Abstinence, fidelity and the church on AIDS prevention

By  Rev. Michael Czerny, S.J., Catholic Register Special
  • April 3, 2009
{mosimage}On a plane last month taking him to Yaoundé, Cameroon, Pope Benedict XVI was asked whether the church’s approach to AIDS and HIV in Africa was realistic and effective.

First, the Holy Father explained the church’s holistic program. He pointed out how the church’s approach of dealing with ignorance and misery on many fronts is naturally different from the necessarily narrower approach of public policy. Then the Holy Father critiqued the further reduction of public policy to a single means and method: “the problem cannot be overcome by the distribution of prophylactics: on the contrary, they increase it.”

This fragment of the Pope’s reply launched a media frenzy which has left many perplexed, saddened and even outraged. Let’s look at what Pope Benedict XVI actually said and meant.

In Europe and North America where condoms are culturally accepted by many, people ask, “Why on Earth does the church oppose their promotion?” Some have even accused Popes John Paul II and Benedict XVI of presiding over an AIDS genocide.

According to prevention experts, a condom when it is correctly used can reduce the risk of HIV infection during an act of intercourse, and individuals who use condoms consistently are less likely to give or get HIV.

When a man and woman have sex before, within or outside marriage, modern public health is unconcerned with the morality of what they do in the privacy of the bedroom. Culturally and legally, in Europe and North America, there is considerable acceptance of sexual behaviour as long as it is consensual. In this context, the condom seems common sense.

The church, however, understands sexual intercourse as part of a moral vision. Catholic faith permits intercourse only within a marriage and excludes artificial means of contraception. Doing something wrong might be safer with a condom, but safety doesn’t make the act right. The church cannot encourage “safer sex” outside marriage without suggesting it is somehow right. To say “Do not commit adultery but, if you do, use a condom” is tantamount to saying “The church has no confidence in you to live the good life.”

A man and woman not married to each other who have consensual intercourse are disregarding the church’s teaching. They hardly need the Pope to tell them to use a condom. What they badly do need is for the church to help them live a respectful and responsible sexuality.

“Abstinence and fidelity are not only the best way to avoid becoming infected by HIV or infecting others, but even more are they the best way of ensuring progress towards lifelong happiness and true fulfillment,” said the African bishops in 2003.

In the age of AIDS, there is a special case — married couples who are discordant (one spouse being HIV-positive) or doubly infected (both being HIV-positive). Here, the church accompanies a couple pastorally in making the most life-enhancing decision about their lives, their family, their marital relationship and their desire to have children.

They deserve the same respect and dignity as every other Christian, which includes help to form their consciences. That’s not a neatly packaged solution dictated to them from the pulpit, much less from the press or a billboard.

What of the many situations that make Africans, especially women, more vulnerable to HIV infection — poverty, conflict, displacement, abuse and rape?

We can imagine a discordant couple, where the husband refuses to be tested, insists on intercourse and invokes church teaching not to use a condom. Involved in several layers of self-deception, the man is not entitled to claim the moral high ground, putting his wife’s life at risk. But no general solution is going to address the evils at work here. At the parish level, the church can and usually does offer moral formation, encouraging people to get tested and defending the rights of women.

As for a strategy for whole populations, there is widespread belief that condom-use programs are effective in reducing HIV infection rates. However, this proves true only outside Africa and amongst identifiable sub-groups (prostitutes, gay men), not in a general population.

There is no evidence that condoms as a public health strategy have reduced HIV infection rates at the level of the whole population. Greater availability and use of condoms is consistently associated with higher (not lower) HIV infection rates.

How does an aggressive condoms policy “increase the problem”? It deflects attention, credibility and resources from more effective strategies such as abstinence and fidelity.

Abstinence and fidelity win little public support in dominant Western discourse, but they are vindicated by solid scientific research and increasingly included, even favoured, in national AIDS strategies in Africa. The Pope has identified correctly where the emphasis should go — toward maintaining mutually faithful monogamy. Not to be underestimated is the custom, ridiculed in the West but prized by many ethnic groups in Africa, of preserving the woman’s virginity before marriage.

Promoting condoms as the strategy for reducing HIV infection in a general population is based on statistical probability and intuitive plausibility. It enjoys considerable credibility in the Western media. What it lacks is scientific support. Some specialists in prevention of HIV assume that, since vast numbers of people do not know whether or not they are infected, condom use should be automatic, mandatory and universal. Yet 95 per cent of Africans between 15 and 49 years of age are NOT infected.

Knowing your status is a crucial step towards taking responsibility for your actions. Several Africans have told me that once they tested positive, they made a firm option for abstinence rather than risk infecting someone else.

The fact is, culture counts.

A condom is more than a piece of latex. It makes a statement about the meaning of life. In Africa fertility is prized and the condom seems foreign and strange, and the values it embodies alien. A Jesuit in South Africa wrote to me, “Most people here think that ‘the Pope and condoms’ is a side-show, stoked up by the media, and not an issue on which we want to spill more ink or destroy more forest.”

So when Benedict XVI affirmed that “the distribution of prophylactics … increase(s) the problem,” it was not a casual remark or a gaffe. He had good grounds for saying so.

(Czerny directs the African Jesuit AIDS Network from Nairobi, Kenya.)

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