Science Questioning Their Efficacy in Halting HIV/AIDS
NAIROBI, Kenya, 26 JUNE 2004 (ZENIT)The Catholic Church has long been
criticized for opposing condom promotion as part of AIDS prevention
programs and "safe sex" campaigns. Yet opposition to condoms does not mean
the Church does not care about AIDS. Last year Kenya's health minister,
Charity Ngilu, praised the Church for its role in fighting HIV and AIDS,
the Catholic Information Service for Africa reported Aug. 17.
Ngilu commended the Catholic Church for its focus in three key areas:
prevention through awareness-raising and promotion of behavior change;
care and treatment of the people living with HIV/AIDS; and social and
economic support for those infected and affected by the scourge.
And recently published information is showing the wisdom of the Church's
refusal to back condoms. The journal Studies in Family Planning in its
March issue published a wide-ranging review of scientific literature on
the subject of condoms.
Authored by Norman Hearst, a professor at the University of California,
and Sanny Chen, an epidemiologist with the San Francisco Department of
Health, the article "Condom Promotion for AIDS Prevention in the
Developing World: Is It Working?" notes that "Measuring condom efficacy is
nearly impossible." A commonly accepted figure for their efficacy is 90%,
the article affirms.
But this is not enough for condoms to be effective in AIDS prevention. For
example, the articles notes: "In many sub-Saharan African countries, high
HIV transmission rates have continued despite high rates of condom use."
The authors admit that "no clear examples have emerged yet of a country
that has turned back a generalized epidemic primarily by means of condom
promotion."
Uganda's noted success in reducing the prevalence of AIDS was due a
program that focused on delaying sexual activity among adolescents,
promoting abstinence, encouraging faithfulness to a single partner, and
condom use. Condom promotion was last in order of importance, notes the
article.
Hearst and Chen explain that increased use of condoms was not responsible
for the decline in AIDS among Ugandans. "The main cause of falling
incidence in Uganda was a substantial drop in numbers of casual sex
partners," they wrote. Their article also attributes falling HIV
prevalence among pregnant women in parts of Zambia and Tanzania to
reductions in numbers of sexual partners.
In another article, a group of experts on HIV stressed the need for
greater emphasis in changing sexual behavior. "It seems obvious," said an
article in the April 10 issue of the British Medical Journal, "but there
would be no global AIDS pandemic were it not for multiple sexual
partnerships." The article was entitled "Partner reduction is crucial for
balanced 'ABC' approach to HIV prevention."
The authors explained that a high number of sexual partners is "a crucial
determinant in the spread of sexually transmitted infections." As well,
HIV transmission is facilitated by the presence of other sexual
infections, which in turn are propagated by having multiple partners.
The article also notes that while condoms were credited for Thailand's
reduction in the high levels of HIV infection, their use was also
accompanied "by a striking reduction" in the numbers of sexual partners.
Regarding the campaign in Uganda, the authors state that it is difficult
to prove a direct causal link between the promotion of monogamy and the
fall in HIV rates, though "it seems likely that it was critical to the
success."
The article observed that, despite the evidence of how partner reduction
and monogamy can reduce the spread of HIV, many programs give these means
little attention. "We believe it is imperative to begin including (and
rigorously evaluating) messages about mutual fidelity and partner
reduction in ongoing activities to change sexual behavior," the authors
commented.
Not so safe
Doubts have also been cast on the reliance of condoms for "safe sex"
programs. In the United States more than 15 million cases of sexually
transmitted diseases (STDs) occur every year, according to Dr. Joe
McIlhaney Jr., president of the Medical Institute for Sexual Health, a
nonprofit organization based in Austin, Texas.
Writing in the Atlanta Journal-Constitution last Aug. 25, McIlhaney noted
that the consequences of relying on condoms can be grave. One widely
prevalent STD, the human papillomavirus (HPV), causes more than 90% of
cervical cancer which, in 2001, killed an estimated 4,100 women in the
United States.
"Based on the science and the science alone, there is only one conclusion:
Condoms do not make sex safe enough," McIlhaney commented. "While condoms
can reduce some risk, they still often leave individuals vulnerable to STD
infection."
His arguments received support in a report to the U.S. Congress by the
federal Centers for Disease Control and Prevention earlier this year. The
centers' director, Dr. Julie Gerberding, said that the best way to avoid
HPV "is by having only one uninfected partner," the Washington Times
reported Feb. 3.
The report recommended that men and women not in monogamous relationships
should reduce the number of sexual partners. The report also noted that
most studies show that condoms do not prevent the spread of HPV.
Strangely silent
Abstinence promotion even received support in a long article published
June 13 in the New York Times Magazine. Written by Helen Epstein, a
visiting research scholar at the Center for Health and Wellbeing at
Princeton University, it observed that many efforts aimed at stopping the
spread of HIV have had disappointing results.
Epstein explained that ignoring the need to promote fidelity in sexual
relations "may well have undermined efforts to fight the epidemic." She
noted: "Government planning documents, United Nations agency reports, AIDS
awareness campaigns and AIDS education curriculums are strangely silent on
the subject."
A case in point is the situation in Botswana. The Washington Times on June
17 described how Tsetsele Fantan, leader of the African Comprehensive
HIV/AIDS Partnerships, sponsored by pharmaceutical giant Merck & Company
and the Bill & Melinda Gates Foundation, felt embarrassed on taking a
visitor to a primary school, whose walls had posters about using condoms
and whose children sang songs about prophylactics.
"At that age, they should have been singing about 'saying no to sex,'"
said Fantan. "The message should have been about abstinence. We need to
focus our message better."
Kgomotso Ntsatsi, who directs the Christian AIDS Intervention Program that
promotes abstinence, explained that she needs more financial support to
get that message out, the article reported. "Condoms were the first thing
people thought of. People never stopped to see if it was working," she
said. "It eroded our culture terribly. Condoms brought so much
unfaithfulness and so much early pregnancy. Now it looks like everyone is
promiscuous."
In fact, there are signs that more governments are waking up to the need
to promote abstinence. Recently, Zambia banned the distribution of condoms
in schools, BBC reported March 15. Education Minister Andrew Mulenga
explained that condoms were encouraging young people to have premarital
sex. Some 120,000 Zambians die from AIDS each year, according to U.N.
figures.
BBC quoted Mulenga as saying that students "should be advised to abstain
from sex as a measure to fight the disease instead of being urged to use
condoms which promote immorality."
The Catholic Church's opposition to condoms is not based on medical
studies. Rather, it stems from a profound analysis of the need to
integrate sexuality in an exclusive and permanent relationship open to
life in the context of marriage. The wisdom of this view is becoming
increasingly clearer.
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