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Use condoms to prevent AIDS? The Pope versus the Centers for Disease Control

Regarding the use of latex condoms to prevent Acquired Immune Deficiency Syndrome (AIDS):

Pope Benedict XVI, speaking to journalists aboard his flight to Cameroon March 17, said:

One cannot overcome the problem with the distribution of condoms. On the contrary, they increase the problem.

The solution can only be a double one: first, a humanization of sexuality, that is, a spiritual human renewal that brings with it a new way of behaving with one another; second, a true friendship even and especially with those who suffer, and a willingness to make personal sacrifices and to be with the suffering. And these are factors that help and that result in real and visible progress.

The U.S. Centers for Disease Control and Prevention in Atlanta, Ga., said:

Latex condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV, the virus that causes AIDS. In addition, consistent and correct use of latex condoms reduces the risk of other sexually transmitted diseases (STDs), including diseases transmitted by genital secretions, and to a lesser degree, genital ulcer diseases. Condom use may reduce the risk for genital human papillomavirus (HPV) infection and HPV-associated diseases, e.g., genital warts and cervical cancer.

The CDC Web page on this subject included an overview of laboratory studies, medical/scientific theory and epidemiologic data. Regarding epidemiology the CDC concluded:

Overall, the preponderance of available epidemiologic studies have found that when used consistently and correctly, condoms are highly effective in preventing the sexual transmission of HIV infection and reduce the risk of other STDs.

The Pope offered no laboratory studies, medical/scientific theory or epidemiologic data.

March 18, 2009 - Posted by | Medical Care, Pope Benedict XVI, Religion, Science | , , , , ,

7 Comments

  1. Actually, the Pope is probably right. According to Harvard Researchers (http://www.firstthings.com/article.php3?id_article=6172) it has been clearly established that few people outside a handful of high-risk groups use condoms consistently, no matter how vigorously condoms are promoted. Inconsistent condom usage is ineffective—and actually associated with higher HIV infection rates due to “risk compensation,” the tendency to take more sexual risks out of a false sense of personal safety that comes with using condoms some of the time. A UNAIDS-commissioned 2004 review of evidence for condom use concluded, “There are no definite examples yet of generalized epidemics that have been turned back by prevention programs based primarily on ­condom promotion.”

    Edward Green is director of the AIDS Prevention Research Project at the Harvard Center for Population and Development Studies. He wrote Rethinking AIDS Prevention: Learning From Successes in Developing Countries and reported that, between 1989 and 2001, the average number of condoms per male ages 15 to 49 in African countries skyrocketed. So did the number of those infected with HIV. South Africa, Botswana and Zimbabwe had the world’s highest levels of condom availability per man. They also had the world’s highest HIV rates.

    Norman Hearst is a family physician and epidemiologist at the University of California, San Francisco.

    UNAIDS, the Joint United Nations Program on HIV/AIDS, asked Hearst to do a scientific review to see if condom promotions had reversed HIV/AIDS epidemics. His review found the contrary was true. Countries with the most condoms per man tended to have the highest HIV rates. UNAIDS refused to publish Hearst’s findings.

    “Condom promotion in Africa has been a disaster,” Hearst said.

    Nearly every country on the continent has vigorously promoted condoms to stem the tide of the AIDS epidemic there. But the epidemic has only grown larger.

    Uganda, on the other hand, has experienced the greatest decline in HIV prevalence of any country in the world, according to the Heritage Foundation. The Ugandan public education campaign against AIDS mentioned condoms, but emphasized abstinence.

    Studies show that from 1991 to 2001 HIV infection rates in Uganda declined from about 15% to 5%.

    “The Ugandan model has the most to teach the rest of the world,” said Green. “This policy should guide the development of programs in Africa and the Caribbean.”

    Maybe, just maybe, the Pope is on to something.

    Comment by BM Wilson | March 19, 2009

  2. “‘We have found no consistent associations between condom use and lower HIV-infection rates, which, 25 years into the pandemic, we should be seeing if this intervention was working.’

    So notes Edward C. Green, director of the AIDS Prevention Research Project at the Harvard Center for Population and Development Studies, in response to papal press comments en route to Africa this week. ”

    More propaganda, I know, especially since this quote comes from http://article.nationalreview.com/?q=MTNlNDc1MmMwNDM0OTEzMjQ4NDc0ZGUyOWYxNmEzN2E%3D

    Comment by T Joseph | March 19, 2009

    • Thank you for your comment, T. Joseph. Green is a medical anthropologist, not an epidemiologist. The Centers for Disease Control is an institution whose expertise in epidemiology is well-recognized. The CDC quite clear about “the preponderance of available epidemiologic studies” regarding the use of condoms and HIV infection (quoted in the post above). Also, you’re right. The CDC is about science, while the National Review is a conservative political journal.

      Comment by baptistplanet | March 19, 2009

  3. The CDC references you refer to in your initial post state that consistent and correct use of condoms can reduce the incidents of HIV transmission. What scientific studies does the CDC have to show that condoms are used consistently and correctly by HIV infected individuals in subsaharan Africa? Unless there is evidence showing that condoms are used consistently and correctly, the CDC studies are of little to no value in this discussion.

    You did not respond to evidence from the UNAIDS study that concluded that “there are no definite examples yet of generalized epidemics that have been turned back by prevention programs based primarily on ­condom promotion.”
    How do you respond?

    Your argument that Greene is not qualified to speak on the Aids issue because he is not an epidemiologist seems odd, especially since he is a recognized expert in the area and has been selected by Harvard to run the Aids prevent project. I guess Harvard has no idea what it is doing. Even if Harvard is clueless, you failed to address any of the facts that he presents: between 1989 and 2001, the average number of condoms per male ages 15 to 49 in African countries skyrocketed. So did the number of those infected with HIV. South Africa, Botswana and Zimbabwe had the world’s highest levels of condom availability per man. They also had the world’s highest HIV rates. How do you respond?

    Different contributors have been presenting fairly strong evidence by fairly credible sources – the United Nations and Harvard researchers – that show that condoms have not been an effective solution to the problem of HIV transmission in Africa. Instead of dismissing all this evidence as propaganda, perhaps you should actually engage the question and consider the evidence being presented. If you want to really enter into a good conversation – and I hope you do – it would also be helpful if you responded with some evidence to show how spending millions more on condoms will save Africa. I hope you have some evidence, since that seems to be the direction that Obama is going to take us.

    Moreover, on what grounds do you object to the proposal of the Pope to humanize sexuality and be attentive to the suffering? Isn’t that something all Christians should support?

    HIV transmission is, apart from mother-to-child transmission, largely a behavioral disease. The Pope’s proposal – to humanize sexuality – addresses one of the significant behavioral problems that drive this epidemic. Handing out condoms encourages the opposite behavior: it empowers men to be promiscuous and to treat women as objects. There is ample evidence from North America to show that the incidents of divorce, sex before and outside marriage, promiscuity, and adultery all increased dramatically after the legalization of contraception. Perhaps we should do our best to help Africa avoid a similar sexual catastrophe by offering them the real antidote: the Christian conception of love in marriage.

    As I’m sure you know, Christians have been opposed to the use of contraception since the early Church. In fact, all of the mainline U.S. protestant denominations opposed the use of contraception until the 1930s, and some until the 1960s. At this point, the Catholic Church stands alone as the only significant defender of the traditional Christian conception of sexual morality in marriage.

    I think there is some real beauty in the teachings of the Catholic Church on human sexuality. In particular, the teachings on contraception encourage men to exercise self control and practice the virtue of chastity in their marriages (which is not necessary when the pill or condoms are available and men do not have to pay attention to their wives cycles). The teaching of the Catholic Church also encourages couples to act in ways that are natural for our bodies. Rather than asking our wives to load up on hormonal drugs that can cause all sorts of problems, the Catholic Church asks men to make sacrifices for their wives. How can you object to that as a Christian?

    I know that there are lots of good books on the topic of natural family planning. John Paul II wrote a book called Love and Responsibility and another called Theology of the Body. There are also some protestant books, including Open Embrace. I would also recommend a book by Scott Hahn called Rome Sweet Home how the prostestant teaching contraception changed in the 20th century.

    In all, I think this is a difficult issue for everyone. It is certainly more complex than an issue of the CDC versus Pope. I think as humans we all want to find a solution to the AIDS epidemic in Africa and we want to consider all the options. But I think we also have a sense that condoms alone are not the answer and that morality, behavioral change and spiritual renewal are going to be necessary if we’re going to help resolve the Aids epidemic in Africa and restore a sense of decency in America. The Pope’s solution to the AIDS problem asks Christians to offer more than just social programs where everyone gets a condom; the Pope is calling us to love our neighbors and offer them a new vision for their lives. This is a process that will take longer but will have more permanent and lasting effects – even eternal ones. I think the Pope’s message is one that all Christians should consider with an open heart. In the end, no social program engineered in the State Department – will save us; only Christ can do that, and I think that is what the Pope is trying to teach us.

    May Christ’s peace be with you.

    Comment by BM Wilson | March 20, 2009

    • (1) How condoms are in fact used by people in sub-Saharan Africa is not the issue here. Ensuring their proper use there and for that matter here has always been complex, requiring education, incentives and more depending upon the prevailing circumstances. We partly address that in Death, condoms & abstinence in Uganda.
      (2) This post is not about programs “based primarily on ­condom promotion.” It is about the effectiveness of properly used condoms — something the Pope denied, thereby setting off a firestorm of criticism. UNAIDS says “The male latex condom is the most efficient and available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.”
      (3) We don’t say Green is not qualified to speak. We argue that the CDC scientists as a group are more authoritative. They are.
      (4) We say nothing about the Pope’s call to humanize sexuality and be attentive to suffering. We quote that passage for the sake of completeness. The issue here is clearly the effectiveness of properly used condoms (whose use, at all, the Pope seeks to forbid as a matter of church doctrine).
      (5) We deal somewhat more broadly with epidemiological issues in Death, condoms & abstinence in Uganda because there is enough reasonably well-verified data about the course of the epidemic in Uganda to support meaningful discussion.

      Comment by baptistplanet | March 20, 2009

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