Did He Or Didn't He? The Pope and Condoms

The Pope's comments on condom use have been hailed by campaigning groups and the liberal media as a breakthrough, a long-overdue recognition of the gap between dogma and reality. But what did he actually say? And, more to the point, what did he actually mean?

Last year, Benedict said that condoms worsened the spread of AIDS and the Vatican did nothing to contradict Cardinal Trujillo who claimed that the virus could permeate condoms. They have consistently preached that abstinence is the only moral defense against HIV/AIDS while millions die around the world.

The Pope's latest message to the world was part of an interview with German Catholic journalist Peter Seewald for a new book, Light of the World: The Pope, the Church and the Signs of the Times.

It appears that the Pope said condom use can be acceptable in certain cases, where the protection of life was the primary aim, not the prevention of life (ie, contraception). He apparently said that male prostitutes could use condoms as a step towards 'acting responsibly' - because there is no chance of contraception between two men, presumably. Not that the Vatican has shifted its position on homosexuality one inch.

Benedict has caused a right old flap at HQ with spokesmen falling over themselves to explain what he 'really' meant. Rev Federico Lombardi said the remarks were unprecedented but that they were given 'colloquially', not as part of official church teaching. In case that wasn't clear, Sandro Magister, a Vatican reporter, explained that there is a 'graduated spectrum of authority' between official church teaching and conversational papal remarks.

The Vatican newspaper, L'Osservatore Romano, broke an embargo to say that condom use was justified in some cases. But then the Rev Joseph Fession whose Ignatius Press published the English version weighed in and said that the Italian translation was wrong. The German and English versions talk about male prostitutes while the Italian version refers to female prostitutes. The Pope approved only the German version.

Confusion reigns. Asked by the website of the US-based National Catholic Register whether Benedict's statement indicated that in some cases condoms were permissible, Cardinal Raymond Burke said: "No, it's not." Again, get your act together, guys. Did some of you not get the memo?

But at a press conference in the Vatican to mark the launch of the book, Lombardi said: "I personally asked the pope if there was a serious, important problem in the choice of the masculine over the feminine," Lombardi said. "He told me: 'No.'"

However, a spokesman for the charity Caritas said that bishops conferences in Southern Africa in 2000 and in Chad in 2002 had already sent out pastoral letters to church workers advising them to follow their conscience when advising married couples where one partner was infected.

Other Catholic outlets jumped in to say that the Pope had not changed the church's teaching on condom use and that L'Osservatore - the Vatican's own newspaper, remember - had betrayed him. Blaming the media for getting the wrong end of the stick or going for sensational headlines is often entirely justified, but in this case, it's the Vatican's own mouthpiece that is getting the blame. The right hand really doesn't know what the left hand is doing. You'd really think that after nearly 2000 years at this game they would have got their act together.

What the Pope said was (probably, until the next refutation or 'clarification'):

'There may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be the first step in the direction of a moralization, a first assumption of responsibility, on the way towards recovering an awareness that not everything is allowed and that one cannot do whatever one wants. But it is not really the way to deal with the evil of HIV infection, that can really lie only in a humanization of sexuality'. The Pope added that the church can never regard condom use as a 'real or moral solution'.

What the 'humanization of sexuality' might be is anyone's guess. Presumably, he means sex only between a lady and a gentleman who are married and want to make babies.

Condoms still absolutely cannot be used for contraception. One of the pope's most senior officials, Cardinal Rino Fisichella, told the press conference it was "intrinsically an evil". Could we get some 'clarification' on that?

Maybe this has opened a debate. Maybe the Catholic Church will be forced to discuss condoms and HIV/AIDS. Maybe charity workers on the frontline will continue ignoring HQ and taking the more humane course of action. Whatever happens, the Vatican comes out of this looking like a bunch of amateurs who can't even give a consistent message.

The Pope explained earlier in the book why nothing a Pope says in an interview should be regarded as authoritative. Except for all the other parts of the book that the Vatican doesn't disagree with. So what it boils down to is that the Pope was just having a bit of a chat, what he said doesn't count because he wasn't wearing his big Popey hat at the time and didn't start the sentence with 'Simon says...'

If there are any further 'clarifications', I'll post them here.

Women and AIDS

HIV/AIDS is now the leading cause of death worldwide in women of reproductive age. UNAids has launched a five year plan to deal with the gender inequality and human rights violations behind this epidemic.

The plan by the joint United Nations Programme is called Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV (2010-2014).

One of the main drivers of the epidemic is violence against women. According to the factsheet, some 70% of women worldwide have experienced violence. Country studies indicate that women suffering it have a risk of becoming HIV positive three times higher than women who haven't. In South Africa, UNAids say, a woman is raped every minute. Forced sex increases the risk of infection through tears and lacerations. Too often, violent crimes against women and girls are committed with impunity. Violence against women is one of the clearest indicators of gender inequality and the status of women in a society.

There are many social and cultural factors that put women at risk. For example, in some countries it's common for men to have sex with much younger women. In some settings (for example Southern Africa) this contributes to a three times higher infection rate for women 15-24 than it does for men the same age. In the Caribbean, young women are around 2.5 times more likely to be HIV infected than young men. Men are expected to have multiple sexual partners and often refuse to use condoms.

Women are likely to have problems accessing HIV prevention, treatment and care services due to limited decision-making power, lack of control over financial resources, restricted mobility and child-care responsibilities.

When their partners die, many women lose their homes, inheritance, livelihoods and sometimes even their children. Many of them are forced to become sex workers to survive.

Lack of education can also be a barrier both to avoiding infection and to living with it. Two thirds of the children not in school worldwide are girls and two thirds of illiterate adults in the world are women. In Africa and Latin America, girls with more education tend to delay their first sexual experience and are more likely to insist that their partner uses a condom.

The Agenda contains plans to

• produce better, evidence-based, research and data on the specific needs of women and girls and the socio-cultural and economic factors that prevent them effectively protecting themselves
  


• push governments to act on their stated commitment


• work with key strategic partners


• support women's groups and networks


• encourage men's organizations to support the rights of women and girls.


• work with influential religious leaders to use their influence to support the rights and needs of women, to reduce the stigma of HIV and the right of women to live without violence

Many governments have made a commitment to improve human rights and gender equality for women but so far have done little or nothing about it. The Agenda will encourage them to reform and enact legislation to guarantee impartial, immediate and serious legal consequences for acts of violence against women - including rape both within and outside of marriage.

UNAids recognises that it's essential to work with women, using their experience, knowledge and expertise to help them take control of their own HIV prevention. A lot of these women are marginalised, living with HIV, sex workers, disabled women, women of diverse sexual orientation, migrants, refugees, drug users, racial and ethnic minorities, women in prison and so on.

Changing the attitudes and behaviour of men and boys is another essential part of prevention. This could prove difficult as ideas are so deeply entrenched in many cultures of gender roles, identity, status and rights. Any incentive to change needs to be framed in terms of improving men's health and other social benefits as well as improving women's lot. Strongly patriarchal societies are not going change easily.

Despite the intention to work with religious leaders, there is no mention in the Agenda that it will address the promotion of abstinence as the first and only defence against infection or the opposition of the Catholic church and some evangelical churches to condom use. This is a major problem in some parts of the world, denying information and even lying about the effectiveness of condoms. It also means that many people have to choose between their faith and their health. Religion in some areas also clearly casts women as second class citizens, worth less than men.

Although the Agenda focusses on the developing world, this is not a problem exclusive to those areas. For example, it is acceptable in most parts of the world - and even expected - that young men will have multiple sex partners, many men still refuse to use condoms, many young women are not well-informed about infection risks and sex education in some countries (including the UK) is patchy at best.

Violence against women is not limited to the third world either. Statistics for rape convictions are still depressing reading, date rape and marital rape are contentious areas, it is only comparatively recently that the law in the UK started paying serious attention to spousal abuse and some religious groups still promote the idea that women should be subservient to their men (the latest edition of The Freethinker carries a story about two vicars preaching that women should be subservient to their husbands and one of those stories is reported in The Guardian).

The UNAids Executive Director said: "Violence against women is unacceptable and must not be tolerated. By robbing them of their dignity we are losing the opportunity to tap half the potential of mankind. Women and girls are not victims, they are the driving force that brings about social transformation".

Circumcision and HIV/AIDS: 2

Ritual circumcision is a different area but its practice in South Africa, for example, has important ramifications for the promotion of circumcision as an HIV/AIDS prophylactic.

 This story was in the news this week:

 Eight boys have died and three are in hospital after botched circumcisions in the South African province of Mpumalanga, officials say. The teenagers were at an initiation school in the town of Kwamhlanga. One of the initiates died in hospital and the seven others were found by health officials dead at the school.

These circumcisions were done as part of a widespread traditional rite of passage for boys before they can be considered men and play a full adult role in their community.

 There are two separate issues here, the ethical/moral and the medical.

Commenting on another culture’s traditions has become taboo in some circles thanks to Post Modernism and cultural relativity where one culture may not be judgmental of another, especially if it’s a Western culture commenting on a Third World one. This is seen as a kind of cultural imperialist invasion or at best patronizing and ignorant. Just because something is considered wrong in one culture doesn’t mean it’s wrong for another. Everyone’s traditions and beliefs should be respected because there are no absolutes.

 The question of whether it is a cultural crime to raise ethical and Human Rights objections to children being mutilated without their consent, putting their health and sometimes their lives at risk is not the subject of this current post. But the serious implications for HIV/AIDS prevention is germane.

 The South African Government recognizes the health risk of ritual cutting; in 2001 it passed an act (The Application of Health Standards in Traditional Circumcision Act) requiring a license from a medical officer for each (male) circumcision. But the act seems to be having little effect. In July last year, 15 boys died and 90 were taken to hospital after botched circumcisions. The main causes of death and hospitalisation are blood loss and dehydration.

 Despite the Government’s attempts, community leaders are resisting medical supervision and licensing because, as they said, this ‘infringed community rights’.  Protecting children’s lives is apparently less important than protecting beliefs.

Researchers found that ‘in general, communities considered morbidity and mortality as par for the course. Interviewers were told that "deaths and injury were seen as a way of separating out those boys who were not fit to play the role of men in society." Compounding this 'natural selection' technique, another popular belief is that if an initiate suffers medical complications, he has brought it upon himself through some form of wrong doing, and is therefore being punished.

 There may be cultural resistance to condom use – albeit a different kind of resistance, based on male preference rather than ancient tradition – but overcoming entrenched beliefs about who has the right to cut boys and in what context (ritual rather than clinical) makes it difficult to see how an initiative to encourage it as a preventive will work in areas where it is seen as belonging to cultural practice, a ritual based on a belief that may not be invaded by science – even in the minimal form of sterile conditions and instruments.

 Moreover, some research has found that ritual cutting can increase infection rates:

Traditionally an assegaai is used. Implements may be blunt or reused. This practice has been implicated in the spread of blood-borne infections, such as Tetanus, Hepatitis B and STDs, including HIV/AIDS (source as above).

 In addition, one researcher has revealed a further problem:

 Of late, the practice has degenerated into a money-making operation. People pay as much as R400 per boy for the attendance of (circumcision) schools. The schools are launched annually at some localities (as opposed to the old tradition of every five years) (as above).

 Illegal procedures will prove even harder to monitor and medicalise.

 Even if it were possible to tap into an existing culture of circumcision to use it as a preventive, research done in South Africa and published in the South African Medical Journal states that:

 It is, however, questionable how circumcision, and particularly neonatal circumcision, could achieve such a goal. A rational and critical analysis of the scientific evidence ought to conclude that non-therapeutic infant circumcision is merely the medicalisation of an old ritual that should not, in the 21st century, be advocated as prevention strategy for HIV/AIDS. (my underlining)

 This whole article is worth reading.

 The evidence against circumcision is stacking up. The statistics do not show that it is an effective protection. Ritual circumcision is likely to prove an obstacle to (the alleged benefits of) medical prophylaxis and may also worsen the problem.

Finally, some further information from this article to add to last week’s post about the situation in America, the country behind PEPFAR, a major partnership initiative to promote preventive circumcision in America.

 Teens 15 years and older in the USA have the highest rate of STDs in any industrialised country and half will contract a sexually transmitted disease by age 25, despite two-thirds of young males having been circumcised. Such reports suggest that the social experiment of circumcision to prevent STDs, including HIV, has already failed in the USA, which has the highest rate of non-therapeutic infant circumcision in industrialised countries and the highest rate of HIV in the developed world.

 The call for neonatal non-therapeutic circumcision for prevention of HIV by some members of the Catholic Church suggests misunderstanding of the local context, and supporting genital surgery on newborn boys but discouraging the more effective preventive measure of condom use lacks logic.

 Of course, it is not just the Catholic Church and Catholic organisations that are anti-condom (and often pro-abstinence), there are other religiously-inspired organizations promoting circumcision as the list of PEPFAR partners discussed in the previous post shows.