The Pope and Condoms in Africa

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Blogged by James Preece on 23rd April 2009

I don't think we're being unreasonable...

The whole condoms in Africa question is one of those issues things that comes up with tedious regularity. I've heard priests (and I'm sure you can guess who, so I won't bother) say that Pope John Paul II was responsible for millions of deaths in Africa due to his stance on condoms which many people believe is clearly to blame. Now some are saying the same about Pope Benedict XVI. The people at "Catholics for Choice" have kindly put together a list of dissenting Bishops and Cardinals. It's a long list (including our own Cardinal Cormac).

The problem for you and I, ordinary Catholics on the ground, is how to explain the Church's position to our not particularly religious friends. Nobody is going to tell us in RE classes or Confirmation courses, nobody is going to explain it from the pulpit. We're on our own. When the people we are with in the Pub proudly announce that they went to a Catholic school "but I don't believe all that nonsense now" and then go on to say that the Pope is responsible for millions of deaths...

What do you say?

The Problem Stated

The question usually centres on a married couple. One of the partners has Aids and the other doesn't. That presents us with two options, either they can have sex without a condom and pass on the Aids virus, or they can use a condom and the other partner can remain safe. Clearly, no rational person would suggest that the couple have unprotected sex, so we should obviously allow an exception to the "no condom" rule on this occasion.

Recently I've started seeing a new variation on this. During his recent visit to Africa Pope Benedict said that Aids "cannot be overcome through the distribution of condoms, which even aggravates the problems", our opponents have a field day with that. Silly Pope.. He thinks that giving people condoms increases the spread Aids!

He's right though.

The Short Answer

What should the married couple do? One of them has Aids, the other doesn't. Should they have sex without a condom and pass on Aids or should they have sex with a condom and be safe? The catch is this.. Condoms are not 100% effective. Scientists are divided about how effective a condom is at stopping Aids but in the Pub we can't start pulling out scientific journals and everybody will assume you're just making it up anyway so stick with the commonly accepted figure that condoms are 99% effective.

So that gives our couple two options: They can have sex without a condom and have a 100% chance of passing the Aids or they can have sex with a condom and have a 1% chance of passing the Aids. The condom is still looking pretty good. Surely the condom is the lesser of two evils?

Except there is a third option, which isn't evil at all. They could abstain from sex altogether.

I used the slightly provocative example of a gun. You can shoot it at your wife fully loaded, you can take a chance and shoot it as your wife with some of the bullets taken out or you can not shoot it. What would Jesus do?

The Full Answer

As your opponent will probably point out. The short answer doesn't do a lot to explain how condoms "aggravate" the problem and it's idealistic. It's all very well having these ideals but you need to get in the real world. You might think it's the right thing to do by your moral standard, but you can't impose that standard on other people. Besides which "Science" has "proved" that condoms are the solution to the Aids problem... Has it indeed?

What if there were no condoms...

The first question I would want to ask anybody is this: Imagine you are that person who has Aids and your partner does not. Imagine you live in a remote village in Africa and you have no access to condoms. What would you do? Would you have sex with your partner and knowingly infect them with Aids?

I'm guessing you wouldn't. I'm guessing that if you understood the risks involved you would be willing to abstain from sex because you don't want your partner to catch Aids. What's more, I'm pretty sure you would think quite badly of anybody who knowingly infected somebody with Aids. I don't think you would call it idealistic for an infected person to avoid sex, I'm pretty sure you would consider it a more of a moral duty.

Whether you think you would succeed or not, I think we can all agree that the right thing to do would be to try and abstain from sex in order to save your partners life. I think we can also all agree that the right thing for a moral leader like the Pope to say would be "If you have Aids, don't have sex because you will give other people Aids and that's bad".

What if condoms were really rubbish...

Still talking hypothetically, the second question I would like to ask is this: Imagine if condoms were really rubbish at preventing Aids. I'm not claiming they are, I'm asking you to imagine the situation. Imagine if condoms were 50% effective so that sex with your partner had a 50% chance of getting Aids after a year of regular sex.

Would you take that chance? Is your own sexual gratification work taking a 50/50 gamble with a persons life, a person you supposedly "love"? I expect you would say not. I expect you would say that such a risk is to high, your partner is worth more to you than that and that you would still abstain from sex.

So what if condoms were 75% effective? Your partner now has a 1 in 4 chance of getting Aids. Would you risk it?

I wouldn't.

What price your partners life?

Ultimately, we're just negotiating a price. What risk are you willing to take with another persons life? What price are you willing to pay for your own sexual gratification? Are we talking about 90% or 99%? Give me a figure? How much do you love your partner? What would Jesus do?

It's not hard is it. If you love your partner, if you want what's best for them, no risk is acceptable. I would have thought our hyper-careful-bubble-wrap-the-children culture would get that. If your child married somebody with Aids, what risk would you be willing to accept?

Damn right the Pope says no.

What the Pope is really saying is that human life has a greater value than sexual pleasure. He's saying it is never acceptable to say "this act might result in my partners death but I will do it anyway because I enjoy it and that's more important than their life".

Is don't think that view is unreasonable. Even if you disagree, I'm not sure how you could possible consider it worthy of the kind of derision and mockery it usually receives.

Do condoms really "aggravate" things?

Recently the Pope came under fire for suggesting that condoms actually make the Aids situation worse.

Let's compare the two situations. In the absence of condoms we have a situation in which people are very much aware of the risks involved and do their best to avoid infection. If you knew that sex with a stranger would result in a deadly disease, I expect you would be very careful to avoid sex with strangers. If you knew that sex with your partner would result in her contracting a deadly disease, I expect you would think very hard before having sex with your partner. If you knew that having sex with your partner would result in you contracting a deadly disease, I expect you would think even harder.

Now introduce condoms with their magical promise of "safe" sex. Why not have sex with a stranger? Why not have sex with your partner? It's safe and even if it isn't you've done nothing wrong because you did your best and used a condom. The fact is, that in Africa the "married couple where one partner has Aids" problem isn't the cause of the spreading of Aids, it's the "lots of people have more than one sexual partner" problem.

So we've gone from a situation in which people infected with Aids feel morally obliged to avoid sex and people without Aids are strongly motivated to avoid sex with Aids carriers, to a situation in which people infected with Aids feel they are covered morally by condom use and people without Aids have a false sense of security. What difference do you think that's going to make to the amount of risk taking going on?

The Pope isn't alone on this, Harvard Scientist Edward C Green is not a Catholic nor does he consider it wrong to use condoms for contraceptive purposes, but he agrees with the Pope: Condoms make things worse...

...intuitively, some condom use ought to be better than no use. But that's not what the research in Africa shows.

Why not?

One reason is "risk compensation." That is, when people think they're made safe by using condoms at least some of the time, they actually engage in riskier sex.

[...]

...ongoing multiple concurrent sex partnerships resemble a giant, invisible web of relationships through which HIV/AIDS spreads. A study in Malawi showed that even though the average number of sexual partners was only slightly over two, fully two-thirds of this population was interconnected through such networks of overlapping, ongoing relationships.

So what has worked in Africa? Strategies that break up these multiple and concurrent sexual networks -- or, in plain language, faithful mutual monogamy or at least reduction in numbers of partners, especially concurrent ones.

[link]

A Question of Choice

At the end of the day, whether condoms agravate the situation or not (and I think they do), the Pope isn't there to treat the people of Africa like animals in a zoo. He isn't there to say "African people are animals who can't help having sex so we have to allow them to use condoms". The people who think condoms are a magical solution to Aids tend to talk a bit like that.

As Christians we believe that all people are made in the image of God and endowed with the ability to make their own choices. They have the ability to choose between right and wrong, the freedom to choose the good. Abstinence, sacrifice of ones own sexual acivity for the benefit of others is the more loving, more christlike thing to do.

But what would a celibate Pope know about abstaining from sex?

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Reader Comments

roddy said...

Very interesting,thanks James!I agree with your point of;"what is an acceptable risk."I have just been on the website of Planned Parenthood America.It seems that the risk of pregnancy,whilst using condoms as contraceptive,varies from 2 in every 100,if used correctly to 15 in every hundred if uncorrectly used.Does this same risk apply to HIV infections?Also,Dr Remien of Columbia university explains"Post Exposure Prevention."This requires antiviral therapy and must start within 72 hours of the suspected break in the condom;again,I am no expert but does the treatment exist in rural Africa?

antonio said...

Excellent discussion indeed.
I just want to add a few points:
1. that condoms are not a solution, is easily showed by the compared ratios of condom "exposure" in African countries (usually gifts from First world countries) and HIV infection;
2. this is also made more obvious from the well known fact that free distributed condoms have not been effective in Europe, too; quite luckily, not in relation to HIV but to pregnancy ratios in teenagers (but unluckily, this means too often other deaths... abortions);
3. this is also supported by the statistical truth that the infection ratio is almost the same, now, in Uganda and in Washington D.C., where condoms are obviously quite easy to find;
4. and finally it is worth remember that Catholic (and Muslim) countries in Africa have the lowest infection ratios. That SHOULD be enough to stop talking nonsense about the Church being responsible for all these deaths, and so son.
I do not think that occasional imperfection of the lattex or similar reasons are the main reason of these facts. I just guess that almost nobody wears always (and when I say always I mean always) his condom... But nevertheless he (and she) feels protected. This is a danger.
Excuse my poor English.

Sharon said...

that condoms are not a solution, is easily showed by the compared ratios of condom "exposure" in African countries (usually gifts from First world countries) and HIV infection;

Antonio could you give me the site where the info re ratios of condom exposure in African countries is compared to HIV infection? This would be very useful information to have.

Athanasius said...

That is a very well written article, James - well done. Congratulations also on your TV performance, I thought you were magnificence when considerably outnumbered.

One thing I might add (which I suppose the secularists would never buy) is that - as you say - the argument is often put forward that it is not realistic to expect people to abstain. Not only is this untrue, as you illustrate and the evidence from Uganda and the Philippines proves, but it also encourages a rather dismal approach to humanity. It says that we can never expect the best from people; that humankind, once fallen, must always remain fallen. That is as depressing as it is untrue (by our Catholic vision).

martin said...

An excellent article, a brillant example of clear logical thinking.

Dennis Johnson said...

In an RE classroom, far, far away (but still in England), pupils are being taught that any sexual activity outside of marriage constitutes a grave sin, as does the use of all artificial contraception. Do not despair.

Magnus said...

My wife and I really enjoyed reading your post. Wonderful stuff.

Sharon said...

James, what if the HIV infected partner doesn't particularly care if the other contracts HIV or not? Many women in the third world don't have the luxury of choice.

PaulineG said...

Cracking article James. Thank you.

Just one point: You imply that X% effective means the risk of the initially healthy partner contracting HIV/AIDS (AIDS) after a year of regular sex with an infected partner is X%. Is that the correct interpretation of the X% effective claim? Surely, the risk overall must depend on the number of times the partners have sex over the year.

I suspect (and would be interested if anyone has linked information on this) that the 99% effective figure applies to each instance of sexual intercourse. What follows is based on that interpretation.

If the probability of avoiding AIDS is 99% after one usage, then the probability of having still avoided AIDS after 2 usages is 0.99 x 0.99% or 98%. (Basic probability theory)

Similarly, after 5 usages the probability of having still avoided AIDS is 95%.

OK, now lets look at the situation over a year and assume, for the sake of argument, the couple has sex once a week. (Why ever not? After all they're having 'safe' sex, are they not?) The probability that the initially healthy partner is still healthy has reduced to 60%. That is, there is a 40% probability he or she now has AIDS.

After two years the probability of infection has risen to 65%. After 5 years it is 92%.

Is this information being distributed with the condoms?

No?

So who is really responsible for all those deaths in Africa?

Matthew A. Siekierski said...

PaulineG,
Typically, failure rates for contraceptives with regards to preventing pregnancy are measured over the course of a year. So if condoms have a 99% success rate (a number that assumes proper and consistent use, not typical use), that means that over the course of a year 1 woman out of 100 using just condoms as a means of birth control will conceive.

That's how the numbers work, that I've seen. But that's for pregnancy, not contracting HiV. I don't know what infection rates are for those using so-called protection, if there are any, nor how those numbers are calculated.

All of that isn't really important, though. Would you put a gun to your head and pull the trigger if your gun had 100 cylinders and only one bullet? Would you do it multiple times? I wouldn't.

PaulineG said...

Matthew,

Thank you. I completely agree with your last paragraph: It makes no sense to expose your partner or yourself to that risk.

But the point of my query is that, if my suspicions are correct, those who are being encouraged to use condoms on the basis that sex with an infected partner is 99% safe are being deluded. Rationally, one would never take that risk. But not everyone is rational and for some a 1% risk is no risk at all.

If, as you suggest, that 99% figure is intended to be for a year then it must either incorporate an assumption as to how frequently the partners have sex or be based on empirical evidence. If so, from where? What studies? What circumstances? What culture? What part of the world? Have these studies been verified? That is, have they appeared in a reputable peer-reviewed journals and, if so, which?

These are rhetorical questions. I remain very suspicious of a 99% figure which is not caveated in some way given that it must depend on (as they say in the insurance business) the 'exposed to risk'.

I just hoped someone would be able to provide some evidence one way or the other.

Max Walker said...

"Ultimately, we're just negotiating a price. What risk are you willing to take with another persons life? What price are you willing to pay for your own sexual gratification? Are we talking about 90% or 99%? Give me a figure? How much do you love your partner? What would Jesus do?"

Weak and fatuous argument. By getting in a car and driving down the road there is a high probability you will kill someone. So why aren't you and the pope rallying against vehicle usage? Indeed why aren't you rallying against ALL "evils" which place others in any probability of danger whatsoever? E.g. hedge trimmer usage, fan usage, power socket usage, egg consumption etc. etc....

-1

James said...

You make a good point.

For what it's worth, the Church does speak out against dangerous driving. Back in June 2007 the Vatican released a document on Pastoral Care of Road Users and the media had a field day with the "Ten Commandments for Motorists" (Times, BBC). So the Church isn't only obsessed with condoms, it worries about cars as well.

The document says that "Our attitude when driving should be the same as if we were using dangerous tools, and therefore being very careful." and also that "When drivers endanger their own and other people�s lives [...] they are guilty of a serious shortcoming, even when such behaviour does not cause accidents, because, in any case, it entails serious risks."

As you point out, it would be impossible to lead a life entirely devoid of risk. We do however have a moral duty to avoid "serious risks" and sex with an Aids carrier, even if you use a condom, constitutes a serious risk.

I should point out that the Church objects to condom use in this situation for reasons other than just the risk involved, so even a hypothetical 100% perfect condom would also not be allowed.

Perhaps I should have written about those reasons isnstead...

Joe said...

Congratulations to this great article and your defense of the Faith on TV. I agree 100%

Here is a question for you which I find a bit confusing.

I think one can quite easily say that taking a knife to a robbery it is objectively better (and perhaps less evil) than to take a dynamite.

Does this principle apply to condoms as well? Even though sex outside of marriage is gravely evil (one way or the other), would it be somehow less evil to use a condom under certain circumstances?

Here is how I understand it. We were made man and women and it is within the bond of marriage that we are called to be fruitful and multiply. Anything outside of that bond is an abomination and thus using condoms is no longer an issue because there is no call from God to be fruitful and multiply outside of marriage (only a call to be abstain). So it's would not be more sinful have a sex with a prostitute with condom than without it. It would perhaps be more sinful to have a sex with her without a condom if there was some great danger involved.

Of course even if this is correct it would not pose a problem against what Pope has said because a) we cannot hand out knives to criminals so they stop using dynamite - that would be a formal cooperation with evil, no? - and b) promoting condoms promotes the culture of death.

What do you say?

Rachel said...

James, great article.

About a woman who's not able to refuse sex, it's only incumbent upon her to insist as much as she can on the right thing (not being raped with or without a condom). She's not guilty of anything that's forced upon her.

I don't remember the numbers, but condom failure rates for HIV are always higher than failure rates for preventing pregnancy. This is because HIV is much smaller than a sperm cell, and because a woman can only get pregnant for a few days in her cycle but HIV can be transmitted any time.

Max Walker, there is NOT a "high probability" that you'll kill someone if you go driving. None of your examples are even remotely as dangerous to others as having sex if you're HIV-infected. You know that yourself, because you'd readily engage in any of your listed activities but you'd sure as heck think twice before sleeping with someone who has HIV.

About treating people like animals who can't control their lust, here are some people who are calling for condoms to be made available for free in all pubs, clubs, and taxis.
http://www.telegraph.co.uk/news/uknews/1572765/Binge-drinking-behind-sexual-health-epidemic.html

Magnus said...

readers may also like to see the following link supporting the Holy Father's comments from another specialist in the epidemiology field..

http://www.internationalrelations.house.gov/110/hea092507.htm

Liam said...

James
I'm a lazy sod and I have not read all the comments so if you have answered this question already please ignore this post.
Total continence may be the only way, but it is a very hard thing for people to hear without a lot of help, PRACTICAL help. Remember the words of our Lord "But he said: Woe to you lawyers also, because you load men with burdens which they cannot bear, and you yourselves touch not the packs with one of your fingers" LK 11:46.
Unless the Church gets out of its head and into its heart, I believe it cannot speak to people on this matter

Elizabeth said...

Fantastic, really clear post. Thanks.

Harry said...

I agree completely with James.

-3

Jay said...

Absolutely ridiculous. Not nearly as smart as you think you are. Hypothesies are all very well but not reality. Get off the computer, travel the world and you'll see what it's really like out there. Arg, so infurriating reading stuff like this

Mark Dobson said...

Do you realise that it's possible to disagree constructively?

I mean, James lays out his thinking, so everyone can see it. You say it's rubbish, insult his intelligence, suggest that thinking it through won't help (for an unspecified reason), tell him to get off the computer (from, we can only assume, your computer) and tell us that you're frustrated.

Are we edified? We are not.