THE HIV/AIDS PANDEMIC:
PREVENTION AND CARE

CONDONING CONDOMS

In a sense I am a condoner of condoms against HIV, while in another sense I am not.  In the first I follow a theory to its conclusion, in the second I am moved by prudence and pragmatism.  My purpose here is to discuss this apparently contradictory position.

I accept that condoms may have many uses, not all of them bad.  A witty contemporary, Father Paddy Benson, used to say of Father Joe McSweeney, who could certainly not be charged with laxity in moral theology or his religious life, that he had always used a condom when he was chaplain to Montgomery’s Eight Army when it was sweeping Rommel out of the Libyan Desert -- he used it to protect his watch against the fine desert sand.

I have seen one used as a finger-stock when there was nothing more edifying available.  So I accept that the difference between a condom-as-contraceptive and a condom-as- prophylactic is real and that one may use a condom to prevent HIV transmission, allowing its contraceptive action, according to the Principle of Double Effect.

For this reason, if the condom-as-prophylactic were 100% effective and as safe as abstinence from sex outside marriage as well as fidelity within it, I would have no objection to the “Protect Yourself with a Condom” campaign. I might even be part of it.

REAL SITUATION

That is a theoretical position.  Coming to the real world, condoms are not safe.  Dr. Jacques Suaudeau demonstrated this in a magisterial article as far back as 1997 in “Medicina e Morale''.  Since then we have more authorities evidence.

In single acts, even when used perfectly, condoms will fail to stop the passage of HIV at least 10% of the time, that is, once in every ten acts with HIV present.  I had an e-mail letter conceding this from the Director of Population Services International, the makers of Chishango (shield) condoms in Malawi.  Unfortunately I lost this in a hard-disk crash.  Like people who get HIV, I thought it could not happen to me.  When it did, it was final.  In fact the failure rate of condoms is probably much higher.

A leading condom expert in the United States of America, Susan Weller states, “Condom effectiveness or the risk reduction due to condom use can be estimated at 69%.  However, true effectiveness may be as low as 46%.  It is a disservice to encourage the belief that condoms will prevent transmission of HIV.”

For the sake of argument I will use the lower figure of 46% in what follows.

Our confrere Father John Moore is well known as a scientist and statistician.  He tells me that if you take a one-in-ten risk once a week for eighteen months, it becomes a risk of nine hundred and ninety nine in one thousand: 999/1000.  In other words, in a series of acts the one-in-ten risk of getting HIV when using a condom can rise to virtual certainty.  If you go on relying on condoms for protection you will eventually be unprotected against HIV.  To get HIV once is 100% failure.

The Center for Disease Control (March 11, 1988 -- to be found on their Web Site), under the heading “Perspectives in Disease Prevention and Health Promotion; Condoms for Prevention of Sexually Transmitted Diseases,” says: “Prevention through avoiding exposure is the best strategy for controlling the spread of sexually transmitted diseases (STD).…  Abstinence and sexual intercourse with one mutually faithful uninfected partner are the only totally effective prevention [I prefer to call this '‘avoidance''] strategies.''

Proper use of condoms with each act of sexual intercourse can reduce, but not eliminate, risk of STD.  Individuals likely to become infected or known to be infected with the HIV virus should be aware that condom use cannot completely eliminate the risk of transmission to themselves or to others.  So there is no such thing as “protected sex”.

In view of that, it is surprising to find the United States Physicians Consortium and the Catholic Medical Association in a joint statement (July 24, 2001) accusing the Center for Disease Control of not “telling  the  whole truth about condoms” and of “withholding from the American people the truth of condom ineffectiveness.”  They recall that only four days previously, the US Department of Health and Human Services had released details of research on condom effectiveness.  “This document,” they say, “supports our contention that condoms offer extremely limited benefit to our patients.”

It gives the risk rate in using condoms against HIV as 15%.  “There is a health model,” the Doctors add, “that completely protects against all STD’s, it is abstinence until marriage with an uninfected partner and monogamy thereafter.”  That is the model that Jesuits should be promoting.

EVIDENCE

The presentation of Stoneburner et al. to the last World AIDS Conference (Durban 2000) confirms this from the field.  They collected data on condom use and abstinence from over 98,000 persons in Uganda, Kenya, Malawi as well as Zambia and analysed HIV infection trends in those countries as shown in the table below

The researchers commented as follows:

1.   An important element of the Ugandan success was that knowledge about AIDS was passed on through personal networks of friends and family.  (This suggests that the strategy of Fertility Awareness and Maternal Life International, FAMLI in Malawi is correct: to teach Fertility Awareness with values to young and old in order to lead them to personal decisions).

2.    Prevalence declines in Uganda relate more to reduction in sex partners than to condom use.

3      The potential impact of behavioural change interventions    like    those   in Uganda is equivalent to a vaccine of 80% efficacy.  If applied in South Africa in 1999 it would save 3.2 million lives in ten years.

The ineffectiveness of condoms can be gauged from the fact that they have
been promoted for years without any visible effect on the AIDS epidemic. Condom sales have gone up, but HIV rates have not gone down.

CONDOM PROMOTION

The promotion of condoms encourages the behaviour it is essential to change.  Advertising of Malawi’s condom, Chishango, is aimed at selling condoms and not at checking HIV. They are aphrodisiacs rather than safeguards. The message underlying the campaign is that everybody is doing it, but with a condom you are safe.  I believe we are going to see verified what one condom expert has written: “Contraceptives encouraged sexual activity and the new acceptability of sexual freedom encouraged contraception.”  (“Condoms”. British Medical Journal Books, 2000, page 9. BMJ Publishing Group, London, WCIH 9JR.)  The campaign for condoms will result in increased sexual activity, the very conduct we need to discourage.  The inevitable failure of condoms will lead to HIV infection in a deadly spiral.

President Yoweri Museveni of Uganda said “I have been stressing a return to our time-tested cultural practices which emphasize fidelity and condemnation of premarital or extramarital sex….  Meanwhile we are being told that only a thin piece of rubber stands between us and the death of our continent.”

Therefore, It is wrong to tell people without qualification that they are safe with a condom, or to tell them to use condoms without letting them know the real danger into which they are going.  Anyone who condones condoms such as they are now in practice, lend themselves to that deceit, which is why I do not want to do it.

CONCLUSION

Our attitude to ''Human Life'' (Paul VI, 1967) may influence us here.  If you accept its teaching and reject the condom as a contraceptive, it may be difficult for you to accept even theoretically that the condom might have a role to play in preventing the spread of HIV.

If on the other hand you allow contraception in principle, you may find it hard to swallow that the morality of the Encyclical and the Church’s stand on extra-marital sex are now pragmatically the only safeguard against passing HIV around.  As long as we follow International Planned Parenthood Association (IPPF), United States Agency for International Development (USAID), and others in trying to have it both ways -- “Abstain, but if you cannot, use a condom” -- we are doomed to failure.  That is why I, for one, will go on proclaiming that while sex with a condom may be less dangerous, it is certainly not safe.

Richard Cremins, S.J.
Jesuit Community
Lilongwe

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