At a two-day international conference on HIV/AIDS in Rome last weekend the Vatican reiterated its stance on condom use – never, in any circumstances.
The Catholic Church’s strategy is a combination of caring for infected people and so-called education of consciences, claiming to put human dignity at the centre of its AIDS policies. It is one of the largest providers of HIV/AIDS care in the world but its unmoving doctrine on condom use is often accused of causing millions of needless deaths and the related suffering they entail. They won't help you avoid getting infected but they will look after you when you are. Which is nice.
The conference was organised by the Pontifical Council for Health Care Workers. One of its aims was to address the confusion over the Pope’s statement last year that condom use might be justified in some circumstances to prevent disease transmission. It was made more than clear that’s not what he meant. Absolutely not. Ever. As if they hadn't already covered that one.
Just before the conference, Vatican moral theologian Father Perez-Soba provided a trailer when he published an article saying that condoms make the AIDS epidemic worse because they encourage immoral behaviour. According to him, using a condom shows a lack of respect for the other person.
His advice for married partners where one of them is infected is simple – stop having sex. Ever again. He also wrote that ‘a sexual act carried out with a condom cannot be considered a fully conjugal act.’
Monsignor Suaudeau of the Pontifical Academy for Life backed him up by saying ‘Chastity is joyous’. The Academy's remit is: 'to pay honor to pure science, wherever it is found, and to assure its freedom and to promote its research, which constitute the indispensable basis for progress in science'. Scientists of the world, look away.
The position of the joint United Nations programme on HIV/AIDS (UNAIDS) is that the correct and consistent use of condoms is an integral and essential part of HIV prevention, along with education, limiting sexual partners and marital fidelity.
Not everyone has those options. Much effort has gone into educating sex workers – both male and female - around the world into using condoms. Elizabeth Pisano's excellent book The Wisdom of Whores looks at initiatives with sex workers. It also shows just how unrealistic Vatican diktats about sex are in pretty much every way.
It’s hard to see how human dignity can be respected by preaching celibacy (something the Catholic Church itself has proven to be rather weak on) while ignoring human nature and the realities of life. The Vatican’s unchanging position is both unrealistic and inhumane. But to expect anything else from them is also unrealistic. The only real question is why they bothered having the conference.
Showing posts with label condoms. Show all posts
Showing posts with label condoms. Show all posts
Wednesday, 1 June 2011
Tuesday, 23 November 2010
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.
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.
Thursday, 4 March 2010
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".
Monday, 20 July 2009
Too Much Too Soon - Fear and Loathing in Sex Education
Norman Wells of the Family Education Trust has written a guidance document for parents about the Government's proposed plans for sex education - now called PSHE - and has whipped up a predictable reaction in The Telegraph, The Mail and The Express.
The FET's website makes no overt mention of religion, it promotes 'family values'. But reading between the lines, it is clear where these values come from. Wells writes that sex is not intended to be just about the joining of two bodies together, but the joining of two lives. In the context of faithful, lifelong marriage, sexual intimacy expresses the total self-giving of a husband and wife to each other.
If sex is intended to be anything, who is doing the intending? Once the hand of God becomes clear, what follows is pretty inevitable.
Alongside the propaganda, there are a lot of factual inaccuracies, many of which appear to have been directly copied from the Christian Medical Forum's submission to BCAP that I wrote about recently (and also here). They both claim, for example, that there is no good evidence against abstinence, that condoms are not 100% effective and therefore should not be promoted at all, and that STIs and teen pregnancy are rising therefore sex education doesn't work. One of the FET trustees is Stammers - who wrote one of the papers the CMF cited in its submission.
It is true that STIs and teen pregnancy are a serious problem (although pregnancy is not as much of a problem as certain groups make out, as I mentioned in the previous link). It's also true that sex education is far from what it could be and that parents need to be much more involved and supported. This is hardly a new issue - anyone remember The Specials' Too Much Too Young?
However. And it's a big however.
Wells' guidance is dangerously misleading. Its main target is not just the Government's plans for PSHE, it is sex itself. The usual mix of fear and loathing that has infected hard-line Christians since St Paul is in full flow here. Early on he says that behind plausible-sounding arguments and innocuous-sounding words there is a specific agenda at work to undermine the role of parents and to tear down traditional moral standards. Sex education is an ideological battlefield on which a war is being waged for the hearts and minds of our children.
This emotionally over-wrought opening sets the tone for the whole guidance. As if he doesn't have his own agenda. Frequent use of the word 'children' rather than 'teenagers' ups the emotional ante too.
Wells' three main points are:
- Parents should teach children about sex
- Sex should only ever happen within marriage
- Anyone who suggests otherwise (including the Government) is destroying the moral fabric of society.
His concern is that making PSHE statutory in the curriculum would inevitably reduce the influence of parents over what is taught. His modus operandi is to scare parents that the Government (who let's face it, most Telegraph, Express and Mail readers did not vote for) is going to turn their children into rabbits - pregnant, infected rabbits merrily having abortions with the schools colluding to keep parents in ignorance until society comes crashing down around us. I am not exaggerating.
It is a parent's right, he maintains, to teach children about sex in accordance with their religious beliefs. That's the parent's beliefs, not the child's. They should have the right to take children out of PSHE classes.
Parents should speak about sexual matters with modesty and restraint. If the child's entire education consists of the parent saying 'no sex before marriage' then that is all they will learn. Any misinformation the parent gives, knowingly or not, will be all the child has to go on. Presumably there will be some additional information on the wedding night about what goes where.
There is no need even to teach children the correct names for body parts because all parents talk to their children about their bodies when they wash and dress them from their earliest days and are well able to decide whether to use the proper biological terms or other names for their private parts. So it's fine for a child to grow up thinking it has a woo-woo? Or that 'down there' is something no nice child ever talks about, let alone looks at or - heaven forfend - touches?
Many parents do not feel confident or comfortable talking about sex and schools need to give them full support. However, the religious position is that this support comes from faith, not the classroom - unless schools are free to peddle the religious line too. Wells' main reason for wanting sex education to come from God (via the parent) is that this will instil morality, not facts. He rails against the Government outlines: there is no recognition of moral absolutes and... young people are not to be given any clear moral direction... there is no such thing as objective right and wrong.
Well, that's because there isn't. Only the most religious believe that there are divinely handed-down moral absolutes. And what are these moral values? Homophobia is quite clearly one of them; it is casually strewn throughout the guidance as PSHE will, he claims, equate marriage with same-sex civil partnerships and ... assume that both types of relationships are of equal benefit and stability... it is almost certain that homosexuality will be presented as a normal and natural lifestyle choice.
So what should young people be taught?
Wells does not want them given any information they could use because it is not informed choices we should be aiming for, but wise, moral and lawful choices. It's the old argument that if you tell them about it, they will rush out and do it. Even mentioning the word 'gay' will of course instantly turn a child from the straight and narrow.
Wells is so anti-choice it's not funny. Contrary to the prevalent view among sex educators, young people do not need to learn about a wide range of 'sexualities' and sexual behaviours; they do not need detailed information about the full range of contraceptive methods; and they do not need to be presented with a menu of sexual options from which they can make 'informed choices' when they feel they are 'ready' to become sexually active. Modern sex education is characterised by a lack of honesty, a lack of modesty, a lack of any moral framework worthy of the name, and a lack of respect for marriage as the proper context for sexual expression.
A lack of honesty? Is keeping young people in ignorance honest? Not only does it risk their health, it also means that they are likely to pick up what sex knowledge they do get in the playground or through experimentation.
He continues: Teenagers need to be taught that reproduction is one of the primary functions of sexual intercourse and sex should therefore be set in the context of a faithful, lifelong relationship (ie marriage), which provides the most stable environment in which to raise children.
Wells believes that if parents teach about sex in a (Christian) moral, modest and respectful way, this will prompt young people to save themselves until marriage (that word 'saved' again). Abstinence is the only way. This stance is woefully ignorant of human nature and teenage nature in particular. A bit of a moral lecture, maybe some praying and some vague information about the mechanics of sex (if they're lucky) is hardly going to quench teenage hormones. And is terrifying them with the wrath of God really going to produce mature, healthy and responsible adults?
My particular favourite part of the guidance is there are some sexual practices that it may be better not to know anything about at all, at any age. Sadly, he does not go into any further details.
There is much more to say about this pernicious document. The excellent Dr Petra Boynton will be analysing it in her blog.
Monday, 13 July 2009
Lying for Jesus? :2 Condoms
Following on from my previous post, the second part of the Christian Medical Fellowship's submission to BCAP concerns condom advertising on TV.
They note that the Government's Independent Advisory Group on Sexual Health and HIV wrote to BCAP requesting a review of scheduling restrictions on condom advertising, noting that the UK had the highest teenage pregnancy rate in Europe and spiralling rates of sexually transmitted infections.
First off, it's western Europe. Secondly, as a PubMed article shows, such claims about pregnancy have been inflated by the media: International comparisons suggest that the rate is moderate and that the past six decades have seen a decline rather than a rise (...) We believe that the selective reporting of international and time comparisons by public policy makers results in a 'manufactured risk' and has more to do with moral panic than with public health.
This does not bode well for what follows. But back to the CMF with an open mind. Things can only get better.
Or not. They continue that: The presupposition in this proposal is that more condom advertising to an ever wider range of young people will reduce unintended pregnancy and offer some protection against sexually transmitted infections. Briefly, the evidence shows, instead, a correlation between the government's policy of increasing promotion of contraception and the very rises Baroness Gould [of the AIG] notes. (..) The negative effect of the 'message' trumps any possible positive medical benefits. (my bold)
Does the evidence show that promoting contraception correlates directly with an increase in STIs? It could well be that there are other confounding factors involved, for instance that contraception is not being promoted in the most effective way or that there are reasons for promotions being ignored. Did the rise occur before, during or after the promotion? Or it could be that the evidence doesn't show that at all. No trumps on the table just yet.
The CMF conclude that: Further promotion of condom advertising to children aged 10-16 is unnecessary and unethical.
Why is it unethical? Two papers are cited in defence of their assertion. One is Are condoms the answer to rising rates of non-HIV sexually transmitted infection? No by Stephen Genius. This is a response to a previous piece called Are condoms the answer to rising rates of non-HIV sexually transmitted infection? Yes by Steiner and Cates.
The Steiner/Cates article is a balanced one citing strong evidence that condom use is effective in reducing STIs and unwanted pregnancy but making it very clear that condoms are not the whole story; better sex education about risk avoidance and reduction is essential, with condoms as part of the package. It warns that We need to focus on ensuring consistent and correct condom use rather than denigrating condoms as being less than perfect.
However, Genius' response does just that. His basic position is that condoms cannot be the definitive answer to sexually transmitted infection because they provide insufficient protection against transmission of many common diseases [such as] "Skin to skin" and "skin to sore" infections.
But no one is saying that they are. As all students are taught right from the start - answer the question in front of you, not some other question that you've prepared better for.
Ironically, Genius states early on that A fundamental tenet of medicine is adherence to scientific fact and experiential evidence to develop treatments and programmes that maximise and sustain health and later that Political correctness and ideological interests need to be usurped by sound science. But then he proceeds to cherry-pick data that back up his anti-condom stance. He doesn't even address the main point of the piece he is responding to, which is that condoms can work as part of an educational package. His response is that any package must be a moral one only.
Genius' other objection is that many people do not bother with condoms or do not use them properly, particularly if they are drunk or have taken drugs: protection is usually compromised by compliance issues, incorrect use, or mechanical failure. One of the supportive responses to his article adds that When you talk to young people, it is still considered uncool to carry condoms with you.
So his two arguments against promoting condoms are that they don't protect and most people don't use them properly anyway (which is irrelevant if they don't work).
Instead of recognising that the rising rate of infection is a complex problem, Genius is against anything at all that may reduce risk except for abstinence because: The more that sexual behaviour is trivialized, the greater will be the numbers of those involved in casual behaviour. The correct strategy is to promote responsible sexual choices by young people and television can have great power for good here (...) Those for whom condom knowledge is relevant will find it anyway, and the ever increasing trivialization of sexual behaviour will damage more and more children and young people.
Rather than seeing condom adverts as a way to make condom use more acceptable and more widespread, he disingenuously and consistently tries to discredit condoms to give his moral position some scientific authority. His simple solution to a complex situation is: Just say No.
His other point about condom knowledge being easy to find is the same point that the CMF make about abortions, which I dealt with in the last post.
This promotion of abstinence and warnings about 'trivializing' sex is based on as little reality as the Catholic Church's attempt to prevent teenage girls having the HPV vaccine because it would encourage them to have sex. After protests they reluctantly allowed the vaccine as long as no sex ed accompanied it, thus leaving them vulnerable to every other kind of infection, along with pregnancy.
The second article the CMF cite in support of their submission is written by Stammers, a trustee of Family Education Trust and Challenge Teams UK; both charities provide abstinence centred sex education packages to secondary schools in the UK. He is also a (volunteer) web doctor for Love for Life, the largest provider of abstinence centred sex education to schools in Northern Ireland, and did paid consultation work for them in the past.
Right away, the card are on the table this time. But again, let us not jump to conclusions before looking at the evidence. Being a Christian does not preclude being a good scientist...
Stammers position is that abstinence taught by parents is the answer, the only answer. He thinks, rather quaintly, that 'saved sex' is a more useful term than abstinence and asserts that: The false assumption that "young teens will have sex anyway" is an insult to many young people who have the capacity to rise to a far more effective challenge than just "use a condom every time".
He also says that Of course, to be involved in this way, parents have to be with their children and claims that the lower rate of single parenthood in the Netherlands is an important factor in the lower rate of teenage pregnancy.
This all fits neatly with the CMF'S own stated position that they are advocating marriage as God's intention for human sexual relationships.
So, saved sex and happy families will save society. Not condoms or sex education. Don't do it until you're married, then stay married and teach your children not to do it either. Easy.
Responses to this article in the BMJ are mixed, some in support of the moral stance, some pointing out the flaws in Stammers' argument and his biased starting point. To pick just one of the responses that challenge him:
Stammers' editorial on sex education raises a number of interesting public health issues. However, in the light of our recent investigation into abstinence-based programmes for HIV prevention in high-income countries, several of his assertions appear flawed on key methodological principles.
Recent research also contests Stammers' suggestion that declines in adolescent pregnancy rates (specifially, US adolescent pregnancy rates) are primarily attributable to delayed first sex.
It is interesting to note the contradiction between Stammers' suggestion that sex education studies assessing condom use make "false claims of success", and his acceptance of attitudinal outcomes of an abstinence-only programme trial as indications of "greatly enhanced" effectiveness.
The most methodologically rigorous systematic reviews to date have documented no behavioural or biological evidence that abstinence-only programmes can reduce sexual risk with respect to HIV infection or pregnancy, as compared to a range of control groups. (my highlighting, references to support this extract in the link above)
Flawed methodology, out of date information, cherry picking and pot calling the kettle black, then.
Whereas the part of the CMF submission dealing with abortion made overtly (and unsubstantiated) medical claims against it, this section tries to prohibit or severely limit condom adverts on moral grounds, using a spurious efficacy argument. At best, this is a muddled message; the efficacy of condoms is entirely separate from the moral question but the submission mixes the two. Not only that, the submission itself does not use the A word even though it is the principle message of the two papers. Why not, if this is their real agenda? Perhaps because it would undermine their attempt to appear scientific.
The CMF's moral recipe also appears ignorant of teenage behaviour. Teenagers do not need encouragement to have sex. Some do resist, for whatever reason, but it cannot be assumed that they will. For those who don't, there must be a safer way.
The CMF's preaching is masked as concern for teenagers and for society - the ever increasing trivialization of sexual behaviour will damage more and more children and young people - in the same way that their abortion propaganda indulged in hand-wringing about the dangers to women.
The mission is to save teenagers from themselves. The idea that the teenage sexual urge is something base to be overcome through the Grace of God is a primitive idea, harking back to Calvin and nodding to Descartes with his mind/body dualism. It also has echoes of Freud's concept of the id, the dark and lusty part of our nature to be smacked into submission if we are to be socialized (and, in religious terms, saved - that word again). And then there is the fear/hatred of sex that has permeated religion ever since St Paul. If you must have sex, wait until you're married and then do it only for procreative purposes, never ever for recreational ones. It is easy to caricature the CMF position because they lay themselves open to it with their disingenuous submission and their questionable evidence. But this should not distract from the real dangers that their position entails.
Unbiased commentators recognise that condoms are not the whole answer and that this is a complex issue; they see condoms as an essential part of a package based on evidence and real life, not just religious wishful thinking.
Addendum: Dr Petra Boyton has written in her latest blog about intitatives to reduce teenage pregnancy, something the CMF think are a waste of time.
They note that the Government's Independent Advisory Group on Sexual Health and HIV wrote to BCAP requesting a review of scheduling restrictions on condom advertising, noting that the UK had the highest teenage pregnancy rate in Europe and spiralling rates of sexually transmitted infections.
First off, it's western Europe. Secondly, as a PubMed article shows, such claims about pregnancy have been inflated by the media: International comparisons suggest that the rate is moderate and that the past six decades have seen a decline rather than a rise (...) We believe that the selective reporting of international and time comparisons by public policy makers results in a 'manufactured risk' and has more to do with moral panic than with public health.
This does not bode well for what follows. But back to the CMF with an open mind. Things can only get better.
Or not. They continue that: The presupposition in this proposal is that more condom advertising to an ever wider range of young people will reduce unintended pregnancy and offer some protection against sexually transmitted infections. Briefly, the evidence shows, instead, a correlation between the government's policy of increasing promotion of contraception and the very rises Baroness Gould [of the AIG] notes. (..) The negative effect of the 'message' trumps any possible positive medical benefits. (my bold)
Does the evidence show that promoting contraception correlates directly with an increase in STIs? It could well be that there are other confounding factors involved, for instance that contraception is not being promoted in the most effective way or that there are reasons for promotions being ignored. Did the rise occur before, during or after the promotion? Or it could be that the evidence doesn't show that at all. No trumps on the table just yet.
The CMF conclude that: Further promotion of condom advertising to children aged 10-16 is unnecessary and unethical.
Why is it unethical? Two papers are cited in defence of their assertion. One is Are condoms the answer to rising rates of non-HIV sexually transmitted infection? No by Stephen Genius. This is a response to a previous piece called Are condoms the answer to rising rates of non-HIV sexually transmitted infection? Yes by Steiner and Cates.
The Steiner/Cates article is a balanced one citing strong evidence that condom use is effective in reducing STIs and unwanted pregnancy but making it very clear that condoms are not the whole story; better sex education about risk avoidance and reduction is essential, with condoms as part of the package. It warns that We need to focus on ensuring consistent and correct condom use rather than denigrating condoms as being less than perfect.
However, Genius' response does just that. His basic position is that condoms cannot be the definitive answer to sexually transmitted infection because they provide insufficient protection against transmission of many common diseases [such as] "Skin to skin" and "skin to sore" infections.
But no one is saying that they are. As all students are taught right from the start - answer the question in front of you, not some other question that you've prepared better for.
Ironically, Genius states early on that A fundamental tenet of medicine is adherence to scientific fact and experiential evidence to develop treatments and programmes that maximise and sustain health and later that Political correctness and ideological interests need to be usurped by sound science. But then he proceeds to cherry-pick data that back up his anti-condom stance. He doesn't even address the main point of the piece he is responding to, which is that condoms can work as part of an educational package. His response is that any package must be a moral one only.
Genius' other objection is that many people do not bother with condoms or do not use them properly, particularly if they are drunk or have taken drugs: protection is usually compromised by compliance issues, incorrect use, or mechanical failure. One of the supportive responses to his article adds that When you talk to young people, it is still considered uncool to carry condoms with you.
So his two arguments against promoting condoms are that they don't protect and most people don't use them properly anyway (which is irrelevant if they don't work).
Instead of recognising that the rising rate of infection is a complex problem, Genius is against anything at all that may reduce risk except for abstinence because: The more that sexual behaviour is trivialized, the greater will be the numbers of those involved in casual behaviour. The correct strategy is to promote responsible sexual choices by young people and television can have great power for good here (...) Those for whom condom knowledge is relevant will find it anyway, and the ever increasing trivialization of sexual behaviour will damage more and more children and young people.
Rather than seeing condom adverts as a way to make condom use more acceptable and more widespread, he disingenuously and consistently tries to discredit condoms to give his moral position some scientific authority. His simple solution to a complex situation is: Just say No.
His other point about condom knowledge being easy to find is the same point that the CMF make about abortions, which I dealt with in the last post.
This promotion of abstinence and warnings about 'trivializing' sex is based on as little reality as the Catholic Church's attempt to prevent teenage girls having the HPV vaccine because it would encourage them to have sex. After protests they reluctantly allowed the vaccine as long as no sex ed accompanied it, thus leaving them vulnerable to every other kind of infection, along with pregnancy.
The second article the CMF cite in support of their submission is written by Stammers, a trustee of Family Education Trust and Challenge Teams UK; both charities provide abstinence centred sex education packages to secondary schools in the UK. He is also a (volunteer) web doctor for Love for Life, the largest provider of abstinence centred sex education to schools in Northern Ireland, and did paid consultation work for them in the past.
Right away, the card are on the table this time. But again, let us not jump to conclusions before looking at the evidence. Being a Christian does not preclude being a good scientist...
Stammers position is that abstinence taught by parents is the answer, the only answer. He thinks, rather quaintly, that 'saved sex' is a more useful term than abstinence and asserts that: The false assumption that "young teens will have sex anyway" is an insult to many young people who have the capacity to rise to a far more effective challenge than just "use a condom every time".
He also says that Of course, to be involved in this way, parents have to be with their children and claims that the lower rate of single parenthood in the Netherlands is an important factor in the lower rate of teenage pregnancy.
This all fits neatly with the CMF'S own stated position that they are advocating marriage as God's intention for human sexual relationships.
So, saved sex and happy families will save society. Not condoms or sex education. Don't do it until you're married, then stay married and teach your children not to do it either. Easy.
Responses to this article in the BMJ are mixed, some in support of the moral stance, some pointing out the flaws in Stammers' argument and his biased starting point. To pick just one of the responses that challenge him:
Stammers' editorial on sex education raises a number of interesting public health issues. However, in the light of our recent investigation into abstinence-based programmes for HIV prevention in high-income countries, several of his assertions appear flawed on key methodological principles.
Recent research also contests Stammers' suggestion that declines in adolescent pregnancy rates (specifially, US adolescent pregnancy rates) are primarily attributable to delayed first sex.
It is interesting to note the contradiction between Stammers' suggestion that sex education studies assessing condom use make "false claims of success", and his acceptance of attitudinal outcomes of an abstinence-only programme trial as indications of "greatly enhanced" effectiveness.
The most methodologically rigorous systematic reviews to date have documented no behavioural or biological evidence that abstinence-only programmes can reduce sexual risk with respect to HIV infection or pregnancy, as compared to a range of control groups. (my highlighting, references to support this extract in the link above)
Flawed methodology, out of date information, cherry picking and pot calling the kettle black, then.
Whereas the part of the CMF submission dealing with abortion made overtly (and unsubstantiated) medical claims against it, this section tries to prohibit or severely limit condom adverts on moral grounds, using a spurious efficacy argument. At best, this is a muddled message; the efficacy of condoms is entirely separate from the moral question but the submission mixes the two. Not only that, the submission itself does not use the A word even though it is the principle message of the two papers. Why not, if this is their real agenda? Perhaps because it would undermine their attempt to appear scientific.
The CMF's moral recipe also appears ignorant of teenage behaviour. Teenagers do not need encouragement to have sex. Some do resist, for whatever reason, but it cannot be assumed that they will. For those who don't, there must be a safer way.
The CMF's preaching is masked as concern for teenagers and for society - the ever increasing trivialization of sexual behaviour will damage more and more children and young people - in the same way that their abortion propaganda indulged in hand-wringing about the dangers to women.
The mission is to save teenagers from themselves. The idea that the teenage sexual urge is something base to be overcome through the Grace of God is a primitive idea, harking back to Calvin and nodding to Descartes with his mind/body dualism. It also has echoes of Freud's concept of the id, the dark and lusty part of our nature to be smacked into submission if we are to be socialized (and, in religious terms, saved - that word again). And then there is the fear/hatred of sex that has permeated religion ever since St Paul. If you must have sex, wait until you're married and then do it only for procreative purposes, never ever for recreational ones. It is easy to caricature the CMF position because they lay themselves open to it with their disingenuous submission and their questionable evidence. But this should not distract from the real dangers that their position entails.
Unbiased commentators recognise that condoms are not the whole answer and that this is a complex issue; they see condoms as an essential part of a package based on evidence and real life, not just religious wishful thinking.
Addendum: Dr Petra Boyton has written in her latest blog about intitatives to reduce teenage pregnancy, something the CMF think are a waste of time.
Monday, 25 May 2009
Circumcision and HIV/AIDS
An article in the Independent on May 19 2009 reports that:
'Three landmark randomised controlled trials conducted in South Africa, Kenya and Uganda between 2005 and 2007 demonstrated that adult male circumcision reduced the risk of contracting HIV by 50 to 60 per cent'.
It opens with the assertion that:
'New evidence suggests removal of the foreskin can protect not just against HIV, but other diseases that kill millions. Now some doctors are reconsidering their views on an ancient and controversial procedure'.
What exactly are (or should be) doctors considering? Is circumcision the best option worldwide for HIV/AIDS prevention and why is it being promoted above condom use? Currently, around 30 per cent of males worldwide are circumcised, but this is done mostly for religious and cultural reasons rather than medical ones.
I discussed this with Dr. Antony Lempert of the Secular Medical Forum who pointed out that interpretation of this latest research has to be tempered by the fact that the Cochrane collaboration who reported on these trials stated that the risk of bias is very high.
Moreover, the mechanism by which circumcision may work is not even known yet. The New England Journal of Medicine (NEMJ) report, from which the Independent article is drawn, reports: ‘How circumcision prevents HIV transmission is not completely understood, but scientists believe that the foreskin acts as a reservoir for HIV-containing secretions, increasing the contact time between the virus and target cells lining the foreskin's inner mucosa’.
Even if the research can be shown to be good and that circumcision does reduce the transmission of HIV/AIDS, it still only brings the risk down to around 50:50 and it does not tackle the whole problem of sexually transmitted infections (STIs). According to the article, there is some emerging evidence that circumcision also reduces infection with Human Papilloma Virus (HPV) by 35% and Herpes Simplex (HSV) by 25% but again, these are not persuasive percentages when compared with condom use.
In fact, it may worsen the problem as men who have been circumcised see the operation as a licence to ride bareback, thus spreading other STIs and, of course, causing unwanted pregnancies. In fact, they may ask what is the point of being circumcised if you still have to wear a condom. Many men are not keen to use condoms as they reduce sensitivity so it is hard to see why they would opt for an operation that reduces it permanently.
Although HIV/AIDS is the most serious of STIs, chlamidia and gonorrhoea are not without long-term risks if undiagnosed or untreated, which could be the case in remote, rural or some highly religious communities in the developing world (the jury is still out on the effectiveness of circumcision against syphilis).
Who will benefit even from the 50:50? The NEMJ report also says: ‘Reaching women through other prevention methods is important because there is no direct evidence to date that circumcision reduces the risk of transmission from men to women.’
In addition, the new research looks only at adult men having sex with women, not at the long-term effect on boys or men having sex with men.
In fact, the Independent article quotes Professor Terence Stephenson (President of the Royal College of Paediatrics and Child Health), who says that there is ‘no evidence that circumcision is protective in men who have sex with men’.
The risks of adult circumcision are small but not negligible, especially if they are not carried out in sterile circumstances. One recent report indicated that severe complications developed in 18% of men, and 6% had permanent adverse sequelae including mutilation of the glans, excessive scarring, and erectile dysfunction. (NEMJ).
So adult male circumcision doesn’t appear to protect women or men having sex with men. With such scanty evidence in favour, who is promoting adult male circumcision, particularly in Africa?
One of the largest bodies is PEPFAR, the US President's Emergency Plan for AIDS Relief who are ‘working with local governments and public health partners to create an acceptable and sustainable model for implementing circumcision programs’ in Africa and other countries (including Haiti and Vietnam).
Who are these partners? They include the Catholic Relief Services, Family Health International and the Elisabeth Glaser Paediatric AIDS Foundation. The PEPFAR website lists them and their areas of concern. For many of them, ‘Abstinence and Be Faithful’ are on that list. Taking a random sample of countries, in Rwanda 11 out of the 23 partners promote abstinence and in South Africa, 28 out of 93 partners – for a few of them, this is their only agenda.
Given the Catholic Church’s opposition to condoms to the point of lying about their effectiveness, and that of many American Evangelical organisations, could it be possible that circumcision is being promoted over condom use for less-than scientific reasons? Abstinence has been shown to be an ineffective programme in the US and under the Bush regime, many lies were spread about condom use, so are they promoting circumcision rather than condoms? Pro-abstinence campaigners, especially religious ones, are often anti-condom.
In America, circumcision has been declining in some states but the overall prevalence is still 65% (compared with 16% in the UK). As Dr Lempert points out: ‘the majority of the American male population has been circumcised whilst they have a rather high rate of HIV infection’.
There is also the issue of consent. Adult men may be able to weigh the facts and make their own decision, but boys and new borns cannot.
To go back to the Independent article, it implies that all parents should seriously weigh up circumcising their male children. But the issue is far more complex than is being presented. There is undeniably resistance to condom use in many cultures for a variety of reasons that need to be overcome and logistical questions of distribution, but the promotion of both circumcision and condom use is tainted with many unknowns and mixed motives; should anyone – doctors, funding bodies, sexually active men or parents - be contemplating or recommending an irreversible surgical procedure just yet?
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