Friday, March 20, 2009

Benedict Has It Right The truth about condoms, and Africa

By Travis Kavulla

Benedict XVI is in the middle of a week-long trip to Africa, his first visit to the continent as pope.

There are many issues in African Christianity that are fascinating and worthwhile, from the church’s social advocacy on corruption and governance, to the continent’s evangelical religious upheaval. But you probably will not be hearing about them. No — the media coverage of Benedict’s Africa visit will revolve mostly around one thing: condoms.

The Vatican’s position on artificial contraception, elaborated in Pope Paul VI’s 1968 encyclical Humanae Vitae, is one of the Catholic Church’s most enduringly unpopular dogmas. From a public-relations point of view, the church’s take on condoms is the Catholic equivalent of Bible-thumpers’ creationist weirdness. Both viewpoints are, to the average semi-rational Westerner, some combination of unjustifiably absolutist and embarrassingly backward. As a French NGO worker in Cameroon, where Benedict arrived Tuesday, quipped, “Is the pope living in the 21st century?”

The pope, as everyone knows, has a knack for mis-explaining his views — or sometimes over-explaining them, his nuances soaring well over the heads of illiterate Muslim radicals and the press corps alike. The condom issue is the perfect opportunity to be misunderstood, and Benedict performed in line with expectations. Even before touching down in Africa, the pontiff reaffirmed the Vatican’s position from his Alitalia charter by saying that the continent’s AIDS epidemic “cannot be overcome through the distribution of condoms, which even aggravates the problems.”

This may sound rather baffling to a person who “knows” (we will get to hitches in that “knowledge” in a moment) that condoms do prevent, as a medical certainty, the transmission of HIV if used properly.

Knowing this — and perhaps only this — the pope’s critics have not labored themselves with the details. The most polemic accuse the pontiff of nothing less than abetting murder. Others, like CNN’s Roland Martin, sneer at the Vatican’s “ignorance of reality,” a label that fits neatly with the usual caricature of the “conservative” Benedict or his “ultraconservative” cohort as being dramatically out of touch with everyday human reality.

The pope, of course, is not actually “ignorant.” The Vatican knows well what it is doing, and the church is not deaf to the suffering of those Africans living with AIDS. Indeed, Catholic Relief Services and Caritas Internationalis (the U.S. and worldwide Catholic relief agencies respectively) are leaders in distributing antiretroviral drugs, and in so doing have saved thousands of lives.

But the Vatican’s message on preventing HIV in the first place is often muddled. So here, for the record, is a summation of the Catholic argument. It begins with the premise that while the AIDS epidemic is the result of a virus, it is as much a social as a viral illness. It is not something one catches merely by inhalation or shaking hands or other passive contact. The transmission of HIV in the vast majority of cases can be traced to an elective and deliberate act of sexual intercourse.

Thus, the Catholic logic goes, the disease should be treated essentially as a social ailment. The goal should be to promote widespread delays in becoming sexually active among young people and, when they grow up, encourage them to form committed relationships. Merely mediating a risky behavior with mechanical prophylaxis is wrong because it gives tacit permission to the sex act, and undercuts the moral authority of these larger social goals. In any case, if condoms are to be used regardless, the church should not sully its own approach.

This strikes me as a fairly solid argument, one that deserves a thoughtful reply. But, once the knee-jerk reactions are put to one side, the public-health lobby’s reply is to lament how “unrealistic” the pope is being. The Catholic position seems naïve to the average Westerner who, thinking of himself and his own society’s inability to regulate its collective sexuality, applies this lesson on the impossibility of self-restraint to the whole globe.

In fact, such Westerners, before they criticize Benedict for being unrealistic, may first want to calibrate their own sense of reality to African standards. Because where abstinence and monogamy have been most vigorously promoted, the HIV-infection rate has declined the most dramatically. Particularly, this is true of Uganda, where evangelical Christian influences have imbued the country’s AIDS policy with a moralizing outlook and an emphasis squarely on behavior change. The message was: You have the power to change your behavior and, if you do not, you may very well die.

It proved to be startlingly effective. In spite of the expectations of public-health wonks, Uganda saw a “60% reduction in casual sex . . . equivalent to a vaccine of 80% effectiveness,” according to a review of the policy published in the journal Science. In the wake of the policy’s implementation, Uganda became one of the first African countries to post a decline in the HIV-infection rate.

In contrast, there is little reason to treat condoms as an implement beyond reproach in the fight against AIDS. Let us consider their mere mechanics. In Africa, they have a fail rate per usage of anywhere from 1 to 4 percent. Let’s assume a sexually active teen or 20-something — those age-groups most at risk — takes advantage of the supposedly care-free sex that condoms bequeath to their users, and has sexual relations 100 times over a year or two. Now, statistically, the condom will fail one to four times biannually, in a place where perhaps one-quarter of the population is HIV-positive — putting the condom-user at substantial risk for contracting HIV.

This is the best-case scenario, where condom use is rigorous — and even then, the door is still left ajar to HIV infection. Even more likely is that those who do receive condoms through a public-health organization will not use them in every sexual encounter. And most people will not use them at all. In Africa, there remains a huge cultural obstacle to condoms that is not merely the result of ignorance and lack of condom availability.

HIV in the West was transmitted mostly through casual sexual encounters in discrete populations. The anonymity of the one-night stand and the visibility of one’s cohort dying off so quickly encouraged the quick uptake of condoms in the 1990s. In Africa, on the other hand, the disease is spread wide through society — the target population for any public-health campaign is much larger — and many medically risky African relationships are long-term. Condom use in these seemingly “trusting” relationships is very low and, in any case, would rob them of one of their primary purposes: to produce children, the risk of HIV infection notwithstanding. One can preach condoms in an African society, but many of these polyamorous relationships will be unreceptive to their usage.

One can advocate the science of condoms right up until the point where it becomes a cultural disagreement, between the public-health lobby and Africans themselves, over the intrinsic value of sexual intercourse. That is the level that the debate has now reached. Decades of witnessing AIDS stalk the land have not naturally convinced Africans in dramatic numbers to use devices that are understood to be “life-saving.” Can we expect them to be convinced by the harangues, the budgetary largesse, and the snazzy ad campaigns of the West? I think not.

In its obsession with condoms, the Western public-health community has been every bit as dogmatic as the pope. And it has been even more blinkered to the realities of Africa, which is arguably in the grips of a huge religious and moral revival that has a huge potential to be wielded in the fight against AIDS. Church attendance is soaring, and Africans are willing to make sacrifices, of both their money and their pleasure, for moral causes. In this respect, it is not Benedict and the Catholic Church who are out of touch. It is the West and its condom myopia.
-- Travis Kavulla is a journalism fellow of the Phillips Foundation and was last year a Gates Scholar in African history at Cambridge. He writes from Kenya.