Wednesday, March 18, 2009

The Pope’s Message of Ignorance in Africa

In light of yesterday’s assertion by Pope Benedict XVI that condoms were not the solution to Africa’s fight against HIV and AIDS (I know of no one who says that, alone, they are!), and his statement that “the distribution of condoms” only “increase[s] the problem” of HIV/AIDS, I share the following excerpts from an article entitled Do Condoms Prevent AIDS?, originally published in the Summer 2002 issue of Conscience.


Important Roman Catholic leaders . . . have frequently claimed that condoms are not effective in preventing AIDS. In addition, anti-family planning organizations such as the American Life League and Human Life International have aggressively questioned the efficacy of condoms. They argue that condoms should not be promoted as a way to fight AIDS because the virus that causes AIDS is small enough to pass through latex condoms, or that condoms have an unacceptably high “failure rate” (the frequency which condoms break or slip off), or that condoms are not reliable because they don’t prevent all sexually transmitted diseases.

Such claims that condoms should not play an important role in halting the spread of HIV are unfounded, according to the US Centers for Disease Control and Prevention (CDC) and leading AIDS researchers. Condoms opponents have seized on the fact that condoms are not 100% perfect in preventing AIDS to further their arguments that abstinence and sex within marriage are the only ways to prevent AIDS.

Condoms, like all contraceptives, are not 100% foolproof. Most condom failure is due to human factors such as the failure to use condoms consistently or incorrect use of the prophylactic. (1) Many of these problems can be corrected through safe sex education, which opponents of condoms also oppose. Poorly manufactured condoms, which are sometimes found in the developing world, or those stored at excessive heats for long periods of time, can also fail. Non-latex condoms, such as those made of sheepskin, are not adequate protect against AIDS because HIV can pass through the larger pores of these condoms.

Claims that latex condoms allow HIV to pass through are unfounded. The pores of latex condoms are too small to allow HIV to pass through. Condoms have been shown to be effective barriers not only to HIV, the virus that causes AIDS, but also to herpes simplex, CMV, hepatitis B, chlamydia and gonorrhea. (2)

While condoms are not foolproof, they are highly effective in preventing HIV infection. According to the CDC, studies examining sexually active people at high risk for contracting HIV have found that “even with repeated sexual contact, 98-100% of those people who used latex condoms correctly and consistently did not become infected. (3)

(1) Do Condoms Work?, Center for AIDS Prevention Studies, Feb. 1995.
(2) “Condoms for Prevention of Sexually Transmitted Diseases,” Morbidity and Mortality Weekly Report, 1998; 37:133-137.
(3) How Effective Are Latex Condoms in Preventing HIV?, Centers for Disease Control and Prevention.

Postscript 1 (7:57 a.m.): I appreciate the perspective of the editors of the New York Times who write:

Pope Benedict XVI has every right to express his opposition to the use of condoms on moral grounds, in accordance with the official stance of the Roman Catholic Church. But he deserves no credence when he distorts scientific findings about the value of condoms in slowing the spread of the AIDS virus. . . . There is no evidence that condom use is aggravating the epidemic and considerable evidence that condoms, though no panacea, can be helpful in many circumstances.

. . . [H]ealth authorities consider condoms a valuable component of any well-rounded program to prevent the spread of AIDS. It seems irresponsible to blame condoms for making the epidemic worse.

Postscript 2 (12:50 p.m.): Here is what blogger Colleen Kochivar-Baker has to say about the Pope’s statements on condoms and AIDS:

There is no spin that can address this stupidity. It’s heartless, and that’s the whole problem with the Institutional Church. It lacks any heart, any compassion, any sense of reasonableness. It favors cold logic based on unsupported assumptions and takes these to absurd conclusions, almost exclusively to the detriment of women and children. This is really all about a “culture of life” for some at the expense of others, whether that’s a nine year old rape victim in Brazil or the preventable HIV infection of a mother in Cameroon. Somewhere Jesus weeps.

Kochivar-Baker calls the Pope’s assertion that the use of condoms only aggravates the AIDS crisis an “outright lie,” as there are “reams and reams of evidence to the contrary.”

My sense is that it’s a “lie” that’s quite popular among many of those who uncritically support the sexual theology of the Vatican. Just last October, for instance, the visiting “scholar in residence” at the St. Paul Seminary, Janet Smith, stated that condoms don’t prevent the spread of the AIDS-causing HIV virus. She made this statement during a public presentation given at the University of St. Thomas. Can you imagine it: a statement like that being made at a university of the caliber of St. Thomas? I recall how my friend Mary Lynn objected from the audience to Smith’s comment. She was dismissed and belittled by Smith – a cowardly response that, I’m sorry to report, elicited cheers and applause from many in the audience. (For Mary Lynn, this experience was the last straw in terms of her relationship with the institutional church.)

See also the previous Wild Reed post:
Vatican Considers the “Lesser of Two Evils”

Recommended Off-site Links:
When the Culture of Life is Really the Culture of Death - Colleen Kochivar-Baker (Enlightened Catholicism, March 18, 2009).
Pope Benedict XVI is a Global Health Nightmare - Michael A. Jones (Gay Rights, March 18, 2009).
Should Choosing Condoms Mean Choosing Life? - USA Today, March 17, 2009.
Just Say No? - Rocco Palmo (Whispers in the Loggia, March 17, 2009).
Catholics, Conscience, and Condoms
Statements and Actions by Catholic Bishops Supporting Condom Use as Part of an HIV Prevention Strategy

Vatican Intervenes to Calm Storm Over Pope’s Comments - Riazat Butt and John Hooper (The Guardian, March 18, 2009).
Condom Sense - Editorial (Washington Post, March 19, 2009).


Joseph said...

Even professedly liberals, who have no bias towards the Church, in precisely this field of research, agree with the Pope.

The following is from an interview with Dr. Edward Green, Director of the AIDS Prevention Research Project at the Harvard School of Public Health and Center for Population and Development Studies. Dr. Edward Green is a medical anthropologist with 30 years of experience in developing countries and in the fight against AIDS. [Source]

The Pope’s statement about AIDS and condoms is at the centre of a sharp debate and many – from Mr. Kouchner to Mr. Zapatero, including the EU Commission – have claimed his position to be abstract and eventually dangerous. What is your opinion ?

I am a liberal on social issues and it’s difficult to admit, but the Pope is indeed right. The best evidence we have shows that condoms do not work as an intervention intended to reduce HIV infection rates, in Africa. (They have worked in e.g. Thailand and Cambodia, which have very different epidemics)

In a recent interview to NRO you said that there is no consistent association between condom use and lower HIV-infection rates. Could you deepen this point?

What we see in fact is an association between greater condom use and higher infection rates. We don’t know all the reasons for this but part of it is due to what we call risk compensation. This means that a man using condoms believes that they are more effective than they really are, and so he ends up taking greater sexual risks. Another fact which is widely overlooked is that condoms are used when people are engaging in casual or commercial sex. People don’t use condoms with spouses or regular partners. So if condom rates go up, it may be that we are seeing an increase of casual sex.

So, even if it is surprising, it is proven that a higher use of condoms is associated with higher infection rates.

People began noticing years ago that the countries in Africa with the highest condom availability and highest condom user rates, also had the highest HIV infection rates. This does not prove a causal relation, but it should have made us look critically at our condom programs years ago.

See also this article.

Michael J. Bayly said...

Hi Joseph,

Thanks for stopping by and sharing the perspective of Dr. Edward Green.

I'd like to add to this important discussion the perspective of the BBC's William Crawley, who has the following to say about Dr. Edward Green and the complex issue of AIDS and condom use. (Note: I've added the emphasis to certain parts of the text).

Writes Crawley:

Dr Green is sometimes described as an AIDS researcher in press coverage. We should be clear about his area of expertise. He holds a PhD in Anthropology from the Catholic University of America and studies public health strategies "at the level of population". He is not a medical doctor, nor is he a virologist, nor is he an epidemiologist. He is a widely-respected academic who examines the impact of various public health strategies in various populations.

In 2003, he published a book, Rethinking Aids Prevention, which challenged the general approach to AIDS preventing in the developing world. Specifically, he argued that the most successful strategy for preventing the spread of HIV in Africa was not the distribution of condoms but campaigns encouraging people to reduce their number of sexual partners. Monogamy was a powerful behavioural defence against HIV, he said. Condoms, though technically able to prevent the spread of HIV when used correctly, have failed, according to Dr Green. Why have they failed? According to Pope Benedict, condoms encourage promiscuity and this drives the AIDS pandemic. According to Dr Green -- who has no moral or religious objection to the use of condoms -- this strategy in Africa has had the counter-effect of encouraging people to engage in riskier behaviour while believing that they are protected by condoms. "This may be due in part to a phenomenon known as risk compensation, meaning that when one uses a risk-reduction 'technology' such as condoms, one often loses the benefit (reduction in risk) by 'compensating' or taking greater chances than one would take without the risk-reduction technology," he says.

These conclusions led Dr Green to change his view on the usefulness of condoms in Africa. Notice that he maintains their usefulness in other parts of the world, such as the United States; he regards Africa as a special case for cultural reasons.

. . . The upshot is that [unlike the Pope] Dr Green strongly supports the ABC model in HIV prevention: "Abstain, Be faithful, or use Condoms if A and B are not practiced". In the same year that Rethinking AIDS was published, Dr Green was appointed by George W Bush's Advisory Presidential Council on HIV and AIDS.

It is vital that we have a serious debate about HIV prevention and that we locate that debate geographically and culturally. It is wrong at the outset to simply assume that an HIV prevention model that works in the United States or Europe would necessarily work in sub-Saharan Africa. Researchers who believe condoms are an effective strategy represent the majority position within the HIV prevention community.

Against Dr Green's concerns about "risk compensation", they argue that this points to a greater need for accompanying education programmes explaining the proper use of condoms and challenging risky behaviour.

The UN AIDS programme accepts -- who wouldn't? -- that "other components [of a successful HIV prevention strategy] include delay of sexual initiation, abstinence, being mutually faithful to each other when both partners are uninfected, and reducing the number of sexual partners. But the UN emphasises that condoms still play a very significant role and their promotion must be culturally sensitive: "Condoms must be promoted in ways that help overcome sexual and personal obstacles to their use. Complex gender and cultural factors can be a challenge for HIV prevention education and condom promotion. Due to gender norms and inequalities, young girls and women are regularly and repeatedly denied information about, and access to, condoms, and often they do not have the power to negotiate the use of condoms."

Against Dr Green's claims that condoms have been ineffective in countries such as Uganda, the World Health Organisation maintains that "recent analysis of the AIDS epidemic in Uganda has confirmed that increased condom use, in conjunction with delay in age of first sexual intercourse and reduction of sexual partners, was an important factor in the decline of HIV prevalence in the 1990s." This statement references a 2003 research paper exploring the Ugandan experience, "The Roles of Abstinence, Monogamy and Condom Use in HIV Decline", published by The Alan Guttmacher Institute in Washington DC. (Read the paper in full here.)

This analysis concludes that "positive behavior change in all three areas of ABC - abstinence, being faithful (monogamy) and condom use - have contributed to the decline of HIV in Uganda to sustained lower levels." It's a long way from that statement to the claim that condoms are making the problem of AIDS worse.

To read Crawley's full article, "The Pope and Condoms," click here.