The AIDS conference being hosted by the Vatican this weekend is worth keeping an eye on. Far too much of the commentary around AIDS and condoms as a preventive strategy degenerates into a simplistic either/or: “use condoms to prevent AIDS” (AIDS activists), or “condoms don’t work - abstain from all sex outside of marriage” (Vatican).

Reality, as always, is more complex. The severity of the epidemic in Africa should itself be sufficient to deter people from both sides from promoting supposed solutions based in ideology - but so far, has not done so. For people in the affluent countries of Europe and North America, where infection rates are relatively low, and good health services allow the disease to be managed, it is easy to become complacent. In much of sub-Saharan Africa, where health facilities are not in the same league, and infection rates are appalling, it’s a different matter entirely. Take a look at this map, showing infection rates - and have a good look at the key: those percentages give the percentage of the total adult population infected with HIV! (That’s more than one adult in five in each of Zimbabwe, Botswana, Swaziland, South Africa, Namibia and Zambia.

From a public health perspective, what is needed is a multi-pronged strategy. Total abstinence is obviously the safest, mutual fidelity inside a permanent relationship is next best - and condom promotion is an important back-up. To rely exclusively on condom use without reducing promiscuous behaviour is as foolish as relying entirely on moralistic sermons about avoiding sex before marriage. The public health professionals in the field all know this. For example:

Dr. Edward Green, the former director of the AIDS prevention research project at Harvard University, says empirical evidence is increasingly showing that condoms aren’t the solution, at least in Africa where heterosexual sex among multiple partners in regular, concurrent relationships is largely to blame for HIV’s spread. It’s a different scenario than in Thailand, for example, where high-risk sex workers have driven the spread of the virus.

“I’m not anti-condom,” Green said in an interview ahead of his speech here on Saturday. “They should be accessible, affordable, free. Just don’t bet the house and farm on it.”

Huffington Post, Vatican Invites AIDS Experts To Talk Prevention.

 

Fortunately, there are also Catholic bishops who live in the real world, and know from first hand experience that simplistic solutions just don’t cut it.

Monsignor Kevin Dowling, bishop of Rustenburg, South Africa, knows Africa, too, though he is not speaking at the conference. Since 1997 he has run a community-based HIV program that provides home-care nurses, anti-retroviral clinics, a hospice and program for orphans to cope with the hundreds of thousands of HIV-positive people of the region. He counsels condom use.

The snapshot that he paints is chilling: The area is home to large platinum mines that attract men from around the region to work for months at a time away from their families, and women who come looking for work. Desperately poor, the women are forced to engage in what Dowling calls “survival sex” – to pay for food and shelter since there are no other jobs.

“What am I to say to her? That the only 100 percent sure way of ensuring that you will not become infected is to abstain from sex before marriage, and remain faithful to a single partner in a stable marriage for the rest of your life?” Dowling said in an email. “Such ‘choices’ are totally, but totally irrelevant to such people.”

He says that years of sitting with women in their shacks as they or their children die had led him to take the nuanced position that “in certain circumstances, the use of a condom is allowable not as a contraceptive but to prevent disease,” he said. “We do not give out condoms, but people are fully informed about prevention methods and helped to make informed decisions about how they can protect themselves and, if they themselves are HIV positive, how they can avoid infecting someone else.”

Dowling says he has endured “much trouble” for his views, but he says he believes they are fully in line with church teaching since the condom isn’t being used as a contraceptive but to prevent disease.

Huffington Post, Vatican Invites AIDS Experts To Talk Prevention.

It’s too early to know what the impact of this conference will be - but it’s encouraging that the Vatican is hosting a conference where people from both sides of the divide will be talking (and listening) to each other. The avoidance of condoms is a well-known, established part of orthodox Vatican doctrine - but so is the importance of paying proper attention to the findings of science. Pope Benedict has already shown that it is possible for the Catholic position to shift, ever so gradually, to take account for the reality on the ground. Perhaps an adult conversation will result in some further gradual adjustments in public doctrine, to match those that have already occurred in (some) pastoral practice.

Now - imagine if we could see a similar interdisciplinary Vatican conference on the nature of sexual orientation, and on the broader questions of human sexuality!

Related articles

• UNAIDS to Vatican: Pope’s HIV-condom view helpful (seattletimes.nwsource.com)
• Vatican convenes AIDS experts amid condom flap (seattletimes.nwsource.com)
• Pope’s comments on HIV, condoms open dialogue (ctv.ca)