Debunked: Steven Crowder: The AIDS epidemic was a hoax

[Dan Wilson]

Steven Crowder is a popular political commentator who has quite a large following. Last year he released a video on his YouTube channel stating "the AIDS epidemic never happened!"

The major claim to address in this video is as follows:

@2:28 Statistically, the CDC puts a heterosexual American's chance of contracting AIDS at 0%.

The second claim I want to address is that, because infection risk was nonexistent, the media and government overhyped and overfunded HIV/AIDS research.

The idea that heterosexual non-drug users have a 0% of contracting HIV is profoundly and harmfully wrong. Crowder claims that this was always the case including during the 1980's AIDS epidemic. The graph referenced @2:35 in the video represents data gathered from young males in 2010 in the U.S., a time and place where HIV/AIDS is no longer considered an epidemic. From the very table in the video, however, 4.5% of the total cases reported within the young male age group resulted from heterosexual contact. This already refutes Crowder's claim. It is important to note that data from his referenced table excludes older males and, most importantly, women! Women make up a large portion of the heterosexual population living with AIDS since they are at a higher risk of contracting HIV during heterosexual contact. From the same referenced CDC report published in 2011, we can see that 27.6% of all HIV infections reported int he U.S. in 2011 resulted from heterosexual contact.
https://www.cdc.gov/hiv/pdf/statistics_epidemiology_of_infection_through_2011.pdf

If we look to see what the worldwide situation is, we can start to better understand the full potential threat that a virus like HIV can bring.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543106/pdf/cshperspectmed-HIV-a006965.pdf

What is evident from these estimates is that heterosexual transmission is responsible for nearly 70% of HIV-1 infections worldwide with the remainder largely attributable to MSM, maternal-infant infection, and injection drug use. This is the case despite the fact that transmission probability per coital act is lowest for heterosexual exposures (1 in 200– 1 in 3000) (Hladik and McElrath 2008; McElrath et al. 2008). However, two recent meta- analyses of HIV-1 incidence and prevalence data (Powers et al. 2008; Boily et al. 2009) suggest a far wider range in HIV-1 transmission risk for heterosexual exposures depending on confounding risk factors ...

These numbers demonstrate that Crowder is absolutely wrong in claiming that the risk for heterosexual non-drug users to contract HIV is "0%" or "practically nonexistent." Making such claims is borderline AIDS denialism.

Throughout the video, HIV/AIDS is consistently called a "silent non-killer," implying that the disease is not and was never something to be concerned about. Besides the fact that this completely ignores the risks the disease poses to the gay community, it is outrageously wrong. HIV/AIDS was devastating during the 1980's epidemic and continues to be a huge problem throughout the world.
During the U.S. epidemic in the 1980's, which began mostly in New York City, it is unclear exactly how many cases there were because it was a difficult thing to accurately calculate.
https://www.ncbi.nlm.nih.gov/books/NBK234564/

All these figures, however, are an underestimation of the numbers of actual AIDS cases. There are four sources of this underestimation, which mirror the undercount problems on a national level.

To really get a sense of the seriousness of HIV/AIDS in the 1980's, the mortality rate, which Crowder seems to think was nonexistent, tells the story.

Whatever the precise number of cases of AIDS, deaths from the opportunistic infections that are associated with end-stage HIV disease accounted for a very large proportion of the total mortality among young men and women in New York City in 1989. Among men aged 25 to 44, AIDS was the leading cause of death: 31.6 percent of deaths of men aged 25 to 34 and 35.2 percent of deaths of men aged 35 to 44. Among women aged 25 to 34, AIDS accounted for 26.1 percent of all deaths; in addition, 10 percent of the mortality among women aged 15 to 24 and 17 percent of the mortality among women aged 35 to 44 was also directly attributable to AIDS.

For the rest of this post, I'll focus on the fact that Crowder and his team seem to think that HIV/AIDS got too much attention and stole funding from other diseases. I'll specifically point out the misinformation one by one.
@3:47 in the video, it is claimed that your risk of contracting HIV is 4 in 10,000 if you're heterosexual. Although this statistic is not outside the range of the most conservative risk numbers, it only sometimes applies and strictly to heterosexual males. Compared to a man in the same situation, a woman has double the chance of contracting HIV.
@2:11 the video claims that AIDS became "the single most research funded disease in the modern history of America." The graph shown with this audio shows research dollars spent per individual with the disease and compares HIV to cancer and diabetes. This statistic is misleading because far fewer people suffer from HIV than cancer and diabetes. The truth is that cancer receives about twice as much funding as HIV/AIDS per year. HIV/AIDS does receive more annual research funding than diabetes but there are many technical reasons for that including the NIH overall budget, the number of labs actively researching diabetes, and how the NIH grant review process works.
@4:26 the video claims that "funding continued to soar," implying that this is research funding but the graph depicted shows data for health care dollars committed to HIV/AIDS patients, not research dollars.
@4:58 the video states that HIV/AIDS research is "stealing research dollars" from other more important diseases. This is not how federal funding for diseases works. NIH funds grants based on things like their experimental design, creativity, and scientific impact.

The tone of this video insists on a "nothing to worry about" attitude when it comes to HIV and suggests that the funding and panic during the initial U.S. epidemic was overplayed. This view is harmful. When HIV/AIDS first appeared in the U.S., nobody knew what it was. People were dying in mysterious ways and no one knew why or how. Two years after the first identified case of AIDS in 1981, Robert Gallo and an independent lab both identified HIV as the causative agent of AIDS. Public understanding was slow to come, however, and even back then it was a popular idea that only gay men and drug users could get the disease. There is no telling how much damage such ideas did. During any outbreak of any disease, especially a new one, there is no such thing as too much caution. The danger must be recognized and understood so that action can be taken. A new disease can have the potential to devastate a nation. This is why the CDC and other organizations are trained to respond to outbreaks as fast as possible so that they can be contained. HIV/AIDS was not contained and there is nothing necessarily obvious at the time that we could have done to stop this.

Regardless, 675,000 people in the U.S. have died as a result of HIV/AIDS. Worldwide those numbers climb to over 1 million every year. Even more have suffered from it. Thanks to the funding and research attention it has received, HIV/AIDS is now a manageable disease for those who have access to the right health care facilities. For those who don't it is still a problem. For those who live with it, they have to be medicated for life in order to avoid progression to AIDS. HIV/AIDS must be taken seriously in order for better medicine and prevention to be effective. If it never were taken seriously, HIV infection would still be a death sentence.

8/10/18 Edit: Typos and wording

 

[deirdre]

Regardless, 675,000 people in the U.S. have died as a result of HIV/AIDS. Worldwide those numbers climb over 1 million every year. Even more have suffered from it. Thanks to the funding and research attention it has received, HIV/AIDS is now a manageable disease for those who have access to the right health care facilities. If HIV/AIDS was never taken seriously, this may not be the reality.

I'm going to highlight this ^^^^^ for readers that just skim your post. Crowder must be younger than he looks to be knocking funding for research and treatments!!

 

[Candy-O]

I remember growing up in the 80s when the fear of AIDS was in full swing. You'd see these projections that had been made which predicted AIDS would engulf the country and the world with a decade or so. A lot of us were very afraid.

But it never happened. For heterosexual couples without damaged immune systems/sharing UV needles, the risk of acquiring the virus is extremely small. According to the CDC the risk for women in first world counties getting aids from vaginal sex with an infected man is in 1,250. For men its 1 in 2,500 per encounter.

I distinctly recall hearing many times "when you have sex with someone you are having sex with everyone they ever had sex with" Which may be technically true, the odds are extremely small. Once you get 2 or more degrees away from a carrier, the odds are ridiculously small. For example, A man has sex once with woman A who has HIV. He then he has sex once with woman B. Now if you have sex with woman B, your chance per encounter is 9375000000 to 1 ( 2500 X 1500 X 2500) Of course many people have sex multiple times with each partner, but even then, the chances are very small, given the time frames and frequencies most non-married people are limited to.

Where the numbers get far higher is when you introduce anal sex and IV drug use. But for most suburban straight kids in the 80s, that incredible fear of HIV was unfounded. We should have been far more worried about herpes and HPV.

When my cousin was in medical school, he told me the professor discussed the odds of getting AIDS during one of his classes. The teacher dismissed it as being not worthy of concern unless you fall into a high risk category. Far more likely to catch another STD, so still using a condom is recommended. A student asked why all the fear mongering in the media, and in the professor's opinion it was because early on they didn't have all the data yet as to what was going on, so it was better to give overly cautious advice, and technically anything is possible, however unlikely, so the responsible official medical advice was to imply ANY unprotected sex put you at great risk. And some people may have comprised immune systems and not know it yet, etc. They eventually realized it was not going to overtake the first world countries, but there was little harm in keeping people afraid of it.

So when Crowder says the panic was overblown, for most of straight America it was. Of course the gay community was devastated by it, so the risk to straight teenagers and married couples wasn't really comparable at all to living in San Francisco or on the streets of New York. But to say the money funded was a waste is a bit obnoxious IMO.

links to CDC fact sheet in article: https://www.poz.com/article/HIV-risk-25382-5829

 

[Dan Wilson]

So when Crowder says the panic was overblown, for most of straight America it was.

In hindsight, I could understand the perspective that it was overblown. However, I would still argue that the response was appropriate. It is true that the chances of contracting HIV per heterosexual encounter are relatively low, but heterosexual encounters happen a lot. Even with a low risk of infection, HIV was able to spread across the world in a relatively short amount of time. Even today in South Africa, a country with a relatively high GDP, 18.8% of the population are living with HIV/AIDS and an estimated 1.2 million orphans have resulted from deaths the disease has caused. This happened at least in part because AIDS was not taken seriously by the government until 2007. A swift and aggressive response involving awareness and action is how outbreaks of infectious diseases, especially new ones, need be treated.

I think the point here is, the media will always scare people and getting good information can be hard. Sometimes catastrophes don't happen because people were scared and action was taken. Sometimes that fear can be harmful and lead to the spread of more misinformation. Finding a balance is of course ideal but saying that fear regarding the AIDS epidemic was overblown is a massive oversimplification.

Now if you have sex with woman B, your chance per encounter is 9375000000 to 1 ( 2500 X 1500 X 2500)

This is not accurate. If you carry this equation out multiple times then you will get a number that says it is impossible for the disease to infect more than X number of people. That is not the case. Each sexual encounter should be treated as an independent event with the 1 in 1,250 and 1 in 2,500 figures.

We should have been far more worried about herpes and HPV.

I think statements like this miss something important. Take a different situation as an example. The American media got into a frenzy when the possibility of Ebola coming to the U.S. during the 2014-2015 outbreak. That Ebola outbreak killed a total of 11,310 people and your odds of becoming infected with it would probably have been very low in America. Meanwhile, in 2016 the flu killed an estimated 51,537 people in America, your odds of becoming infected with the flu are much higher than most other infectious diseases, and yet getting your flu shot is something the average American does not worry about. Did the media misrepresent Ebola? Yes. Does this mean we shouldn't care about Ebola? Absolutely not! Does this mean we should care more about flu? Yes! Being aware of HIV and herpes and HPV is extremely important. We should worry and care about all of these diseases.

But to say the money funded was a waste is a bit obnoxious IMO.

I agree. I didn't even mention how much good HIV/AIDS research has done for medicine and medical research in general.

 

[Candy-O]

That is not the case. Each sexual encounter should be treated as an independent event with the 1 in 1,250 and 1 in 2,500 figures.

I do not believe so. For me to have a one in 2500 chance of getting HIV from a woman, she would need to have it in the first place. Only IF she had it, then would it be 1 in 2500. But her chance of having it is only 1 in 1500 from having sex with a partner who had it. So yea, the statistics become insanely unlikely. You multiply the odds per encounter by the odds of the prev encounter and so on. That's the whole point. It never really spread to hetero sexual couples in the US, and that's why.


Source: https://www.youtube.com/watch?v=BQrQBnsKUOU


As per the CDC, when you add in unsafe sexual practices and drug use, the odds increase dramatically, which is why drug users and the gay community were so devastated by it. If you share needles and have anal sex frequently, your odds can quickly stack to an almost guaranteed infection very quickly.

Also, my one night stand vs one night stand best case scenario doesn't really describe many situations. For example, in the real world, a person might sleep with someone. X times who has HIV, and Y of those might include anal sex and Z encounters would be only oral sex, so you'd have to crunch the numbers a bit differently. That CDC pamphlet has the odds for all those acts, so it could be roughly estimated if one wanted to.

 

[Dan Wilson]

Only IF she had it, then would it be 1 in 2500. But her chance of having it is only 1 in 1500 from having sex with a partner who had it. So yea, the statistics become insanely unlikely.

I bolded the above sentence because that is the condition in each independent case. The 1 in 2,500 and 1 in 1,250 figures apply only if one partner has HIV. The situation you described previously would only be realistic in a controlled experiment where an HIV infected female A has sex with male A, who then has sex with female B, who then has sex with male B. In this scenario, the odds of male B ending up with HIV after one sexual encounter would be as you described but that is neither useful nor realistic when thinking about HIV risk.

It never really spread to hetero sexual couples in the US, and that's why.

Yes, it did. Just because the LGBT community was and continues to be hit hardest doesn't mean it was never something that heterosexual individuals had to worry about. They should have then and we still should now. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics

Heterosexuals and people who inject drugs also continue to be affected by HIV. In 2017:

• Heterosexuals accounted for 24% of HIV diagnoses.f
• Heterosexual men accounted for 7% (2,829) of HIV diagnoses.
• Heterosexual women accounted for 16% (6,341) of HIV diagnoses.
• People who inject drugs accounted for 6% of HIV diagnoses.

If you share needles and have anal sex frequently, your odds can quickly stack to an almost guaranteed infection very quickly.

Not under your statistical conditions. A gay male who has sex with an HIV infected male has, at worst, a 1 in 72 (~1.38%) chance of contracting HIV. Using your method to carry these odds out over just three encounters results in a 0.2x10^-6% (1 in a million) chance of contracting HIV. Five encounters bring it to 0.5x10^-11 (1 in 100 billion). Would you use this information to explain HIV risk to a gay man? No, because it is not an accurate representation of risk.

 

[deirdre]

You'd see these projections that had been made which predicted AIDS would engulf the country and the world with a decade or so. A lot of us were very afraid.

But it never happened. For heterosexual couples without damaged immune systems/sharing UV needles, the risk of acquiring the virus is extremely small. According to the CDC the risk for women in first world counties getting aids from vaginal sex with an infected man is in 1,250. For men its 1 in 2,500 per encounter.

Something to point out.. AIDS was first reported in 1981. The "epidemic" that I remember (I became sexually active in 1986) was primarily among homosexuals (and the porn industry), with a legitimate fear that it would spread- like all STDs do- to the heterosexual community. Didn't someone even get AIDS from their dentist? Let alone the blood transfusions. The point is they didn't know much about AIDS at that point, transmissions rates etc.

So to use hindsight data (as Crowder did), that we acquired from years of research, and say AIDS was 'overblown' and didn't deserve the research dollars put into it is a bit silly. I'm glad they did the research. 1 in 1250 is still pretty high. Even today, If you put a bullet in a gun with a 1250 round chamber and told all the women of New York they had to pass the gun around and pull the trigger everytime they had sex..

 

[Candy-O]

Something to point out.. AIDS was first reported in 1981. The "epidemic" that I remember (I became sexually active in 1986) was primarily among homosexuals (and the porn industry), with a legitimate fear that it would spread- like all STDs do- to the heterosexual community. Didn't someone even get AIDS from their dentist? Let alone the blood transfusions. The point is they didn't know much about AIDS at that point, transmissions rates etc.

So to use hindsight data (as Crowder did), that we acquired from years of research, and say AIDS was 'overblown' and didn't deserve the research dollars put into it is a bit silly. I'm glad they did the research. 1 in 1250 is still pretty high. Even today, If you put a bullet in a gun with a 1250 round chamber and told all the women of New York they had to pass the gun around and pull the trigger everytime they had sex..

I fully agree. At that time we had no idea of what might happen. Only in hindsight, after all the data had been gathered many years later, did the full picture come into view. I wasn't defending Crowder's view that all that money was a waste; I was only referring to the fact that AIDs never did consume the general population in the West as was widely predicted.

This kind of reminds me of Global Warming and the predictions and costs vs benefits vs risks of the whole thing.. but this is not the thread for that discussion

 

[Candy-O]

I bolded the above sentence because that is the condition in each independent case. The 1 in 2,500 and 1 in 1,250 figures apply only if one partner has HIV. The situation you described previously would only be realistic in a controlled experiment where an HIV infected female A has sex with male A, who then has sex with female B, who then has sex with male B. In this scenario, the odds of male B ending up with HIV after one sexual encounter would be as you described but that is neither useful nor realistic when thinking about HIV risk. Yes, it did. Just because the LGBT community was and continues to be hit hardest doesn't mean it was never something that heterosexual individuals had to worry about. They should have then and we still should now. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics

Heterosexuals and people who inject drugs also continue to be affected by HIV. In 2017:

• Heterosexuals accounted for 24% of HIV diagnoses.f
• Heterosexual men accounted for 7% (2,829) of HIV diagnoses.
• Heterosexual women accounted for 16% (6,341) of HIV diagnoses.
• People who inject drugs accounted for 6% of HIV diagnoses.

Not under your statistical conditions. A gay male who has sex with an HIV infected male has, at worst, a 1 in 72 (~1.38%) chance of contracting HIV. Using your method to carry these odds out over just three encounters results in a 0.2x10^-6% (1 in a million) chance of contracting HIV. Five encounters bring it to 0.5x10^-11 (1 in 100 billion). Would you use this information to explain HIV risk to a gay man? No, because it is not an accurate representation of risk.

I wasn't asserting that heterosexual couples should NEVER be concerned about it, only that other STDS are far more common.

Many more lifetime partners (4 to 6 times more than straight men) X riskier sex acts X larger pool of already infected to choose from = far greater real world risks. On the whole, straight couples didn't have to worry because their cumulative risk factors were far less. Of course any single person can have bad luck, but when you add up millions of people and look at the numbers as a whole, it's very clear why AIDS never exploded into the straight population across the county - fewer partners, typically safer sexual acts, and less risky pool of partners to choose from.


good info on gay vs straight numbers of lifetime partners:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334840/

 

[Dan Wilson]

it's very clear why AIDS never exploded into the straight population across the county - fewer partners, typically safer sexual acts, and less risky pool of partners to choose from.

Action, awareness, and medical research are why AIDS never spread in the U.S. like it continues to in Swaziland and South Africa. The risk is relatively low compared to other STI's, yes, but those numbers do not tell the whole story. I feel the need to keep stressing this. From my original post:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543106/pdf/cshperspectmed-HIV-a006965.pdf
What is evident from these estimates is that heterosexual transmission is responsible for nearly 70% of HIV-1 infections worldwide with the remainder largely attributable to MSM, maternal-infant infection, and injection drug use. This is the case despite the fact that transmission probability per coital act is lowest for heterosexual exposures (1 in 200– 1 in 3000) (Hladik and McElrath 2008; McElrath et al. 2008).

The rest of that paragraph reads as follows:

However, two recent meta- analyses of HIV-1 incidence and prevalence data (Powers et al. 2008; Boily et al. 2009) suggest a far wider range in HIV-1 transmission risk for heterosexual exposures depending on confounding risk factors such as genital ulcer disease, male circumcision, HIV disease stage, and exposure route. For example, penile-vaginal transmission of HIV-1 was reported at a frequency as high as 1 in 10 exposures and penile-anal transmission as high as 1 in 3 depending on confounding risk cofactors (Powers et al. 2008). Thus, the commonly quoted risk estimate for heterosexual HIV-1 acquisition of 1 in 1000 exposures must be considered a lower bound.

This information is acknowledged in the legend for the table of statistics we have referred to from the CDC. https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html

* Factors that may increase the risk of HIV transmission include sexually transmitted diseases, acute and late-stage HIV infection, and high viral load. Factors that may decrease the risk include condom use, male circumcision, antiretroviral treatment, and pre-exposure prophylaxis. None of these factors are accounted for in the estimates presented in the table.

I'm trying to make it 100% clear that if we were to go back in time to the 1980's knowing what we know now, it would still be best to advocate for swift and effective action and that boiling down this story to the modern and incomplete estimations of risk listed in that CDC table can be very misleading.