Wednesday, April 1, 2009

By Father Earl Fernandes

In his online report March 20, John Allen of the National Catholic Reporter wrote: “It’s almost as if the pope has made two separate visits to Cameroon: the one reported internationally and the one Africans actually experienced. In the U.S. and many other parts of the world, coverage has been ‘all condoms, all the time,’ triggered by comments from Benedict aboard the papal plane to the effect that condoms aren’t the right way to fight AIDS. In Africa, meanwhile, the trip has been a hit…”

What did Pope Benedict XVI say and what has been the church’s response to the global AIDS crisis? The answer to the latter question helps explain the former.

A translation of the pope’s remarks reads: “I would say that one cannot overcome this problem of AIDS only with money. These (funds) are necessary, but if there isn’t the soul (anima) which knows how to apply them, they do not help; one cannot overcome it (AIDS) with the distribution of condoms: on the contrary, they increase the problem.”

To understand these remarks, we must look at how the church responds to the global AIDS crisis. The church is unjustly blamed for “millions of deaths” due to AIDS because of church teaching on contraception. But the issue for he church is not principally about contraception. Catholic moral theologians, who accept the church’s teaching on birth control, are engaged in a complicated and vigorous discussion about the morality of condom use in HIV prevention strategies.

For the church, the issue is about offering real solutions to the people affected by AIDS. The church’s response to the global AIDS crisis is three-pronged. First, the church responds through works of charity and mercy. More than one-quarter of all AIDS-related care (spiritual and bodily) is provided by Catholic organizations, priests and religious, Catholic hospitals and orphanages. In many areas, the Catholic presence is the only response to the AIDS crisis.

Second, the church responds to the crisis through her vast network of schools. Providing people with an education and labor and communication skills helps fight some of the effects of AIDS, which are worsened by structures of poverty. In a special way, the church helps women to have a greater sense of self-respect, opportunity for work, and economic independence.

Third, the church responds to the AIDS crisis by promoting behavioral change and virtue through her moral teaching.

This third component marks the sticking point. While in the West many associate HIV with high-risk groups (homosexuals, commercial sex workers, and intravenous drug users), globally HIV/AIDS affects the heterosexual population. Among high-risk groups, there is a record of reducing HIV prevalence through condom use. Some presumed that the same strategy would be successful in a heterosexual epidemic.

The response of the political and scientific communities has been to promote a technological solution to the problem (condom promotion, research and development of a cure, a vaccine, gel, anti-retroviral drugs, etc.); these efforts would be “funded” by developed countries. Scientists and politicians have been reluctant to make judgments about people’s sexual choices, so they promote a technological approach rather than a behavioral change. The scientific evidence indicates that this approach, largely condom promotion, has never brought about the reduction of HIV prevalence in a heterosexual epidemic.

These HIV prevention strategies rely upon consistent and correct use of condoms, which rarely happens in many cultures. Westerners have failed to account for the cultural values, include family life and the gift of children, of sub-Saharan Africans. Husbands and wives do not use them because they want to welcome children. Some refuse to use condoms because they associate them with the commercial sex industry. Often women are not in a position to refuse husbands who may be HIV-positive; there are many instances of marital violence in which negotiation for condom use is impracticable. Many find this approach inadequate, believing that because of inconsistent and incorrect condom use people are actually exposing themselves to greater risk of infection.

On the other hand, in Uganda, where condom use was only a minor part of HIV prevention efforts, there has been a noticeable decline in HIV prevalence, because the government worked with the churches to emphasize primary behavior change — delay of sexual debut (abstinence) and partner reduction (fidelity). Some behaviors are medical risk factors for HIV. Primary behavior change, which involves discipline and virtue, was essential to reducing HIV prevalence. People need the skills that allow them to avoid these risky behaviors; this is where the Catholic Church’s role is pivotal. That is why the pope says that money is insufficient for overcoming AIDS. We need solutions that reach the human heart and which address issues of character, behavior, poverty and violence. It is an integral view of the human person, of friendship and of human sexuality that provide the true solution to this problem. Amin Abboud, an Australian bioethicist, suggests the effectiveness of the role of Catholicism, in its teaching and presence:

“A regression analysis done on the HIV situation in Africa indicates that the greater the percentage of Catholics in any country, the lower the levels of HIV. If the Catholic Church is promoting a message about HIV in those countries it seems to be working. …The solutions go beyond mere latex. If anything, the holistic approach to sexuality that Catholicism advocates, based on the evidence at hand, seems to save lives.”

Father Earl Fernandes, STD, is the dean of Mount Saint Mary’s Seminary and an assistant professor of moral theology. His doctoral dissertation is titled Marital Sexual Communion and the Challenge of AIDS: A Critical Inquiry into the Responses of the Scientific and Political Communities and of the Catholic Church to the Crisis of HIV and AIDS (Rome: Academia Alfonsiana, 2007).