HIV Prevention Drugs Set to Sidestep Vatican’s Condoms Ban

Using HIV drugs to protect yourself from getting HIV is now on the horizon. This offers Catholics who do not have HIV, especially those in Africa, an effective alternative form of protection to using condoms which are banned by the Catholic Church.

Science Breakthrough of the Year - HIV treatment for prevention

There are also other new effective alternatives for people affected by the Vatican’s condom ban. The people affected by the condom ban are not just Catholics, because in sub-Saharan Africa and elsewhere, Catholic agencies and clinics provide a huge amount of healthcare to the general public.

The other condom alternatives include a vaginal gel that women without HIV can apply before sex to protect themselves from HIV. This doesn’t prevent conception, just HIV. And when people with HIV take HIV treatments properly, this reduces the risk of passing on HIV to partners, even better than using condoms. HIV prevention prospects are now far better than they ever have been, but the financial costs and practical problems of making these new forms of HIV protection widely available are great, even in well resourced countries like the UK, Ireland and the USA.

Vatican HIV conference disappointment

two Nuns making hundreds of red HIV ribbons into two huge HIV ribbon shapes

There were hopes last May that the Vatican HIV conference would lead to a change in the Church’s opposition to using condoms for HIV prevention, but those hopes were dashed. The Vatican continues to teach that condoms should not be used, because sex must always be open to procreation.


Using HIV drugs for protection

There is now clear evidence that using HIV treatment drugs can be highly effective in preventing someone from getting HIV. HIV experts call this ‘Pre-exposure prophylaxis’ (‘prophylaxis’ means protection), or PrEP.

Project PrEPared - rethinking HIV prevention logo of a head with a red bandana

This week the US Food and Drug Administration (FDA) took a decisive step towards approving the use of the combination pill Truvada (containing two HIV drugs, tenofovir and FTC) as a prevention method for HIV-negative people. A final decision will be taken by the FDA in the middle of June. If that gives approval, that would make PrEP available to people without HIV in the US who have the necessary health insurance to pay for it.

In the UK the Health Protection Agency is planning to start a trial of this for gay men who are at the greatest risk of getting HIV. Rather further down the road, PrEP may become part of the global strategy of UNAIDS in Africa and elsewhere.

HIV prevention in the future will soon begin to look very different from the over-simplistic messages ‘always use a condom’, or the Catholic version, ‘practice abstinence’.

  • When people living with HIV are on effective treatment there are 95% fewer transmissions to their partners (effective treatment provides the double benefit of HIV treatment working well for the person with HIV and also being highly effective at preventing that person from passing on HIV).
  • Among HIV-negative gay men who take a daily Truvada pill, the HIV infection rate falls by 43%; in those who report taking the pill daily (as they should), this rises to 73% fewer HIV infections. Among heterosexual couples where one has HIV and the other doesn’t and the HIV negative partner takes Truvada daily, there are also 73% fewer HIV infections. (This is PrEP)
  • Women using a vaginal microbicide gel containing Tenofovir reduce their risk of getting HIV by 39%.
  • Progress on developing anti-HIV vaccines is frustratingly slow but there is one vaccine that reduces HIV infections by 31%: this is the first HIV vaccine that has showed any benefit.

7,000 newly infected a day

Globally there are 7,000 new HIV infections every day, which is 2.6 million new HIV infections every year (the majority are in sub-Saharan Africa), so reducing this by making PrEP, treatment as prevention, microbicides, and vaccines available, would have a significant combined impact.

Getting HIV To Zero - zero AIDS-related deaths, zero discrimination, zero new infections

However 65% of HIV-positive people still do not receive HIV treatment, and making treatment available to all who would benefit is still the goal of UNAIDS and the global community. The world failed to achieve its ambitious target of treating all who need this by the end of 2010 with 65% still without treatment, so attempting to add PrEP, microbicides and vaccines would further delay and complicate progress on that goal. An additional $1.6 billion has just been announced by the Global Fund to Fight AIDS, TB and Malaria for new commitments over the next three years. UNAIDS latest HIV strategy ‘Getting To Zero’ includes aiming for zero new infections by 2015.

UNAIDS

Pre-exposure Prophlaxis

That disappointing Vatican HIV conference

The Vatican HIV conference in May 2011 was held following the world’s confusion over what Pope Benedict really meant in late 2010, when he said that use of a condom by certain individuals, like a male HIV-positive prostitute, might be a “first step in the direction of a moralisation, a first assumption of responsibility.”

HIV and condoms statement by Pope Benedict XVI in his book.

Some interpreted his words to be a potential loosening of the Church’s long-held stance against condoms, which are “the single, most efficient, available technology to reduce the sexual transmission of HIV,” according to UNAIDS. But the Vatican insisted the statement reflected no change.

Cameroon woman to Pope - but how will I know my husband will be faithful - Pope replies you'll just have to prayondoms“The truth is a condom is seen as something illicit because it goes against the Christian marriage,” said Monseigneur Jacques Suaudeau, from the Pontifical Council for Health Care Workers. “People thought they could continue with their lifestyle thanks to the use of condoms. … To many it was simply a way to continue to be totally irresponsible,” he said, with a large measure of condescending judgementalism.

Archbishop Silvano Tomasi said condoms were presented as a “quick fix” by public health authorities and governments, and claimed the Church has been unfairly accused of standing in the way of HIV prevention by advocating abstinence and faithfulness instead.

“Promotion of behavior change toward more responsible sexual relationships has been much more effective than condom promotion in decreasing new HIV infections,” Tomasi claimed.

As evidence, the Vatican wheeled out Edward Green, the former director for the AIDS Prevention Research Project at Harvard University in the USA, who was almost unique at the conference, a speaker not from the Church. However he’d been invited to the conference because he had a Church-friendly message: he claimed his work shows that only male circumcision and reducing the number of partners have produced declines in a country’s HIV infection rates. Condoms, he claims, encourage riskier sexual behavior and are often not used by people in relationships. “Consistent condom use is achieved by only a small number of people in general populations,” Green claimed.

But globally the consensus of expert evidence and opinion is against him: condoms are still the single most effective prevention method health care workers can offer people, and they are scientifically proven to be highly effective against HIV infection when used correctly and regularly, contrary to some bishops’ ridiculous lies that HIV passes through condoms.

What the global fund for HIV means to Africans - an African mother and babyThe Global Fund to Fight AIDS, Tuberculosis and Malaria provides funds for condom prevention programs, as well as hundreds of millions of dollars to Catholic charities involved in providing health services in the developing world. Christopher Benn, head of external relations for the Global Fund talked to the conference about HIV treatment.

“Condoms are an important element of HIV prevention,” Benn of the Global Fund said. “But this can be done through governments and other agencies.” He emphasized that no single prevention method will stop the HIV epidemic alone.

Filippo Von Schlosser, head of the HIV patient advocacy group Nadir Onlus, based in Rome, said activist organizations like his were not allowed to participate in the conference and that is part of why the Church’s stance on condoms won’t change.

“I think that the Catholic Church has gone so far away from the real life and the human beings [on this issue] that actually nobody listens,” Schlosser said. “I think that the Church has lost a big opportunity.”

Vatican Holds Line on Condoms at Conference

The HIV prevention future

Rolling out HIV treatment to all who need this by 2015, which is part of the ‘Getting to Zero’ strategy of UNAIDS, will make a significant difference to HIV transmission rates, provided everyone with HIV is diagnosed. However a very substantial proportion of people with HIV do not yet know this and therefore can’t be offered HIV treatment. Undiagnosed and untreated people put all their partners at risk of getting HIV. HIV testing rates need to rise sharply to find and then treat all people with HIV. The combination of treatment of people with HIV, and preventive treatment of people at risk of HIV by PrEP, microbicides and vaccines will all contribute, in the not too distant future, to sidelining the Vatican’s ban on condoms. It would be far better if the Vatican supported the use of condoms, but that appears highly improbable in the forseeable future since the Vatican HIV conference let that opportunity slip from its grasp.

 

Also at Queering the Church

Vatican, Condoms and AIDS

So, Let’s Talk About – Condoms and AIDS Prevention

 

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2 comments for “HIV Prevention Drugs Set to Sidestep Vatican’s Condoms Ban

  1. May 13, 2012 at 8:37 am

    The availability of preventive medication is obviously good news, and not only for those who are anxious to conform to church teaching. It will also benefit those married couples who actively want children, and all those who resist condoms for other reasons. Across Africa, the low use of condoms has less to do with Catholic orthodoxy than with cultural factors, and male refusal to have their sexual pleasure reduced by them.
    The impact of AIDS is huge, and the struggle complex and overwhelming. It is sad that in the face of the complexity, the Church’s response that condoms alone will not solve the problem is true, but simplistic. The church’s own solution, pf advocating complete abstinence outside of monogamous marriage, will also not solve it. The fact is that simply advocating abstinence or fidelity, does not magically achieve it.
    In South Africa, where infection rates are among the highest in the world, and funerals of young adults a regular feature of Catholic parish life, I regularly heard from public health professionals that a multi-pronged strategy is essential, often presented as “ABC”:

    A is for Abstinence: the only guaranteed way to avoid sexual transmission is to avoid sex completely, but this  is unrealistic for many people, and inappropriate for an entire population.
    B is for Be Faithful: absolute, mutual fidelity within a monogamous relationship also works – provided that both partners are infection free from the start – and provided that fidelity is absolute. That ideal is not universally achieved.
    C is for Condoms:  for those who, for whatever reason cannot or will not comply with the requirements of A or B, condoms are the only recourse available. While not perfect, the evidence is that where they have been widely adopted, infection rates have fallen.

    Now it seems, we can extend ABC to ABC – and D:

    D is for Drugs: where condoms are rejected.
    Anything that extends the armoury is to be welcomed.

    Your report on the Vatican conference is disturbing. I was encouraged by the advance publicity, which indicated a joint conference of speakers from the Church, and outside experts. That there was just a single external speaker, of distinctly heterodox views, confirms that for all its fine words about respecting the findings of human and social sciences, the only findings of science they respect, are those that support their own pre-convictions.   

    • Chris Morley
      May 13, 2012 at 2:33 pm

      There are already a range of ways for couples where either or both have HIV who want to have children can do so, with minimal risk of infecting an uninfected partner, or of having a baby with HIV. Discussing this with the HIV clinic will identify the best choice for each couple. Preventing a mother with HIV from transmitting HIV to her baby is straightforward these days http://www.aidsmap.com/Mother-to-baby-transmission/page/1044918/.
      This illustrated leaflet gives the key points for would-be parents where either, or both, have HIV http://www.aidsmap.com/v634336406068830000/file/1050017/Having_a_baby_pdf.pdf?

      The ABC HIV prevention formula is viewed sceptically by most HIV prevention experts: it was an unsatisfactory but politically acceptable compromise between abstinence approaches, and proper sex education and empowerment. UNAIDS for example has moved beyond ABC. Most experts argue that you need tailored solutions specific to local needs.
      A major problem with ABC is that it ignores the particular vulnerability of women to HIV and that the use of condoms is not in women’s control. It’s also a strategy that sidelines the needs and issues of  gay and bisexual men and of injecting drug users and it does nothing to prevent mother to baby transmission.
      There’s a discussion of some of the problems and alternatives here http://www.avert.org/abc-hiv.htm

      Trustworthy and useful information on the Vatican HIV conference is in short supply. The Vatican does not appear to have published anything of substance since it happened and I did not find a list of speakers, nor the conference programme. Independent reports from people knowledgeable about HIV are non-existent. I got most of the information from PBS, the US Public Broadcasting System, which had reporters there.

      Edward Green was not the only non-Church speaker, because Dr Michel Sidibé, Executive Director of UNAIDS, for example, was another. WikiLeaks diplomatic cables summarise key points made by some of the conference speakers http://dazzlepod.com/cable/07VATICAN3/

      This Vatican conference was unlike those international HIV experts expect, where speakers with different perspectives make presentations and there’s room for debate and questions; the Vatican also seems to have had no input from people living with HIV. Many years ago international HIV conferences learnt that showing ‘respect, compassion and understanding’ means always including and involving some of the people most affected, those living with HIV: ‘Nothing about me, without me’.

      The Vatican cancelled at the last minute its April 2012 conference about Stem Cell Research. It couldn’t control the agenda and speakers enough.
      One unnamed member of the Pontifical Academy for Life told a news
      agency: “The news of the cancellation of the Congress is an enormous
      relief to many members of the Pontifical Academy for Life, who felt that
      the presence on its program of so many speakers, including the keynote
      speaker, committed to embryonic stem cell research, was a betrayal of
      the mission of the Academy and a public scandal.”
      The official reason given on the website: “Due to serious economic and logistic-organizational reasons that
      have completely jeopardized the success of the 3rd International
      Congress on Responsible Stem Cell Research, the Organizers have decided
      to cancel the event.”
      http://www.boston.com/Boston/whitecoatnotes/2012/03/vatican-stem-cell-conference-cancelled-partly-over-keynote-speaker-george-daley-from-boston/SYR0tP3YoxW5Risl1PcdZP/story.html

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