The Pope, condoms, and some real contributions to HIV prevention on the ground

November 22, 2010

Posted by Kevin Orr

Regional Programmes Manager, Africa

Will the Pope’s brief statement about condoms end up being a step forward or a step back?  What effects will it have in practice, once this gets debated, distorted, re-clarified and finally interpreted by Catholics and non-Catholics alike?

The news shows a lot of quick reaction – either this is an about-face for the Catholic Church, or the Pope “does not in any way think the use of condoms is a part of the solution.”  Father Lombardi, the Vatican spokesperson, said the Pope’s words are further reasoning on established teaching, but “certainly” not “a revolutionary shift”.

There is even some disagreement on what the Pope actually said – was he condoning use of condoms by “male prostitutes” only, as it appears in the book’s English translation, or was he actually referring to women sex workers, which is what the Italian version indicates?

Some of the more balanced news stories point out that bishops in Africa have been saying for years that the church should accept condoms as part of the fight against AIDS, at the very least among couples where one of the partners is living with HIV.

And people working on HIV in different contexts have also understood for decades that the Vatican’s stance has not always reflected what’s put in practice by Catholic leaders and community workers in countries that are highly affected.

Most importantly, people in dioceses in many African countries joined with others in providing care and support for people directly affected by HIV – starting almost 30 years ago, a time of terrible HIV stigmatisation when this was not an obvious thing to do.

Beyond that, for the sake of prevention it was a Catholic priest, working in Tanzania in the early 1980s, who first thought of the three boats,’a simple but more considered way of talking about the ABC choices, which has been used over and over in different countries:
Be faithful, having sex with one uninfected partner, or ,
Condom use.

The message was simple: AIDS is like a flood, and “do not stay in the water, climb into a boat!”

Crucially, the three boats’ message also said something that hadn’t been made explicit before: “If life becomes dangerous or unbearable on board of a ship, switch from one boat to another.”  You can always go back, especially if you stay safe.

If you want to read more about faith-based approaches, a ten year old issue of AIDS Action is still a good read, and clearly still relevant given how far we’ve come.

On difficult issues for people working in communities, it addresses the simple topic of talking about sexuality.  “Some people also believe that promoting condom use could result in people practising ‘unacceptable’ sexual behaviour rather than abstinence.”

“However, research has shown that educating young people about sex, HIV and AIDS and health in general does not result in increased sexual activity, but leads to a decrease in adolescent sex, unwanted pregnancies and STIs.”

This research has never been disproven.  Still, many young people in developing countries – even those who get to attend school – still have no real access to sex education that really helps them make informed decisions, to enjoy their sexuality and exercise reproductive choices while figuring out their principles, and to get on with their lives.

As for the Vatican’s clarifying statement, it also indicated that “the condom is not the solution to the problem” and that it is important to “ensure that sexuality is treated as a positive value and to enable it to have a positive effect on the whole of man’s being.”

Okay: from a public health point of view, this would mean the right approach includes:

•    Not treating the A, B and C options as a political football, or making a false dichotomy between the A and B choices versus C

•    Providing full information and skills building for young people and adults who will find themselves having to make choices in real life situations

•    Going beyond ABC messages and condom promotion, to combination prevention that includes these things but also addresses underlying social issues – starting with women’s empowerment

    Meanwhile, the Catholic News Service says that four years ago the Pontifical Council for Health Care Ministry completed a 200-page study on condoms for HIV prevention.  But the report is still on hold, “in part because there was not unanimity of opinion, and in part because of fear that the nuances involved would only invite confusion in the media and among Catholics.”

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