How Anti-Circumcision Activists Try To Squelch HIV/AIDS Science

Innovation, the Internet, gadgets, and more.
Sept. 24 2012 12:07 PM

Amazon Warfare

How an anti-circumcision fringe group waged an ideological attack against AIDS scholarship.

(Continued from Page 1)

Infuriated by the authors’ inclusion of male circumcision among effective HIV prevention approaches, anti-circumcision activists launched a smear campaign to discredit the book and its authors by spreading misinformation on Amazon. The intactivists co-opted Amazon’s normally informative readers’ reviewing system through a sudden mass-posting of viciously negative, one-star reviews. These reviews were then rated en masse as “helpful,” which made them rise to the top of the book’s webpage. At the same time, all the positive reviews of the book were marked “unhelpful,” instantly pushing them into obscurity. Anyone who ventured to the site would see a string of negative reviews urging the potential buyer not to bother wasting their money on this “misguided propaganda” for the practice of male circumcision.

As a public-health professional interested in male circumcision and other aspects of HIV prevention, I asked co-author Daniel Halperin if the intactivists’ campaign seemed to have had any noticeable effect. He noted that immediately after the viral attack began in late March, the sales ranking of the book on Amazon plummeted.

What is particularly telling about the negative reviews is that they focus almost entirely on male circumcision, rather than the main focus of the book, which is the history of AIDS in Africa. Most of the negative reviewers appear not to have read the book. Several reviews also appear tinged with anti-Semitism, accusing Halperin of pushing a religious agenda just because he is Jewish.


Intactivists have a long history of hounding Halperin and other researchers. Years ago, they attempted to have him removed from the faculty of the University of California at San Francisco. They alleged that he was guilty of scientific fraud and was a “promoter of genital mutilation.” (After university administrators were forced to waste many hours investigating the charges, Halperin was cleared of any wrongdoing.)

HIV researchers are not the only ones who have been targeted by anti-science campaigns on Amazon. Recent books on childhood vaccination have been stigmatized through the review system by activists who believe that vaccines cause autism or other negative health issues. Rigorous studies have thoroughly disproven any link between autism and these vaccines—which save millions of lives each year across the globe—yet conspiracy theorists persist.

Where does all of this leave us? Two diligent and dedicated authors spent years researching the origin, spread, and potential prevention of AIDS in Africa. Two minutes and a few clicks were all that was required for a passionate extremist group to obfuscate and delegitimize their findings in front of one of their most important and public audiences. Having failed to prove their beliefs through scientific evidence, the intactivists decided to have circumcision, and this entire book, judged in the court of public opinion. Unfortunately for the public, this jury was rigged.

Authors who fall victim to ideological warfare by fake peer reviewers have little if any opportunity for recourse. Amazon’s response to inquiries about this case was that the company is unable to take any corrective action. In the same way that negative reviews can seriously impact book sales, the personal or financial interests behind positive reviews can go undisclosed. “Any one review could be someone’s best friend, and it’s impossible to tell that in every case,” said Russell Dicker, Amazon’s Director of Community in a New York Times article last year.

Last year Cornell researchers created an algorithm designed to root out what they called “deceptive opinion spam”—in other words, fake reviews. The authors found that reviewers on popular sites such as Amazon, TripAdvisor, and Yelp had been paid, offered free trips, or given free products in exchange for positive reviews. New books by undiscovered authors are often rated more highly than Tolstoy, and small restaurants and hotels surpass the Ritz.

Undoubtedly, reviewer systems can help consumers make sense of a complex array of options by providing what others “just like them” have said about a product. However, the very real potential of such systems to be held ransom by a politically-motivated fringe group should be enough to give anyone pause before purchasing (or not purchasing) a product based solely on these reviews.

Paul Meade, president of Clear Point Health (a health care consulting company), contributed significantly to this article.