The Evidence Supports the Pope’s View about Condoms
By Richard Bastien
In spite of all the media hype about Benedict XVI’s statement regarding the AIDS crisis in Africa, there is ample evidence to suggest the Pope has a point. To judge whether this is true or not, one need only look at the facts, first with respect to the effectiveness of condoms in preventing the spread of AIDS, and then with respect to other methods of fighting AIDS.
As regards the first point, the U.S Centers for Disease Control and Prevention (CDC) acknowledge that condoms do not provide perfect protection against HIV. While their web site starts out by mentioning that “the most recent meta-analysis of epidemiologic studies of condom effectiveness …demonstrates that the consistent use of latex condoms provides a high degree of protection against heterosexual transmission of HIV”, it then goes on to caution that “condom use cannot provide absolute protection against HIV”. More importantly, it says that “the surest way to avoid transmission of HIV is to abstain from sexual intercourse or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected.”
More specific information about the effectiveness of condoms in the fight against AIDS is provided by organizations supportive of the use of condoms. For example, the Guttmacher Institute, whose mission is “advancing sexual and reproductive health”, did a study on The Effectiveness of Condoms in Reducing Heterosexual Transmission of HIV”. The study concludes that the level of protection from HIV provided by condoms “approximates 87 %, with a range depending upon the incidence among condom nonusers”. It also concludes that “the condom’s efficacy at reducing heterosexual transmission may be comparable to or slightly lower than its effectiveness at preventing pregnancy”. (Family Planning Perspectives, 1999, 31(6):272-279).
In short, using a condom does not provide perfect protection against HIV – it merely reduces the risk. It is like playing Russian roulette with better than usual odds. On June 17, 1987, Dr. Maria Crenshaw, past president of the American Association of Sex Educators stood up before 800 sex-educators at the World Congress of Sexology, in Heidelberg, and asked a revealing question: “If you had available the partner of your dreams, and knew this person carried the HIV virus – would you rely on a condom for protection?” Not a single person raised a hand.
The relative ineffectiveness of condoms in the fight against HIV-AIDS is also attested by experience. Indeed, over the past 20 years, the promotion of behavioral changes has proven much more effective than that of condom use. The director of the AIDS Prevention Research Project at Harvard University, Edward C. Green, recently stated that “research has produced no evidence that condom promotion – or indeed any of the range of risk-reduction interventions popular with donors – has had the desired impact on HIV-infection rates at a population level in high-prevalence generalized epidemics.” Professor Green goes on to note that if we are to progress in the fight against AIDS, “we must accept that the evidence is much stronger for fidelity or partner reduction than for any of the standard-package HIV-prevention measures – in Africa at least”. He also mentions that many African countries that have not seen declines in HIV have seen increases in condom use. However – and this is the point that never gets reported -, in every country in which HIV has declined there have been increases in levels of faithfulness and usually abstinence as well. (First Things, April 2008).
Professor Green’s views are consistent with the findings of various learned journals, like Studies in Family Planning which, in its March 2004 issue, admitted that “no clear examples have emerged yet of a country that has turned back a generalized epidemic primarily by means of condom promotion”. The findings published by this journal further indicate that the promotion of condoms has been accompanied in some cases, not by a reduction, but rather by an increase, in the prevalence of HIV/AIDS. The best example in this regard is Cameroun, where annual sales of condoms increased from 6 million in 1992 to 15 million in 2001 – while the prevalence of HIV rose from 3% to 9% of the total population.
James Shelton, of the US Agency for International Development, expresses similar views in the December 2007 edition of The Lancet, one of the world’s best-known medical journals. He mentions that “something is not working” in the fight against AIDS and then goes on to enumerate “ten myths and one truth about generalized HIV epidemics.” One of the myths is that condoms are the solution. “Condoms alone have limited impact in generalized epidemics”, says Shelton. His view is that the priority should be on “the key driver of generalized epidemics – concurrent partnerships”, i.e. the practice of having sex with multiple partners. He advocates programs that enhance partner-limitation behavior – a solution not inconsistent with what the Pope has been advocating.
The foregoing pertains only to the “mechanics” of sexual relations, which suggests that even from the point of view of a crass materialist, the promotion of condoms as a means of fighting against the scourge of AIDS is, at best, questionable. However, for those who still believe that man is endowed with a soul, it may be noted that, to the extent that it removes a disincentive to engage in casual sex, the promotion of condoms contributes to a moral breakdown which can only facilitate the spread of AIDS.
One need not be a pillar of the Church to see that the views expressed by Benedict XVI are eminently reasonable. To dismiss them as “grievously wrong” or as “contrary to the accumulated evidence” reflects an attitude that is based more on ideology than on common sense.
Richard Bastien is the director of the Catholic Civil Rights League for the National Capital Area and a regular contributor to Égards.
Canadian Centre for Policy Studies
On the subject of AIDS prevention, the Pope is right
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