Thursday, April 21, 2005

Religion and AIDS: Does Roman Catholic Teaching Kill?

In the Melbourne Herald Sun, Andrew Bolt challenges the conventional wisdom on AIDS prevention, suggesting that multiple sexual partners, not the lack of condoms, is the real problem in the spread of HIV/AIDS in the developing world.

An excerpt:

It is a fact that Pope John Paul II opposed condoms, telling African bishops again not long before his death that "fidelity within marriage and abstinence outside are the only sure ways to limit the further spread of AIDS infection".

So is this the advice that killed millions?

First, to believe that we must believe Africans are so obedient to the Pope that they won't wear a condom, but also so disobedient that they'll still have casual sex.

We’d also have to believe that more were killed by having unprotected sex outside marriage than were saved by doing as the Pope said and zipping up. We must further believe that most or very many Africans are Catholic, and are hit hardest by AIDS.

Naturally, the truth is the very opposite.

The countries with the worst HIV infection rates in the world turn out to be Swaziland and Botswana, where more than a third of adults have the virus -- but only 5 per cent are Catholic.

Botswana, incidentally, is pro-condoms, not that it seems to have helped much.

In contrast, Uganda, where half the people are Catholic, is the one African country that has slashed its rate of infection -- from a devastating 15 per cent of all adults to "just" 5 per cent. And, heavens, it worked this miracle by doing much as the Pope had preached.

Since 1986, Ugandan President Yoweri Museveni, backed by religious leaders, pushed his ABC program – telling people to Abstain until marriage, Be faithful to their partner, and, if all else fails, to wear a Condom.

This morals-heavy message was not welcomed by the usual condoms-please AIDS experts, many the kind of folk now heckling the dead Pope. Yet it worked so well that Dr Edward C. Green, a prominent AIDS adviser and medical anthropologist from Harvard's School of Public Health, was driven to write Rethinking AIDS Prevention, to warn us to learn this lesson.

"I said it in my 2003 book that the single most important behavioural change (in Uganda) was fidelity, and most of that is marital fidelity," Green has explained.

"The second change is the proportion of youth engaging in sex – that went down in a big way."

Fancy that. Christian morality makes you safer. How scary is that to a progressive? And in case you're wondering, Green says he's a "flaming liberal" who doesn't go to church or even vote Republican. He just follows the facts.

To make things worse, he adds: "Twenty years into the pandemic, there is no evidence that more condoms leads to less AIDS."

If they did Africa, which imports about 700 million condoms a year with the help of international agencies, would not today have 25 million people with AIDS.

Indeed, the University of California's Professor Norman Hearst, who has studied infection rates in condom-happy countries such as Kenya and Botswana, warns that pushing condoms and the safe-sex message so hard encourages people to be promiscuous, thinking they're protected.

They're not, of course. As Hearst says, condoms sometimes fail; so if you have enough sex with enough people enough times, you're flirting with danger.

The moral of the story? The Pope was largely right: saving sex for marriage is the best defence against AIDS. Save sex, not safe sex. We've seen it work, as other leading AIDS workers agree.

Last year, for instance, respected AIDS experts appealed in the British Medical Journal for more to be done to preach faithfulness instead of just condoms.

"It seems obvious but there would be no global AIDS pandemic were it not for multiple sexual partnerships," said the gurus, from groups such as the Global Fund for AIDS, the Bill and Melinda Gates Foundation, and the US Agency for International Development.

Emphases mine. Thanks to Ken’s comment at Kendall Harmon’s blog for the heads-up.

My question: does Bolt set up a straw man? Is the argument he’s answering really as simplistic as “Catholic teaching causes AIDS?” Is it really one of the biggest problems of the developing world that so many of its people are devout Catholics who want to behave and shun condoms, while misbehaving and fornicating constantly? Are those men really going to start using condoms because the church says so? Or is that even the charge?

So much debate over this and every other charged issue gets reduced to polemical soundbites instead of nuanced discussion. Maybe we can see some of the latter in this space...

4 comments:

Pepper said...

Reducing the charge to "men don't use condoms because the church says not to" is too simplistic. Rather, it's a contributor to a culture where condom use is not encouraged. In fact, in many areas where the African Catholic church plays a prominent role, there exists a widespread lack of knowledge about condom use. Misinformation, such as the idea that condoms do not help prevent the spread of HIV, is widely believed. If that is the only channel through which condom use is being discussed within a community, even those who are not Catholic may be affected by the bad information.

Matz said...

Read Pepper's post but replace African Catholic Church with Evangelical Texans and you've got a pretty good picture of Texas.

Garrett said...

The logic required here doesn't require too many jumps or even ideas that are that controversial (from the epidemiologists perspective).

Health in the third world is compromised by

A: lack of access to contraception
B: spread of AIDS
C: reruns of Family Ties
D: being in the third world

Correlate B1: condoms unquestionably stunt the spread of HIV. denying this is silly, and another 30 minute medline search could lead me to write another long post showing that the medical literature supports this notion absolutely.

The Catholic Church
a) discourages distribution and utilization of oral contraception
b) discourages distribution and utilization

Any Logic 101 student can draw the conclusion: the Catholic opposition to contraceptives exacerbates third world problems involving lack of access to contraception and underuse of condoms.

The ONLY debates involve 1) the magnitude of this exacerbation, and 2) whether other aspects of Catholic teachings might offset this exacerbation.

Given the enormity of the problem of maternal-fetal health and HIV in the third world, an argument that states that the catholic church's opposition to contraception and condoms is not related to negative health outcomes seems extremely unlikely, especially given the ubiquity of catholic aid in family planning programs.

any sort of abstinence program has been shown in the US to be ineffectual en masse. do we question that having fewer partners or less risky sexual behavior would not lead to less disease transmission? of course not. we question whether any sort of education campaign based on this sort of behavior modification alone can be effective en masse. again, a quick medline search shows indubitably that anything resembling abstinence education alone is a waste of time and money, and in this case, life.

i hardly think the opposition to the catholic church's policies on contraception and the spread of HIV in the third world is at all a liberal talking point, but simple evident epidemiology.

and that's why we have epidemiology studies. because when a few individuals believe things based on their own experiences that don't mesh with what's happening in the larger scheme of things, we can thus dismiss their conclusions with all the benefits and authority of rigorous statistical analysis.

Jim Bob might say condoms aren't the answer. But Jim Bob doesn't know how to calculate a p value or a confidence interval. Thus, Jim Bob's public health conclusions are veritably useless except possibly within the small niche that Jim Bob might occupy in a much larger universe which he knows nothing about.

Kyle said...

Good response, Garrett. Thanks.

You medical professions must remember, however, that if you want to affect public policy by convincing "laypeople," you must either teach Jim Bob to calculate some p values and confidence intervals, or convince him in some other way.

Or elect more doctors and researchers, whichever you think easiest. ;0)

But you've helped me clarify: indeed the question is to what magnitude RCC teaching exacerbates the problem, and whether other teachings offset this in some way. That's a question I'd like to see argued; have you found anything on it?

Cheers!