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The Pope and Condoms: Debate

March 30, 2009

In a short reaction piece, I linked to the comments made by Pope Benedict regarding the impact of condoms on the HIV/AIDS epidemic in Africa. In short, the Pope made clear his belief that the International aid approach to battling the health crisis using condoms is worsening the problem. His comments, and the reaction to them, have been the source of growing discussion on the Internet. See, Ross Douthat at the Atlantic.

My initial reaction to the Pope was that his comments will, at the very least, confuse the issue of condom usage when what is sorely needed to combat the crisis is clarity. And at the worst, the position of the Pope and the Catholic church contribute to the spread of the disease.

In reading more about the issue, however, I’ve found that the scholarship on condom use doesn’t necessarily lead to clarity. Here’s a report from Kaisernetwork, a non-partisan health information service for the benefit of health policy professionals, discussing the controversy:

Research May Support Pope’s Comments Against Condom Use in Africa, Opinion Piece Says
via HIV/AIDS Daily Report on 3/29/09

Pope Benedict XVI “set off a firestorm of protest” earlier this month when he commented that condom distribution “isn’t helping, and may be worsening” the spread of HIV/AIDS in Africa, but “in truth, current empirical evidence supports him,” Edward Green, a senior research scientist at the Harvard School of Public Health, writes in a Washington Post opinion piece. The condom has become a “symbol of freedom and — along with contraception — female emancipation,” Green writes, adding that those who “question condom orthodoxy are accused of being against these causes.” Members of the HIV/AIDS and family planning communities “take terrible professional risks if we side with the pope on a divisive topic such as this,” Green writes, noting that his comments “are only about the questions of condoms working to stem the spread of AIDS in Africa’s generalized epidemics — nowhere else.”

According to Green, several research articles published in 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.” He adds that condom promotion “has worked” in countries such as Cambodia and Thailand, where HIV is transmitted primarily through commercial sex. “In theory, condom promotions ought to work everywhere,” Green writes, adding that this is “not what the research in Africa shows.”

Green writes that “people think they’re made safe by using condoms at least some of the time” and they “actually engage in riskier sex.” In addition, many people in Africa rarely use condoms in stable relationships “because doing so would imply a lack of trust,” Green continues, adding that it is “those ongoing relationships that drive Africa’s worst epidemics” where most HIV cases occur in general populations rather than high-risk groups like commercial sex workers, men who have sex with men or injection drug users. “And in significant proportions of African populations, people have two or more regular sex partners who overlap in time,” creating an “invisible web of relationships through which HIV/AIDS spreads,” Green writes. What has proven effective in Africa are “[s]trategies that break up these multiple and concurrent sexual networks — or, in plain language, faithful mutual monogamy or at least reduction in numbers of partners, especially concurrent ones,” Green writes, adding, “‘Closed’ or faithful polygamy can work as well.”

Green says that he is “not anti-condom,” adding, “All people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship.” In addition, “liberals and conservatives agree that condoms cannot address challenges that remain critical in Africa such as cross-generational sex, gender inequality, and an end to domestic violence, rape and sexual coercion,” Green continues, concluding, “Surely it’s time to start providing more evidence-based AIDS prevention in Africa” (Green, Washington Post, 3/29).

After reviewing that piece, as well a whole host of reasonably reliable sources, the conclusion must be that while the use of condoms by individuals will, in fact, provide protection for both partners on the individual level, the same is not necessarily true at the population level. In essence, because of the unique characteristics of human behavior which have led to the epidemic and which continue to contribute to the spread of the disease, encouraging the reduction in the number of partners and fidelity within relationships may be the most efficacious means of tackling the spread of HIV/AIDS in Africa. The use of condoms, and international efforts to make condoms widely available, still appear to play an important role where individuals can and will use them.

The comments of the Pope and the teaching of the Catholic church, then, on the issue of condom use and HIV/AIDS may have more in common with the findings of health professionals and development academics than I, and I suppose many others, would have originally thought. Of course, the church’s blanket ban on contraception still has a significant and potentially troubling impact in those situations where monogamy is either not possible or unlikely. No matter the larger cultural forces working against condom use, there is no denying their usefulness in preventing viral transmissions between two individuals. If overall clarity is elusive on the issue of condom use as it pertains to the whole African epidemic, it is hoped that they can be encouraged as part of a multi-pronged approach to battling the disease.

2 Comments leave one →
  1. Jill permalink
    March 30, 2009 6:00 pm

    First, a question. When you say what is needed is “clarity”, what do you mean ?

    Further, and I could be wrong from my reading of your commentary, but to me it seems to place some blame on the AIDS epidemic on culture, supporting the idea that to fight AIDS, people simply need to change their behavior (if only those “cultural forces” would permit them to do so). I’m reminded of the Museveni approach in Uganda in the 90s, a political endeavor, which was highly effective in reducing rates.

  2. March 30, 2009 7:02 pm

    When I said that clarity is needed, I meant that, under ideal circumstances, the following question would have just one answer: Does the use of condoms reduce the spread of HIV/AIDS? If the answer is yes, then any individual or institution inhibiting the availability or use of condoms would inarguably be contributing to the spread of HIV/AIDS and all the negative consequences related to the spread of the disease. If the answer is no, then anyone arguing against the use of condoms–in this case, the Pope– could not be guilty of contributing to the spread of the disease. Unfortunately, the application of condoms, as both a prophylactic device and as a concept, to the problem of HIV/AIDS is more complicated than the simple question posed above. There are, as I am sure you well know, cultural, behavioral, ethical, medical, financial and other factors to consider when analyzing the proper role to afford to condoms and condom education as components of an overall strategy in combating the existence and spread of HIV/AIDS. The complexity of the problem, then, allows neither for simple answers nor simple questions.

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