The Catholic Church, HIV/AIDS and Condoms

Richard Bernier

Last revised January 19th 2007

•  First, let us assume for the sake of argument that condoms are 100% effective in preventing HIV/AIDS

•  What is the Church saying to unmarried people ?

• Don't engage in extramarital sex;
• What is at stake is not only your health but the good of children, the sanctity of marriage, your own spiritual welfare, etc. Because, therefore, of HIV/AIDS but also because of many other values, chastity is the Church's advice to the unmarried ;
• The Church calls us to holiness, which isn't a matter of half-measures; of course common sense shows that the Church prefers us to commit the least evil. So if people are engaging in unchaste activity, they shouldn't compound the evil by spreading disease, and risking pregnancy outside of a stable family structure;
• But even on the assumption that condom promotion is 100% effective, we can't expect the Church to become a condom marketer , anymore than her pastors can go on record saying (for example) “Don't rob dépanneurs; but if you must rob a dépanneur, at least do so at knifepoint rather than with a firearm so that danger of fatal injuries will be less”;
• When the Church's teaching is blamed for some part of the HIV/AIDS epidemic, accusers are making the ludicrous assumption that the populations involved are totally attentive to the Church when it comes to refraining from condom use - even though, where HIV/AIDS is a problem, populations are clearly generally disregarding the Church when it comes to chastity.

•  What is the Church saying to married people ? (still assuming 100% effectiveness of condoms)

• Contraception is contrary to God's plan, though natural methods of family planning ( eg sympto-thermal) are permitted when there is good reason to avoid pregnancy (1);
• The principle of double effect (2) seems to permit the use of medically indicated procedures or drugs even when these have a conception inhibiting effect;
• Therefore, there is a legitimate debate right now about whether condom-use-by-a-married-couple-to-prevent-HIV falls into the category of permissible acts (3).

•  However: Condoms are not 100% effective (4), and a new set of moral issues arises:

• If there is even a 1% chance of infection with condom use – and this is entirely consistent with the acknowledged range of condom effectiveness even with 'perfect use'- should a loving spouse run this risk for the non-infected spouse?
• The data shows (5) that condom promotion has not been effective in preventing the spread of HIV in Africa (though it appears to be so in Thailand , where HIV is spread primarily among prostitutes). “No clear examples have emerged yet of a country that has turned back a generalized epidemic primarily by means of condom promotion.” (6) What has been more effective ( eg Uganda ) is abstinence programmes as well as social values in favour of chastity. Ugandan First Lady Museveni had this to say in 2004:

“The message was simple, and it was this: that AIDS is transmitted mainly through heterosexual contact (in the Ugandan context); that it has no cure and leads to death; that young people can avoid it by completely abstaining from sexual activity until they are married; married people should stick only to their marriage partners and be faithful, and those who have risky lifestyles should use the condom to reduce the likelihood of infection or re-infection in the case of the already infected…

Looking back, I can say that the message of Abstinence and Faithfulness has been effective in Uganda for four main reasons. First of all, it is simple and uncompromisingly strong in its intention, and it is delivered continually and with consistency. Secondly, the alarm that was sounded by the political leadership has been taken up and magnified a thousand times by every responsible citizen. The third reason for the effectiveness of the message of Abstinence and Faithfulness is that it was based on the traditional and cultural beliefs and moral framework of the people of Uganda … Traditionally, in Uganda , sexual purity was required… Happily, sexual purity and faithfulness to one's marriage partner were also emphasized by the Christian tradition when it was introduced in Uganda , a century ago. Even the people of the Muslim faith attach great importance to strict moral conduct among the young. The fourth reason why the message of Abstinence and Faithfulness has been effective in Uganda is that people have been confronted with the horror of death, first hand and at close quarters. There is no person, young and old, in Uganda , who has not witnessed a loved one, a family member, or a neighbor, suffer horribly and die prematurely because of AIDS. In such a situation, facts tend to speak for themselves. The sight of fallen comrades is a strong deterrent, and a clear sign that a change in behavior is called for..” (7)

• There is a further possibility that condom promotion as the primary means of addressing HIV/AIDS may be counterproductive, given the high rates, in practice, of failure in condom use. That is, if condom use leads to higher rates of sexual activity (which seems to be the case) but really effective condom use is difficult to ensure, there will actually be higher rates of infection than if other strategies such as promoting abstinence and delaying sexual involvement are the primary solutions (8).

On April 25th, 2006, the Zenit news service (Zenit.org) published a press release concenring a study to be conducted by the Holy See toconsider the issue of possible licit uses of condoms in response to HIV/AIDS:

"The question the study addresses in particular is that of couples united in sacramental marriage, in which one of the spouses suffers from AIDS.

The discussion as to whether in such cases it would be licit to use a condom to save a life arose with the idea of the establishment of the Good Samaritan Foundation in September 2004. The Vatican-headquartered group aims to financially support the neediest sick, in particular those suffering from AIDS.

"In that process the discussion arose over the action of condoms in cases of married couples with AIDS," Cardinal Lozano Barragán said. "This discussion took place in John Paul II's last months of life, but John Paul II was very, very conscious of these problems. I know it through personal experience, because I had access to him in this respect." "

The results of this study have not yet been released.

NOTES:

1. For a detailed explanation of such a method, see Evelyn BILLINGS, The Billings Method , (Toronto: Life Cycle Books, 1998).

2. This principle maintains that it is permissible to do a good action even if it entails a bad consequence, provided the bad consequence is an unintended secondary effect, provided the action is not intrinsically evil, provided the bad consequence is not the means by which the good is accomplished, and provided also that the good obtained is proportionate to the bad caused. The classic example is a hysterectomy when a pregnant woman developes uterine cancer; the hysterectomy will save the woman's life and is therefore permissible, even though a very regrettable unintended (though foreseen) secondary effect is the death of the child in utero . See Benedict ASHLEY, Living the Truth in Love , (New York: Alba House, 1996), pp. 141-143. Fr Ashley's work is a fine introduction to Catholic moral theology.

3. See Benedict GUEVIN and Martin RHONHEIMER, “Debate – On the use of condoms to prevent AIDS”, National Catholic Bioethics Quarterly (Spring 2005, vol 5 no 1), pp. 37ff.

4. While there are methodological difficulties in establishing a theoretical (ideal) rate of efficacy for condoms, many studies suggest that under the best conditions, condom effectiveness both as a contraceptive and as a prophylactic is around 90%; see Hearst and Chen, cited below, p. 40.

5. See Norman HEARST and Sanny CHEN, “Condom promotion for AIDS prevention in the developing world: Is it working?”, Studies in Family Planning (March 2004, vol 35 no 1), pp. 39ff.

6. Ibid. , p. 41.

7. From an address by Her Excellency Janet K. Museveni, First Lady of Uganda, at "Common Ground: A Shared Vision for Health" Conference, hosted by The Medical Institute for Sexual Health, Washington, DC June 17- 19, 2004. Retrieved from http://www.medinstitute.org/Museveni.htm. (The text of the address has been removed from the Medical Institute website but it can be found here).

8. See, for instance, John RICHENS et al., “Condoms and seat belts: the parallels and lessons”, The Lancet , (no 355; January 29 th , 2000 , pp. 400-403) who warn of one such counterproductive effect.