Let's not condemn condoms in the fight against AIDS: a South African bishop who faces the daily reality of AIDS in his diocese urges the church to reconsider its ban on condoms to stop the spread of HIV. It's not only a matter of chastity, he says, but one of justice--and a prolife issue as well.

I WAS VISITING ZINC SHACK "HOMES" IN A HUGE SQUATter camp in my home Diocese of Rustenburg, South Africa with one of our home-care nurses when I met young mother. She was an economic refugee from a neighboring country, an "illegal" unable to access any welfare benefit, existing in desperate poverty. Her only hope for survival? Miners (with money) in hostels at a nearby platinum mine.

Lydia, 22, was dying of AIDS. Her tiny baby, emaciated like herself, was dying also. She looked at me and said, "Father. I have no hope." The despairing eyes and voice have be come familiar to me ever since I began my personal response as a bishop to the AIDS pandemic some 10 years ago.

I looked into her eyes, and the questions surfaced again. If, as a church, we uphold the sanctity of life, is the life of every person not only sacred at conception but right through until eternity? If so, are we as passionate about the systemic "life" issues that condemn a disadvantaged woman like Lydia to prostitution as the only way out of extreme poverty as we are about abortion? And if Lydia's sole option in life was to sell her body to a man for $2 to survive just one more day, what do the norms we promote actually mean to her and others? What does it mean to Lydia that we require Catholics to abstain from sex before marriage and to remain faithful within marriage?

There are hundreds of thousands of women like Lydia among the 29.4 million people with HIV in sub-Saharan Africa. Many others decide, for whatever reason, that they cannot or will not follow the church's ideals in sexual ethics and in doing so could transmit a death-dealing virus to another through a sexual encounter. We do not live in an ideal world--on the contrary. What do we have to say to this real world?

WITHOUT A DOUBT, BEHAVIOR CHANGE, MODELED ON OUR values around sexuality, is the only certain way to prevent HIV infection. I also believe, however, that the issue of condoms--used not as a contraceptive but as a means to prevent the transmission of death through AIDS--demands serious consideration.

When speaking of condoms, I also include female condoms and microbicides (topical medicines that would prevent the spread of HIV) presently being developed that would prove much more effective especially for abused and vulnerable women, who are my main concern.

Since HIV first came to light in the early 1980s, there has been a horrendous increase in the infection rate in sub-Saharan Africa where the strain is virulent. Factors like extreme poverty, malnourishment, and lack of sanitation, water, and anti-retroviral medicines mean that HIV-infected people pick up opportunistic diseases like TB and pneumonia and die very quickly.

HIV in our area is not a "manageable" disease as in the developed world. It is a passage to death. In two neighboring countries, Swaziland and Botswana, the official infection rate is almost 40 percent. In South Africa we have more than 5 million cases (with some 600 dying each day) and 1 million AIDS orphans. The issue now is the very survival of humankind--and we need to construct an ethic and a moral theology around this issue of survival.

Hence the need to promote values that protect and enhance life, reverence for the dignity and rights of people, especially women and children, and a mature sexuality. Within that context I am trying to "theologize" about the use of condoms and microbicides. But does this not go against traditional church teaching?

That one cannot use condoms to prevent the spread of AIDS could hardly be called "traditional teaching." The only traditional teaching I am aware of concerns contraceptive actions. And wearing a condom to prevent the spread of AIDS is not a contraceptive action.

The use of condoms for the prevention of AIDS is more akin to the moral teaching that one can remove a diseased fallopian tube carrying an ectopic pregnancy since it was done for health reasons, thus allowing the secondary effect of the abortion of the fetus. Or doctors prescribing the birth-control pill to stop dysfunctional uterine bleeding or to correct irregular menstrual cycles. Catholic moral teaching regards this as licit, even though the unintended side effect is that these women become at least temporarily infertile--and it is clearly accepted in section 15 of the 1968 papal encyclical Humanae Vitae (On the Regulation of Birth).

Some will say the condom issue is different because there is the option of abstinence. But this is not about people freely choosing sex within "regular" relationships. The issue is: What is the morally correct thing to do if someone insists on having intercourse (or is "forced" into this) in a situation where transmission of the AIDS virus is very possible?

In that case the condom may be the only health accessory available, and any prevention of conception will be an unintended side effect. Surely there is something wrong with our moral theology if we reason thus: If you are going to have sex anyway, then don't commit the added sin of reducing the risk of infecting someone--or being infected--by using a condom.

I have wondered whether appealing to the traditional Catholic moral principles of "double effect" and "the lesser of two evils" is not granting an assumption that itself needs questioning. That assumption is that the very act of using a condom is evil and can conceivably only be justified if there is a greater evil to be prevented.

But our only theological "tradition" about condoms is not that they are evil but that the attempt to prevent conception is evil and that their use for that purpose is evil. If one were to use them to promote health--life rather than death--then one is not grudgingly accepting one evil to prevent a greater one but rather is promoting something that in the context is not simply good but a moral imperative.

"BUT CONDOMS ARE NOT EFFECTIVE ANYWAY!" SAY OPPOnents. No one pretends that they ensure 100 percent safety, but scientific evidence shows that proper and consistent use of condoms can lessen the risk of infection considerably. That they are not totally safe in every case cannot be advanced as an argument that they should never be used in any circumstance. In an imperfect world, sometimes even imperfect interventions can save lives.

But some contend that while the church recognizes the need to find a "pastoral solution" for people in difficult situations, this should be done in the "internal forum"--that is, by a priest discussing the problem confidentially with a person. "Why go public on this?" I am asked.

Indeed, I have experienced much criticism from within the church for raising this issue in the public arena. However, I believe our credibility as a church is on the line here. The "pastoral solution" approach creates the impression that the advice given may, in the end, differ from "official Catholic teaching."

Why can we not be a humble, searching church that debates issues openly, that recognizes that we don't have all the answers to complex issues but that we can offer people the experience of the compassionate, caring God no matter what happens in their lives? In other words, to discern and state what may be "the greater good" in very complex situations.

For me, the condom and microbicide question is not simply a matter of chastity but of justice. In this frightening pandemic, should we focus all our efforts on proclaiming an ethic of sexuality, or should we not also commit ourselves to an ethic of protecting and saving life? If life is indeed sacred to us, we should surely not compound one failure in regard to chastity with another failure in terms of justice by not taking the means we have to prevent the transmission of a death-dealing virus. USC

Feedback

Q: In a case like that of Lydia, the church should...

Allow--indeed encourage and support--any measures that promote her health, dignity, and survival.

Betsy Reifsnider Sacramento, Calif.

Work to prevent the situation in the first place. Give people skills to work and allow them to earn a decent wage.

Susanne Drotte Smith Beaver Creek, Ohio

Comfort her. Don't preach to her. Get down on our knees to weep with her, to ask forgiveness in the world's name for allowing this to happen to her.

Dorothy P. May Devon, Pa.

Preach that condoms can save lives.

Gerard W. Sheridan Staten Island, N. Y.

The church should reject prostitutes unless they want to repent and change. It is good to have the church in the world but not the world in the church.

Joseph Lebooa Centurion, South Africa

Try walking a mile in her bare feet.

Dennis E. Novak Fort Worth, Texas

The church needs to put greater emphasis on the teaching that personal conscience is primary.

Kathleen Hansmann Wayzata, Minn.

Q: If the church were to allow the use of condoms to prevent AIDS, my reaction would be...

Finally! Seems to me we focus too much on condom use and forget the situation of the user. Using a condom is not a sin, selfishness is.

Brother Harry Eccles, C.F.X. Hinche, Haiti

We've lost another round to immorality.

Hilda Consiglio El Paso, Texas

Why allow the use of condoms only for AIDS? Other reasons are as valid.

Billie Ingrassia Lake Ridge, Va.

To say that we have awakened to life as it is today, not as it was 50 years ago or 1,050 years ago.

Deacon Frank May Titus, Ala.

It would be another nail in the coffin. The church needs to guide society, not be guided by society.

Michael E. Goodboe Palm Beach Gardens, Fla.

So what? For married couples, those who are well informed, following their consciences, this is not an issue.

Frances Lafferty Bristol, Conn.

Supportive. I am a pediatrician who has worked overseas in a Catholic mission hospital. There are many situations in which we cannot do the ideal thing, and so we must do at least whatever good is possible.

Name withheld Modesto, Calif.

Met with mixed feelings. How do we judge if the use is truly to prevent AIDS or to satisfy the lust of the participants?

Name withheld Abbeville, La.

One of satisfaction that the church is realistic, has a heart, and is better informed on sexual morality than it has yet shown itself to be.

Father James M. Gower Bar Harbor, Maine

Q: My biggest concern about changing church teaching about the use of condoms is ...

It is completely immoral.

Deacon Raymond Duthoy Anaheim, Calif.

That the decision-making will drag on and on while millions of people are dying.

Name withheld San Antonio, Texas

Such a change would have to be accompanied by appropriate information and education.

Elise Frederick Rosemead, Calif.

Black and white is easy. Exceptions to the rule can cause confusion.

Marie Zorn Levittown, Pa.

Millions of Catholics already ignore church teaching on birth control. Why continue to propagate a view that scarcely anyone agrees with?

Maureen Sloan Warren, Ore.

Not any. Those who use condoms to be promiscuous have already numbed their consciences to what the church teaches.

Glenda Hutton-Stejskal Cedar Rapids, Iowa

My fear is that we would send young people a message that sexual promiscuity is OK.

Name withheld Lawrence, Kan.

That we will use worst-case scenarios to justify changing the solid moral teaching of Christ's messengers.

Ed Valdez Monterey Park, Calif.

Q: About Bishop Dowling speaking out on this issue, I feel ...

He is courageous, but he won't move up the ladder where daring vision is needed--he may even lose his bishopric.

Father Frank R. Piro Atwater, Calif.

He is an honest man caught in a terrible bind.

Jane W. Urso Bridgeport, W. V.

Finally, a bishop who has his feet firmly and courageously planted.

Arlene Walters Moneta, Va.

More bishops should join in this dialogue, although the U.S. bishops' credibility has been seriously eroded due to the sexual abuse of children and cover-up of perpetrators.

Gregory Gauthier Tampa, Fla.

I feel that his desperate and seemingly hopeless situation has pushed him to think that condoms are the solution when, in fact, they are not.

Name withheld Fairfax, Va.

For him to remain silent would be the greater sin.

Joan Vinnacombe Newman, Ga.

Dowling is not taking issue with core teaching of the church. He is seeking to respond, as Jesus would, to the needs of his people.

Tom Beiswenger Corning, N.Y.

There are many confused people out there, and someone in his position who speaks out against the moral teachings of the church has a lot to answer for.

Maureen Henry Prescott, Ariz.

He needs to be clear that premarital sex is wrong and that having sex is no one's right.

Name withheld Mahtowa, Minn.

I applaud him. I wish I were so brave. As you can see, I'm afraid to sign my name because I might find myself on the outside looking in if my local priest or bishop knew my feelings.

Name withheld Carmel, Ind.

General Comments

Lydia and her baby are dying of MDS, and we are more worried about how we will appear if we support her use of a condom than the fact that she can only survive by prostituting herself. May God have mercy on us!

Mary Ann Kelly Milford, Ill

Life that is living now is more real and precious than the potential for life.

Brother Charles Gregg, C.S.C. Notre Dame, Ind.

I live in a small rural community. The people here live with the false notion that AIDS cannot or will not be contracted by them. I feel it is a pastoral duty to speak about AIDS from the pulpit.

Martha L. Kent New Washington, Ohio

A problem with Catholicism is that it teaches that an act is either moral or immoral, when most often in life we encounter situations that are somewhere in between.

Name withheld Lafayette, N.J.

Could AIDS be a punishment for sexual sins? Our son died of MDS in 1988. He was a homosexual. He paid the price for his immorality, and we as a family all suffered.

Patricia and Richard Scott Rockaway Beach, Ore.

What the church says or does not say affects people like Lydia very little--the men in her world make the decisions.

Name withheld Lafayette, La.

Unless the church has reversed its approval of Natural Family Planning, it is condoning the intention of having sex without producing a child. Since condoms are not abortive, the church's position that they are an unacceptable technology to facilitate that same intention is ludicrous.

Joe Cron Federal Way, Wash.

AND THE SURVEY SAYS...

1. Like Bishop Dowling, I believe the reality of AIDS compels the church to change its teaching about the use of condoms for the prevention of HIV infection.

agree       82%
disagree    12%
other       6%

2. The church should not water down its teaching that abstinence is our only recommendation to prevent the spread of AIDS.

agree       28%
disagree    61%
other       11%

3. About the use of condoms, I believe:

It is not immoral at all.

18% It is immoral if used for contraception, but not to prevent AIDS.

15% It is Immoral. but pastorally should be allowed to prevent AIDS.

9% It is immoral under any circumstance.

12% Other.

4. In my parish, the issue of AIDS...

81% Is rarely or never

6% Is only mentioned on World AIDS Day or other special occasions.

5% Is addressed by one or more ministries.

5% Is addressed from the pulpit,

3% Other.

5. Through its uncompromising leaching against condom use the church has become complicit in the tragedy of millions of AIDS deaths in Africa.

agree       72%
disagree    17%
other       11%

These results are based on survey responses from 180 U.S. CATHOLIC readers and Web sire visitors.

By BISHOP KEVIN DOWLING, C.Ss.R. of the Diocese of Rustenburg, South Africa.