AIDS epidemic.”

Indeed, there are perfectly valid reasons why dismissing HIV could whip up strong emotions: people may get the idea they are free to indulge in risky sexual behavior or ignore beneficial treatments. In other words, HIV denialism may endanger lives by creating doubt about well-established medical thought (as happened in 2006 when Andre Parenzee, an HIV-positive Australian man who was convicted of endangering human life by having unprotected sex with several women, appealed his conviction by claiming that HIV’s existence had not been proven.)

Yet Scythes believes safe sex is necessary to stop the spread of AIDS and agrees that the disease is passed along by sexual transmission. He just thinks that what’s being caught is syphilis. “The [HIV] test result is a very important immunological marker,” he remarks, arguing that testing positive for HIV likely suggests that your immune system is impaired. But he adds: “I don’t know what it means 100 percent of the time, but I don’t think it represents a new retrovirus.”

What frustrates Scythes is that the Cold War that’s characterized the AIDS debate has not only ruined the careers of HIV-skeptical scientists but also had the effect of billions of dollars being spent studying one retrovirus—with decidedly mixed results—and very little on any other ideas. “The problem with science, you know, is that it’s like a religion,” Montagnier explained in 2004. “There are fashions or beliefs which are considered dogmas like in a religion. And you have to believe in it. And if you don’t, you are not executed, you are not burnt now but you are put away out of the field. You don’t have money, it is very difficult to exist or persist. So you have to follow the fashion.”
For Scythes, the story of how the medical community’s belief in HIV became a dogma overshadows the controversy of how HIV was discovered, and the failed search for a cure. It’s a story of big egos, big careers, big prizes, big money, Big Pharma, rampant medical misconduct, botched tests, corruption, falsehoods and treatments that never pan out quite as promised.

TO BEGIN, AIDS IS NOT a new disease, at least according to Michigan State University physiologist Dr. Robert Root-Bernstein, who has found cases of AIDS going back to at least the 1870s. But in its latest reincarnation, AIDS arose in 1981 when Kaposi’s Sarcoma, a rare form of a relatively benign cancer, was diagnosed in at least eight young gay men in New York.  At the same time, in both California and New York, cases of a lung infection called Pneumocystis carinii pneumonia (PCP) began to show up. What was found in all of these sick men was that their T-cell counts—the cells that fight infections in the body—were low and dropping. And as they fell, cancers, pneumonias, diarrhea and other infections began to kill them.

With this mysterious “gay plague” spreading and deaths mounting, panic gripped both the general population and the medical science field. What was causing the collapse of the victims’ immune systems? How infectious was it, and who would be next? By 1983, a group of scientists led by Montagnier at the Institut Pasteur, a research laboratory based in Paris, France, had found a common retrovirus in a group of gay men afflicted by this so-called gay plague. This retrovirus—which is a type of hard-to-find virus often connected to cancer—was labeled LAV (Lymphadenopathy Associated Virus).

What happened next has not only been described as one of the greatest scandals in the annals of medicine, but likely led to a rushed judgment over the role of HIV. In 1983, the Institut Pasteur sent a sample of LAV to the National Cancer Institute, part of the US National Institutes of Health (NIH), in Bethesda, Maryland, whose lab chief at the time was Dr. Robert Gallo. Gallo, in the eyes of HIV critics, is the Dick Cheney of medical science, a vulpine, ethically blinkered glory-hound. Despite winning many prestigious awards and being a member of the National Academy of Sciences, Gallo’s track record before AIDS came along was heavily stained.

For example, in 1975, Gallo announced he’d found a retrovirus associated with leukemia. Yet he’s reported to have contaminated samples of his “find” before sending them to other labs to be replicated. In the end, his new discovery was deemed bogus. Later, when another scientist in his lab thought she’d found a molecule important in the immune system—what were later identified as T-cells—he’s accused of ignoring her work and firing her. And then, when her discovery was found to be real, of taking credit for it. When another of his staff found a cancer retrovirus that was eventually labeled HTLV-1 in the late 1970s, Gallo stole credit again.

When AIDS arrived, Gallo was just another ambitious scientist hungering for the glory of finding the cause and cure. But then Montagnier made the blunder of sending the sample of LAV to Gallo’s lab to confirm its connection to the new disease. Using the LAV sample, Gallo’s staff managed to cultivate and grow it. Then, in April of 1984, months after Montagnier sent Gallo the sample, the US Secretary of Health and Human Services, Margaret Heckler, announced at a press conference that Gallo had discovered the “probable cause” of AIDS—a retrovirus he called HTLV-III (which was later renamed HIV). “Today we add another miracle to the honour roll of American science and medicine,” she boasted. Days after this announcement, four papers co-authored by Gallo appeared in the journal Science, laying out why he thought HTLV-III might be the cause of AIDS.

These papers state the French LAV and Gallo’s HTLV-III were probably not the same virus. But the original draft of the lead 1984 Science article has since come to light. Written by one of Gallo’s underlings, the Czech doctor Mikulas Popovic, the draft clearly says they used the French discovery, LAV, “which is described here as HTLV-III.” But Gallo crossed this line out along with any other references to using the LAV sample. Popovic also wrote that “despite intensive research efforts, the causative agent of AIDS has not yet been identified.” Gallo crossed this line out, too. At no point in his paper did Popovic attempt to assert that any one virus caused AIDS. Gallo heavily edited the paper to suggest the opposite—that there was a single culprit, and they had found it: HTLV-III.

Gallo’s wrongdoings would soon be exposed. But not before his lab and the Institut Pasteur used the LAV sample to develop an AIDS test which searches for HIV antibodies. A war soon broke out between the US and French governments over credit for the test’s discovery, patent and royalties. This dispute wasn’t resolved until 1987 when both governments agreed that the French and American scientists would share in the spoils and credit for the HIV test. By 1992, $50 million US had already been earned in royalties from the blood tests alone (Gallo and Montagnier were personally pocketing $100,000 a year).

But the issue of who found HIV refused to die. In 1989, a Chicago Tribune investigation dug up suppressed evidence that the LAV sample which Monagnier sent Gallo in 1983 was the same virus that Gallo later called HTLV-III. A genetic test proved this to be the case. This revelation triggered two investigations: one launched by the NIH, later taken over by the Office of Research Integrity (ORI); the other by the US Congress’ Subcommittee on Oversight and Investigations, chaired by Democratic Congressman John Dingell.

These two investigations uncovered evidence that proved Gallo had pinched the Institut Pasteur’s LAV virus and that the French scientists were first to invent the HIV blood test. The investigations also found that Gallo covered up his theft by claiming he had many other samples of the virus beyond the one the French had sent him—a claim he couldn’t substantiate. “The consequences for HIV research were severely damaging,” said the Dingell report in regards to the actions of Gallo’s lab, “leading, in part, to a corpus of scientific papers polluted with systematic exaggerations and outright falsehoods of unprecedented proportions.”

The 1992 ORI report is condemnatory. It says that “Dr. Gallo committed scientific misconduct” due to his misleading Science articles, which stated LAV and HTLV-III were different viruses when, in fact, they were the same. The lead paper, written by Popovic and edited by Gallo, “was replete with at least twenty-two incorrect statements,” said the ORI report, of which “at least eleven of which were falsifications amounting to serious deviations from accepted standards for conducting and reporting research.” The ORI also found that Gallo “placed inappropriate pressure upon [his] scientists to publish frequent and important articles, pressure that Dr. Gallo knew or should have known compromised the accuracy and precision of the work performed in the lab and reported in papers.”

Yet despite the Dingell and ORI reports Gallo’s career trajectory remained unaltered, his funding intact, and his claim as the co-discover of HIV unchallenged to this day. In fact, the ORI, after “scientific misconduct” was redefined, withdrew the charge against Gallo in 1993.

What does one make of this? Does it really matter, given that the French scientists at the Institut Pasteur also believe HIV is the cause of AIDS? After all, the medical science community has since produced thousands of research papers linking HIV infection to AIDS. Consider this, however: Gallo’s actions immediately put a halt to all other lines of inquiry into a cause for the disease. Moreover, as many HIV skeptics will tell you, the Institut Pasteur scientists had a motive for claiming HIV as the cause—they stood to garner fame and millions of dollars from the blood test patent. In fact, AIDS quickly became a cash cow for everyone involved—a multibillion-dollar boondoggle for drug companies and researchers.

And of course Montagnier, the man most responsible for finding HIV, has long been uncomfortable with the belief that HIV is the sole cause of AIDS. In 1990, he stunned his colleagues at the Sixth International AIDS Conference in San Francisco when he suggested there was likely a co-factor also involved, a bacterial agent known as mycoplasma. At another point, he told one reporter “there are too many shortcomings in the theory that HIV causes AIDS.” He has called it a “peaceful virus” that only becomes a killer when linked with another bug.

Then there was the fact that three years after Gallo announced he’d found the cause of AIDS, a scientist with unimpeachable credentials stepped forward and stomped all over the HIV theory. Unlike Gallo, whose career is dogged by controversy, Dr. Peter Duesberg was a highly respected star in the field of molecular and cell biology at the University of California, Berkeley. German-born, his accomplishments include demonstrating that the influenza virus has a segmented genome, isolating the first cancer gene through his work on retroviruses, and mapping the genetic structure of these viruses. He was elected to the National Academy of Sciences in 1986 at age 50—the youngest man ever to receive the honour—and was the recipient of a seven-year Outstanding Investigator Grant from the National Institutes of Health, one of only twenty-three scientists in America deemed worthy of the award, and had even been named California’s “Scientist of the Year.” Gallo once said that Duesberg “knows more about retroviruses than any man alive.”

But in 1987, after spending nine months writing it, Duesberg published a paper in the journal Cancer Research in which he argued that retroviruses don’t cause cancer and HIV cannot cause AIDS. Basically, Duesberg wondered how a latent, inactive retrovirus could kill billions of cells when it infected only a few? How could it cause a deadly disease when it could barely be isolated in the last stages of the disease? And why wasn’t there an animal model for HIV—meaning when HIV was injected into test animals, they didn’t seem to get AIDS? He found that HIV violated too many basic rules of virology—including the fact that there had been four thousand cases of AIDS where no trace of HIV or its antibodies have been found.

Duesberg didn’t dispute the existence of HIV or that it was present in more than 90 per cent of patients who developed AIDS—he just didn’t believe it wrecked immune systems so completely. “It is concluded that AIDS virus is not sufficient to cause AIDS and that there is no evidence, besides its presence in a latent form, that it is necessary for AIDS,” he wrote.

The scientific community attacked Duesberg intensely for such dissent. One critique of his work is called “Malignant Narcissism in the Cancer Lab: Duesberg’s AIDS Denialism Is Driven by Ego Inflamed by Professional Failures.” To this day, only a minority of scientists embrace his ideas, while the vast majority of the medical research community cites evidence and analysis disproving his findings about the potency of HIV.
Duesberg’s career suffered: he lost all his grant money, was stripped of his graduate students, and his ideas have been pilloried and denounced.

Duesberg’s mistake may have been dissenting too late. The scientific community and pharmaceutical manufacturers had already fastened on to HIV as the cause, and with billions of dollars on the line, they were not about to change course.

Unfortunately, much of what was initially claimed about HIV and AIDS has not materialized in North America. For instance, AIDS failed to become an epidemic in the heterosexual community and has remained an affliction primarily of the gay or bisexual population. And while Gallo once said HIV “kills like a truck,” some people can live very long, even healthy lives after testing positive for HIV (basketball star Magic Johnson remains hale and hearty since being diagnosed with HIV eighteen years ago). And the search for a cure has floundered, while drug treatments have proved controversial.

In 1987, for example, AZT was rushed onto the market as the first drug treatment of AIDS. AZT had been developed in 1964 by the British pharmaceutical giant, Wellcome PLC, as a chemotherapy drug. But it was shelved after it was discovered it was so toxic it killed too many healthy cells. When it was found to obliterate HIV in a test tube, AZT was resuscitated and quickly approved by the US Food and Drug Administration on the basis of a tampered study and rushed to market. In 1995, after it became GlaxoWellcome, the company was earning $317 million US a year from AZT sales. For those AIDS patients who could tolerate its toxicity, AZT seemed to help. But it wasn’t until 1993 that a full-scale (and now controversial) study on the efficacy of AZT was released. Called the Concorde study, it showed that AZT had no more beneficial effects than people who didn’t take the drug at all. (The drug can delay onslaught of full-blown AIDS but it does not increase survival.)

In 1996, there appeared to be another breakthrough when protease inhibitors were introduced. This cocktail of drugs was designed to create a wall that protected the patient’s immune system from HIV. And again it seemed to work—patients appeared to improve and live longer lives. But within a few years, protease inhibitors were showing problems—disfiguring side effects, such as a horrible redistribution of body fat, mysterious heart attacks, liver and kidney damage. And AIDS was not being stopped. By 2000, because of the toxicity of the drugs, the US government dropped its recommendation that protease inhibitors should be prescribed to patients with HIV who were otherwise healthy.

One drug used in the cocktail is nevirapine, developed by the German drug company Boehringer Ingelheim. Twice, in 1996 and 1998, the drug company tried to get it approved in Canada where it was initially rejected for being too toxic. In the States, however, the FDA gave approval for nevirapine as long as it was used with other drugs. A large trial for nevirapine was started in Uganda in 1997 where it was tested on 1,500 HIV-infected pregnant women. Two years later, Boehringer said the drug lowered the risk of HIV transmission in newborns.

But when Jonathan Fishbein, director of the National Institutes of Health (NIH) Office for Policy in Clinical Research Operations, began examining the Uganda study in 2003, he charged the study was seriously flawed by mistakes in record-keeping and procedure, and that its results were faked by the drug company. Fishbein’s superiors fired him. He then fought a successful campaign to get reinstated.

According to a 2006 study funded by the National Institute of Allergy and Infectious Diseases (NIAID), these drug treatments, while imperfect, have “provided 3 million years of extended life to Americans with AIDS since 1989.” NIAID Director Anthony S. Fauci, argues that “although the rate of new infections in this country remains unacceptably high, for many people, HIV infection is no longer the death sentence it once was.” John Scythes, however, has another take on this situation. “They have moved the goalposts three times since the mid-1980s,” he says, meaning that the T-cell count definition of what constitutes an AIDS patient has been expanded to include people in better health than the original patients. By doing so, he says, it’s no surprise people seem to be living longer.

Ultimately, whether you embrace the arguments put forward by HIV critics or reject them as dangerous and unfounded, the reality is that we are no closer to an AIDS cure and vaccine, despite the billions spent. “It was felt that the drug discovery against HIV would be sufficient to get rid of the disease,” Montagnier has said. “Now we know they won’t succeed.”

WHEN JOHN SCYTHES heard about HIV he had no reason to think it wasn’t the bug killing his friends. He remembers getting anxious too: after all, like many gay men, he’d had his fair share of unprotected sex. “People began to die who I had slept with,” he recalls. “I am just lucky to be alive.”
Born in Montreal to a middle class family that owned textile factories, Scythes got an undergraduate degree at the University of Toronto in the late 1960s, worked in his family’s factories, and then got his plumbing papers and became a contractor, renovating small buildings and homes. In 1991 he bought the Glad Day Bookshop, a popular gay and lesbian bookstore on the edge of the gay district in downtown Toronto. Along the way he developed a passionate interest in medical history.

Scythes came of age in the post-Stonewall riots era of gay liberation, when more homosexuals came out of the closet and were having sex more frequently and with more men. Gay bathhouses and pickup bars sprang up in cities like San Francisco, New York and Toronto. “So suddenly you had five to seven million Americans doing gay sex who wouldn’t have done it before,” says Scythes. “The gay guys, of which I am one, conducted an unwitting experiment with venereal disease, primarily syphilis.”

Venereal disease was soon very prevalent among gay men who had multiple partners. “People wore their diseases like badges,” recalls Scythes. All told, the annual rate of new syphilis infections were one hundred times the national average among gay men in the 1970s—which is why well over half of all syphilis cases reported in the States during that decade were among homosexuals. Scythes remembers taking friends to health clinics in Toronto to be treated for syphilis in the late 1970s and early 1980s.

Scythes grew critical of the HIV hypothesis for two reasons. One was Peter Duesberg’s opposition to the link and the other was the pioneering work of a New York physician, Stephen Caiazza, who theorized that syphilis was the real culprit. Scythes soon discovered that other medical experts were wondering about the role syphilis played with AIDS too, notably Bob Notenboom, the chief serologist with Ontario’s Ministry of Health, and Douglas MacFadden, director of the HIV Clinic at Toronto Hospital’s Western Division. They joined forces to take a closer look at this matter.

One question mystified them: after the emergence of AIDS in the 1980s, where had all of the syphilis cases in the gay population gone? Given the epidemic rates of syphilis among gay men, by then many of them should have been showing the late stages of the disease, including fatal consequences. Instead, the men dying of AIDS were not even testing positive for syphilis, despite the fact that many had histories of syphilis exposure. Given that when you get syphilis, you are rarely able to get rid of it, this finding made no sense. “That’s what drove our interest,” says Scythes. “A population saturated with syphilis, with—according to one study—a 90 percent epidemiological overlap with AIDS cases. That incredible overlap, and still no excess mortality, and no deaths from classic late syphilis? That’s impossible.”

So Scythes began reading any literature he could find on syphilis. And what he discovered reinforced his suspicions. Syphilis is a venereal disease caused by a corkscrew-shaped bacterium called Treponema pallidum (or T. pallidum). Once they enter someone, these spirochetes multiply at a steady rate and spread throughout the body within seventy-two hours. If left untreated, they can ultimately destroy the body’s tissue, damaging the heart, liver, nervous system, weakening bones, and can cause blindness, arthritis, tumors and even madness.

First recorded as a new disease in Italy in the fifteenth century when it was brought back to Europe by explorers who’d traveled to North America, syphilis was called “The Great Pox” when it reached epidemic proportions and spread throughout Europe and eventually to all corners of the world. In the 1800s, as much as 10 to 20 percent of the populations of some European countries were infected with syphilis.

If you are infected, syphilis may pass through three stages. In the first stage, a sore known as a chancre may appear and eventually disappear; during the second stage, symptoms include swelling of lymph nodes, rashes and skin lesions. Healthy people often go immediately into a stage of latency, where the disease appears to go into hiding. Finally, a small percentage of people lapse into the third or tertiary stage where the catastrophic damage to the body and organs manifest.

For centuries, syphilis resisted treatment. Then, in the 1940s, it was discovered that penicillin killed T. pallidum and often seemed to cure the disease. Ironically, penicillin pushed the study of syphilis into decline. By the 1960s, syphilis was no longer considered an important and sexy area of research or concern—at the very moment, ironically, that North America’s gay population was about to launch a whole new epidemic of the disease.

What did Scythes discover about syphilis? For starters, he found startling parallels to AIDS. In fact, many early syphilologists believed that in its latent stage, the disease disrupted and impaired the immune system. “Syphilis changed the immune system,” says Scythes. “It causes immune changes that allow opportunistic infections to occur. It doesn’t actually wipe it out ... You are not dying due to the direct effects of syphilis. In other words, the only way they could have died is they had their immune systems turned off.”

Thus, Scythes found evidence that many people with untreated syphilis would die of cancers, pneumonias and TB (a very common bacterial infection up until the 1960s)—in other words, many of the things from which people with AIDS expire. Two long-term studies on syphilitics (called Oslo and Tuskegee) found that early deaths were mostly due to complications from these diseases and not tissue-destroying manifestations of late syphilis.

Scythes also discovered it’s common for symptoms of syphilis to go undetected. This was especially true if you got infected, were treated and then got re-infected with T. pallidum. The second time around, the immune system may no longer produce antibodies or respond clinically. So not only would symptoms be invisible, you wouldn’t test positive for a new infection. “Syphilis is a disease that’s like an iceberg,” remarks Scythes. “Ninety per cent of it is underneath the surface.”

One reason syphilis goes undetected, and even seems to disappear, is because syphilis testing is problematic. The current test—as developed  by the German bacteriologist August Wassermann in 1906—only detects the absence or presence of non-specific antibodies. And given that these antibodies generally appear in the early stages of syphilis, or when the disease is active, someone infected with T. pallidum—especially in the latent or tertiary stages—will not necessarily be caught by this test. Nevertheless, despite its flaws, the Wassermann-type test remains the standard screening method in the US to this day.

Bob Notenboom saw the problems with this firsthand. When he began working for Ontario’s health ministry in 1980 as the chief of serology, testing blood samples for venereal disease, he was shocked to find that the levels of “active” syphilis in gay men in downtown Toronto were no higher than the general population when the Wasserman test was applied.

“Let me tell you, it started to worry me more and more,” he says, “because the question was, ‘Are we missing something? Is the test adequate?’” Notenboom kept these samples and a few years later re-tested them using a more up-to-date and sensitive test. This time the results came back very differently. “We found an instance of treponemal antibody that was at least five times higher than the general population,” recalls Notenboom. “Now, were those individuals adequately treated? Of course, we were not able to get that answer.”

Eventually Scythes came to believe that many of the gay men exposed to syphilis in the 1970s and 1980s saw a variety of outcomes. If they were diagnosed, they were treated. If they were re-infected, which often happened, the disease went undetected the second time around. In men who were never diagnosed at all, their syphilis went latent and carried on altering their immune systems. And if they developed what is called AIDS, by that stage of the game, the usual syphilis tests were not sensitive enough to pick up T. pallidum antibodies anyway, because they had gone underground.

“Basically syphilis goes silent in a population,” says Scythes. “And there is a word in the literature that describes this, in the old books. And it is called syphilization. That’s what it does if you catch it two or three times, you get syphilized. And that is the beginning of the process for people with sexually acquired AIDS.”

Given the inadequate testing and the ability of syphilis to hide itself, in the mid-1970s British venerologists suggested that from half to two-third of syphilis cases in the US were not being treated. A 1981 study by the US Center for Disease Control estimated there were 325,000 cases of undiagnosed and untreated syphilis, and that number could have reached closer to half a million. “What we are saying is that based on all of our work with better testing, the patients were slipping by—and always have,” says Scythes. “So that is what helped kill the gay men. Because we didn’t catch it. Because we couldn’t catch it.”

What makes Scythes confident about his theory is it appears that most if not all of the men who were originally diagnosed with the mysterious “gay plague” in the early 1980s had earlier been exposed to syphilis. This includes the Institut Pasteur patients, from whom the first LAV (later called HIV) samples were drawn, as well as the men in California dying of AIDS. “The first guys were all syphilitics, although they did not look like symptomatic syphilitics,” he says. Moreover, men who have had syphilis have a much higher rate of turning HIV-positive and developing AIDS. A study of five hundred gay men in Amsterdam showed that men who had unprotected sex with multiple partners were roughly twice as likely to be HIV-positive than those who had not. However, those who had caught syphilis were over twenty times as likely to be HIV-positive than those without a history of syphilis.

One other interesting thing about syphilis: you can’t make a vaccine for it. And so far, HIV has resisted a vaccine. Scythes thinks this is more than a coincidence. In fact, Scythes points out that the inability of the medical research community to develop a vaccine for HIV/AIDS is further evidence they have it mostly wrong. “Vaccines don’t always work in all diseases, but they always work somewhat,” he notes. “There are diseases we don’t have vaccines against, I know that. But we don’t have zero efficacy. I will say HIV does not cause AIDS simply because in any way it is presented to the immune system, they cannot make any efficacy with vaccines.”

Yet mainstream experts on syphilis reject Scythes’ belief that syphilis might be behind AIDS. Dr. Justin Radolf, a professor of genetics and developmental biology at the University of Connecticut who studies syphilis, feels the evidence is overwhelming that HIV causes AIDS. “I am amazed anyone is pursuing this issue of whether HIV is the primary or sole cause of AIDS,” he explains. “It is well accepted that the acute stage of HIV does a very good job of devastating the immune system.” Radolf says it is difficult to imagine that scientists have overlooked syphilis as being the cause of AIDS.

Moreover, Radolf says the idea that co-factors contribute to the development of AIDS has long been accepted. “There are really two kinds of co-factors: things that enhance HIV transmission and things that push the virus along, or increase the virus to express its genes.” Here, Radolf means diseases like TB, malaria and even possibly syphilis. “There is actually pretty good clinical evidence that systemic effects of syphilis can enhance HIV,” he remarks. “In other words, if they have HIV infection and they get syphilis, before it’s treated, their viral loads will go up as a result of syphilitic infection. But the mechanism of that is probably no different than many other systemic infections than can drive viral loads to group.”

Radolf doesn’t deny that there are some striking parallels between HIV and syphilis. “It’s not a shock that the groups with a high rate of HIV had high rates of syphilis,” he observes, in particular gay men who were having lots of unprotected sex with multiple partners. But Radolf argues that you can’t mix up HIV with syphilis. “There is not enough data, there is no data that would convince anyone of that … If a person who is infected with T. pallidum and does not have HIV infection—they will not get AIDS. On the other hand, a person who gets HIV but does not have syphilis still has a good chance of getting AIDS.”

Still, Radolf does confirm many of the things that Scythes avers—that syphilis was indeed very common among the men who first developed AIDS in the early 1980s, that the testing likely misses people who are infected, and that people with syphilis and HIV are more likely to develop full-blown AIDS.

For now, Scythes’ contention that people with AIDS are really dying of latent syphilis remains only a hypothesis. And that’s because, despite the best efforts of he and his friends in the medical community in Toronto, he’s been unsuccessful in getting any clinic in North America to do better molecular testing (called a PCR test) on people with HIV that would also show they have undiagnosed, untreated latent syphilis.

Scythes has had more success in Europe, in particular with a medical school in Budapest which, in 2001, arranged tests on a group of gay men and found that a molecular test uncovered more cases of otherwise undetected syphilis. Four years later, despite enlisting the help of Luc Montagnier (whom Scythes has met and discussed his theories with), Scythes failed to persuade clinics in Montreal to hand over blood samples of HIV-positive men to do PCR testing for syphilis. Montagnier, for one, feels syphilis’ role in AIDS, along with other potential co-factors, needs to be better explored.

So, in the end, is syphilis just aiding and abetting HIV, or is it the actual cause of AIDS? Realistically, until the Cold War in AIDS research begins to thaw, we may never know. For now, Scythes’ theories remain tantalizing conjectures. But he insists: “When they rewrite the history properly and understand the word syphilization, HIV will be put in its place.”