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Musings of an Anglican/Episcopal Priest

Tag: Pope-Benedict-XVI

More on the condom conversation

I posted some comments other day about the reaction to Benedict XVI’s remarks regarding the possibility that condom use in Africa might actually be having a negative consequence on the spread of HIV/Aids.  Today I read two interesting comments in the continued conversation over the reaction to the Pope’s remarks.

The first of these comments comes from Ross Douthat, currently of <i>The Atlantic</i> and recently announced conservative pundit at the New York Times.  Douthat is a conservative Roman Catholic and admits his bias, but makes some interesting observations:

I should note that I don’t pretend to be an expert on this topic, and my own conservative and Catholic biases have no doubt shaped the reading that I’ve done about AIDS-fighting strategies. But it’s my impression – created, in large part, by reading Helen Epstein’s The Invisible Cure (and if there’s a devastating rebuttal to her arguments, please send it my way) – that an awful lot of the money poured into condom-promotion over the years would have much been better spent promoting “partner reduction” in cultures inclined to promiscuity and de facto polygamy instead. This isn’t the same as promoting abstinence exclusively, and indeed, Epstein is witheringly critical of some of the abstinence-only programs that American dollars have funded in the Bush era. But “partner reduction” is a lot more consonant with the Catholic Church’s longstanding position – that it’s better to promote monogamy and fidelity than to take promiscuity as a given and make it as safe as possible – than you’d think from the overheated talk about how the Vatican’s flat-earth position on condoms has cost millions of lives.

What’s more, I have a hard time believing that the public-health and foreign-aid community’s longstanding preference for condom promotion has nothing to do with ideological biases of their own. Yes, the Catholic Church’s conservative position on sexual morality determines which public-health interventions the Vatican willing to support, and limits the willingness of Catholic institutions to simply follow the data wherever it leads. But what’s true of Catholics is true of other groups as well. And when you read Epstein on how slow the AIDS establishment was to acknowledge the importance of partner-reduction – or when you read about Bill Gates getting booed at an international AIDS conference when he mentioned abstinence and fidelity – it’s awfully hard to escape the conclusion that the combination of a liberationist view of sexual ethics and a post-colonial unwillingness to critique existing African patterns of sexual behavior has seriously hampered the international community’s efforts to curb the spread of HIV.

{Read it all}

Later in the day, someone emailed me this opinion piece from the Washington Post, written by Edward C. Green, research scientist at the Harvard School of public health.  Green writes that the Pope was right about his assertion:

When Pope Benedict XVI commented this month that condom distribution isn’t helping, and may be worsening, the spread of HIV/AIDS in Africa, he set off a firestorm of protest. Most non-Catholic commentary has been highly critical of the pope. A cartoon in the Philadelphia Inquirer, reprinted in The Post, showed the pope somewhat ghoulishly praising a throng of sick and dying Africans: “Blessed are the sick, for they have not used condoms.”

Yet, in truth, current empirical evidence supports him.

We liberals who work in the fields of global HIV/AIDS and family planning take terrible professional risks if we side with the pope on a divisive topic such as this. The condom has become a symbol of freedom and — along with contraception — female emancipation, so those who question condom orthodoxy are accused of being against these causes. My comments are only about the question of condoms working to stem the spread of AIDS in Africa’s generalized epidemics — nowhere else.

In 2003, Norman Hearst and Sanny Chen of the University of California conducted a condom effectiveness study for the United Nations’ AIDS program and found no evidence of condoms working as a primary HIV-prevention measure in Africa. UNAIDS quietly disowned the study. (The authors eventually managed to publish their findings in the quarterly Studies in Family Planning.) Since then, major articles in other peer-reviewed journals such as the Lancet, Science and BMJ have confirmed that condoms have not worked as a primary intervention in the population-wide epidemics of Africa.

[…]

Let me quickly add that condom promotion has worked in countries such as Thailand and Cambodia, where most HIV is transmitted through commercial sex and where it has been possible to enforce a 100 percent condom use policy in brothels (but not outside of them). In theory, condom promotions ought to work everywhere. And intuitively, some condom use ought to be better than no use. But that’s not what the research in Africa shows.

Why not?

One reason is “risk compensation.” That is, when people think they’re made safe by using condoms at least some of the time, they actually engage in riskier sex.

{Read it all}

The general consensus seems to be that–in the situation of an epidemic–behavioral changes have to reach a certain point, and to have limited infection to a certain degree before condom use has any measurable impact.  This indicates that prophylactics without attendant behavioral changes–including a lessening of promiscuity and a trend toward fewer sexual partners–is not enough.

All of this is to say, no one should assume that it is only the religious who hold opinions religiously or by faith.  I long ago discovered that for most people (at least most Americans) their political and cultural views, whether liberal or conservative–even if supposedly secular–are ideological and operate on the same level as religious faith, even to the extent of being irrational.

The Pope get's Lambasted over Condom comment

The Lead has posted the following remarks from BBC News regarding Benedict’s remarks about condom use and the prevention of HIV infection:

One of the world’s most prestigious medical journals, the Lancet, has accused Pope Benedict XVI of distorting science in his remarks on condom use.

It said the Pope’s recent comments that condoms exacerbated the problem of HIV/Aids were wildly inaccurate and could have devastating consequences.

“When any influential person, be it a religious or political figure, makes a false scientific statement that could be devastating to the health of millions of people, they should retract or correct the public record,” it said.

“Anything less from Pope Benedict would be an immense disservice to the public and health advocates, including many thousands of Catholics, who work tirelessly to try and prevent the spread of HIV/Aids worldwide.”

Our correspondent says the article shows how far the Pope’s attempts to justify the Vatican’s position on condoms have misfired.

Having read the Pope’s comments (namely that condom use may not actually decrease the spread of HIV/AIDS, but have the opposite effect) I actually wonder whether he intended to make a scientific statement or a sociological/cultural observation. The intelligibility of the Pope’s comments seems to hinge upon what he is comparing to.  Certainly it is incorrect to say that condom use increases the risk of HIV/AIDs compared to sexual activity without a condom.  However, sexual intercourse with a condom certainly does increase the possibility of infection when compared to total abstinence.  Additionally, it has long been the claim of some who oppose the widespread distribution of contraception that it increases sexual activity generally–including unprotected sex–by lessening the barrier/strictures against it.   I have no evidence that these views are correct, but it does make sense to me that a general allowance for sexual activity brought on by the easy availability of contraception might result in higher levels of unprotected sexual activity as well.  Indeed, I’ve seen anecdotal evidence of that among people that I know.  Regardless, I do wonder if folks are perhaps up in arms over something not at all surprising: the Pope believes the availability of and emphasis on contraception increases the likelihood of sexual activity outside of marriage, which by extension increases the possibility of contracting HIV/AIDS when compared to restricting sexual activity to one partner within marriage. This is not the same thing as saying that the empirical evidence in the first case (comparing the possibility of infection between protected and unprotected sex) is wrong.

I may believe it is absurd for there to be any question about the appropriateness of the use of a condom by a married couple to prevent an HIV positive spouse from infecting their partner, but reason, science and observation all support the notion that abstinence is ultimately the only sure-fire way to prevent the contraction of HIV. The USAID report on HIV in Uganda indicates as much, when it discusses the behavioral changes that have resulted in a decline in HIV there, making it one of Africa’s success stories.  These include a lessening stigma toward those with the disease, delayed sexual debut among youth etc… When it comes to condom use, the report makes an interesting observation:

Condom social marketing has played a key but evidently not the major role: Condom promotion was not an especially dominant element in Uganda’s earlier response to AIDS, certainly compared to several other countries in eastern and southern Africa. In Demographic Health Surveys, ever-use of condoms as reported by women increased from 1 percent in 1989, to 6 percent in 1995 and 16 percent in 2000. Male ever-use of condoms was 16 percent in 1995 and 40 percent in 2000. Nearly all of the decline in HIV incidence (and much of the decline in prevalence) had already occurred by 1995 and, furthermore, modeling suggests that very high levels of consistent condom use would be necessary to achieve significant reductions of prevalence in a generalized-level epidemic. Therefore, it seems unlikely that such levels of condom ever-use in Uganda (let alone consistent use, which was presumably much lower) could have played a major role in HIV reduction at the national level, in the earlier years. However, in more recent years, increased condom use has arguably contributed to the continuing decline in prevalence.

This seems to indicate that condom use can play an important role, but only as part of over all behavioral changes.  People seem to be angry because they believe the Pope’s remarks about condoms will decrease their use, but as I recently read elsewhere: if people aren’t going to listen to the Pope’s teachings about sexual abstinence and marital fidelity, then what makes anyone think his views of condoms will impact the behavior of those same people?  It seems to me that, rather than critisizing a statement that is utterly unsurrprising given the source, those folks who are admirably waging the war against HIV in Africa ought to accept the support of the Roman Catholic and other Churches where they can, and take a lesson from the glimers of hope in Uganda, which seem to have been the result of widespread cooperation between faith communities, the government, and the medical field.

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