Change Behavior, Stop AIDS

Vatican conference focuses on ways to effectively and morally thwart the deadly disease.

(photo: Shutterstock)

VATICAN CITY (CNS) — Back-to-back speeches at a Vatican AIDS conference illustrated that condoms in AIDS prevention remains a sensitive issue for both Church officials and international health experts.

Michel Sidibe, executive director of UNAIDS, told conference participants May 28 that he was delighted when Pope Benedict XVI, in his recent book-length interview, Light of the World, hypothesized that use of a condom to prevent infection could be a first step toward moral responsibility.

As Vatican officials listened with rather pained expressions, Sidibe quoted the relevant section from the Pope’s book.

“This is very important. This has helped me to understand his position better and has opened up a new space for dialogue,” Sidibe said.

A few minutes later, Archbishop Silvano Tomasi also quoted from the Pope’s book — the part that began, “We cannot solve the problem (of AIDS) by distributing condoms.”

Like other Church officials at the conference, Archbishop Tomasi, the Vatican’s representative to U.N. agencies in Geneva, took the view that condom campaigns have failed to tackle the fundamental issue of irresponsible sexual behavior in the spread of the AIDS virus.

The two-day conference was billed as a forum for clarifying pastoral practices when it comes to the Church’s efforts against AIDS. No guidelines were issued, but they may come later; the Vatican typically lays down principles at a gathering like this one, and specific instructions may emerge somewhere down the road.

One thing, however, was already crystal clear: Whatever the moral arguments over an individual’s use of a condom for disease prevention, the Vatican has judged condom promotion a failure in the battle against AIDS.

Several speakers cited data to show that countries in Africa that rely primarily on condom campaigns have not stopped the spread of AIDS, while the continent’s “success stories” have featured a strong emphasis on sexual responsibility.

Edward Green, the former director of the AIDS Prevention Research Project at Harvard University, told the conference that there was a growing international consensus that AIDS can be controlled only by changing patterns of sexual behavior. This is not simply a moralistic point of view, but one based on practical effectiveness, he said.

He cited the case of Uganda, where a government emphasis on sexual fidelity and abstinence helped reduce the HIV infection rate from about 14% in 1991 to about 4% in 2003. But over the past eight years, he said, the focus on sexual responsibility has diminished. Drugs and condoms are now viewed as the solution, and the HIV rate has begun to rise again, he said.

Green said that while faith-based organizations have worked successfully to change high-risk behavior, they sometimes are denied international funding because they won’t support condom distribution.

“Willingness to promote condoms should not be a litmus test for working in AIDS prevention,” he said.

Several speakers at the Vatican conference said the Church supports greater access to medical care for AIDS patients in poor countries. Antiretroviral drugs have proven very effective in treatment but are too costly for many Africans.

Green cautioned, however, against thinking that drugs are the answer to AIDS. Most countries simply can’t afford it, he said.

Instead, he urged support for “simple, low-cost, sustainable and culturally tailored solutions,” like behavioral change, and less reliance on “the multibillion dollar industry of biomedical research and pharmaceutical companies, hospitals and clinics.”

In a keynote address to the conference, Archbishop Zygmunt Zimowski, head of the Pontifical Council for Health Care Ministry, said it would be a mistake for the Church to drop its insistence on sexual responsibility and to support all anti-AIDS measures with the idea that “the end justifies the means.”

Like others at the conference, Archbishop Zimowski said he was intrigued by recent advances in early antiretroviral treatment of AIDS and evidence that it dramatically lowers the risk of transmission.

At the same time, he said the very success of the drugs, especially in richer countries where they are widely available, has led people to resume high-risk sexual behavior.
Archbishop Zimowski said the success of early antiretroviral treatment in preventing AIDS transmission has brought hope to married couples where one spouse is infected with HIV.

He said the early therapy has also been shown to greatly reduce the risk of transmission of HIV from mother to child during pregnancy. That means HIV-positive couples, in some circumstances, could risk having sexual relations in order to have a child, he said.

In general, the archbishop said, the Church recognizes that it is proposing “the most difficult path” in limiting the spread of AIDS, but he said it was a path that respects the values of conjugal fidelity, human life and the family.