Amid the uproar surrounding Pope Benedict XVI’s often-misunderstood remarks on condom use in the book “Light of the World” (Ignatius Press, $21.95) the pope and other Vatican officials have continued to stress the Church’s teaching that reliance on condoms is not the answer to stopping the spread of AIDS.
And according to noted researcher Edward C. Green, the Church has more than moral reasoning to support its stance. Green, director of the New Paradigm Fund in Washington, D.C., and former director of the Harvard School of Public Health’s AIDS Prevention Project, cites “mounting empirical evidence” that widespread promotion of condoms as the so-called “best weapon against AIDS” has had little success in decreasing the number of cases.
As detailed in his recent book, “Broken Promises: How the AIDS Establishment Has Betrayed the Developing World” (Polipoint Press, $17.95), research in Africa — where two-thirds of the world’s HIV infections occur — paints a different picture of how to best control the spread of the disease. Green discussed with Our Sunday Visitor what his research reveals and the Church’s role in AIDS prevention.
Our Sunday Visitor: What are the general global trends in the spread of HIV/AIDS today?
Edward Green: HIV prevalence has declined globally, including in Africa. UNAIDS says that the rate of new infections has declined by 25 percent. The trouble is, they say this in a way that suggests that its formula for condoms, testing and drugs has been the reason for this decline. It has not been, especially in Africa. My colleagues and I looked closely at the first eight or so African countries showing prevalence decline, and in all cases the proportion of men and women reporting more than one sex partner in the previous year had declined. In most cases, the proportion of unmarried teenagers reporting they are sexually active has also declined. I would say these behavioral changes came about not because of major interventions, but rather in spite of them.
OSV: Pope Benedict XVI has been outspoken on this issue, arguing that the promotion of condom use as the primary weapon against the spread of AIDS is failing and may even be worsening the situation. Is there evidence that supports this view?
Green: Yes, there is evidence, especially in Africa. When people think they’re safe by using condoms at least some of the time, they tend to engage in riskier sex. Another factor is that people seldom use condoms in steady relationships because doing so would imply lack of trust. However, it is these ongoing relationships that drive Africa’s worst epidemics, not casual or commercial sex, where there is a chance that people will use condoms.
OSV: Would the same approach that’s worked in Africa be as successful elsewhere in the world?
Green: This approach should certainly work with both forms of sexually transmitted HIV, heterosexual and homosexual. When I started reporting my research findings a dozen or more years ago, I was naive about the politics and ideology supporting what I saw as a failed paradigm. For example, I had no idea that “faithfulness” was considered an offensive term among certain groups in the West. Or that many feminist groups would be against marital or couple fidelity, not in theory perhaps, but they would depict African women powerless and chronically victimized by men, therefore they knew a priori that fidelity would not work in Africa. Meanwhile, African women would like nothing better than for husbands to listen to the fidelity message and follow it. This is not to say women do not also need the message.
OSV: Do you think people are more dismissive of the abstinence and fidelity message when it is presented by the Church?
Green: Now that’s an interesting question. Many Western activists find moral language confrontational, insulting or otherwise problematic. Most Africans are religious, whether Christian or Muslim. They have no problem hearing or using moral-ethical language. I’ve never really heard an African opposed to the promotion of abstinence or fidelity, unless they are on a non-African salary and are expected to oppose them. I think sexual restraint should be promoted by both religious and secular organizations. It is not easy to change or influence sexual, or other, behavior. It requires genuine social mobilization, and this cannot be done — especially in Africa — without major input from religious groups.
OSV: What do you think the role of the Catholic Church needs to be in helping to stop the spread of AIDS?
Green: I think Catholics and other faith groups should acquaint themselves with the true facts of AIDS prevention and feel empowered to continue to promote faithfulness and abstinence. The Church should, of course, continue to take care of the sick and dying, reduce stigma discrimination, provide clinics and hospitals, educate people, etc.
OSV: How is the spread of antiretroviral drugs impacting AIDS prevention efforts?
Green: Everyone is again jumping on the bandwagon, with the promise that we can end AIDS soon, if only we have the political will to come up with more billions of dollars every year for AIDS. This was the message from the UN and from the Global Fund at the Vatican meeting. We need to remember our public health history. We tried to eradicate syphilis many years ago. It seemed feasible to trace partners and give everyone a single shot of antibiotic. Yet syphilis is still very much with us. And compare that effort with tracing everyone who might have had contact with an HIV-positive partner in rural Africa, and then persuading them to take several pills a day for the rest of their lives. The truth is, we cannot keep up with the rate of new infections. The only sensible, public health approach is sound prevention.
OSV: Having participated in the recent Vatican conference on AIDS, do you think it helped to advance understanding of the issue?
Green: I’m not sure of the purpose of the conference. I don’t think it clarified the Church’s position on condoms, even though a few outside speakers expected it would — or that it even did. I personally think condoms should be sanctioned among married discordant couples [in which one partner is infected] — actually, all discordant couples — even though we know married people rarely use condoms, no matter how they are provided or promoted. But the Church takes a moral position and I take a public health position. I have been saying to my non-Catholics colleagues, “Keep on trying with condoms, but don’t be surprised when they don’t deliver on their promise.” Because that is what the evidence shows, especially in Africa.
Scott Alessi writes from New Jersey.
Global Epidemic (sidebar)
According to a 2010 report by UNAIDS, the Joint United Nations Program on HIV/AIDS, HIV infections are prevalent in all corners of the world:
Region - Number of HIV Infections
Sub-Saharan Africa 22.5 million
South and East Asia 4.9 million
Central & South America 1.4 million
North America 1.5 million
Western & Central Europe 820,000
Eastern Europe/Central Asia 1.4 million
Middle East/North Africa 460,000
Total 33.3 million