Why some clergy question abstinence in the fight against HIV/AIDS.

Father Michael Stogre, S.J., in an article on AIDS in The Catholic Register of Toronto, May 22, 2005, stated, "Currently, when a spouse has AIDS ... the use of condoms to prevent transmission of the virus is more and more being seen not as a contraceptive measure, but as a justifiable medical intervention."

Support for the use of condoms to prevent the spread of HIV/AIDS has recently come from some surprising sources--cardinals, individual bishops, and Catholic bishops' conferences. Since 2004, support has been expressed by spokesmen for the bishops' conferences of Spain, Mexico, and England and Wales (through its agency, the Catholic Agency for Overseas Development). The French bishops expressed their support in 1996. Supporting cardinals included Murphy-O'Connor (Westminster, England), Daneels (Brussels, Belgium), Barragan (President of the Pontifical Council for Health Care Workers), and Cottier (household theologian to Pope John Paul 11). Supporting bishops are Kevin Dowling (South Africa), and Fabian Marulauda (Colombia). The Spanish bishops' subsequent clarification said that responsible and moral sexual activity is the only "advisable" way to avoid disease. The statement stopped short of the Catholic teaching that sexual abstinence and faithfulness in marriage are the only morally permissible means of avoiding disease. One is forced to ask the question whether this clerical support is morally correct and based on sound medical science.

Catholic moral teaching

The nature of an act (its object) determines its morality. Intercourse with a condom is intrinsically disordered, evil in and of itself.

The intention of the acting person is important, but it cannot change the nature of the act of intercourse with a condom. It remains an intrinsic evil.

The reason why a good intention is not in itself sufficient, but a correct choice of actions is needed, is that the human act depends on its object, whether that object is capable or not of being ordered to God ... thus bringing about the perfection of the person" (Veritatis splendor, n. 80). "... Reason attests that there are objects of the human act which are by their nature incapable of being ordered to God, because they radically contradict the good of the person made in his image. These are the acts which, in the Church's moral tradition, have been termed 'intrinsically evil' (intrinsece malum) on account of their very object, and quite apart from ulterior intentions of the one acting and the circumstances" (VS, n. 80).

The law of "double effect" requires that, if an action has two effects, the action itself must be morally good or indifferent. Since intercourse with a condom is intrinsically evil, the law of double effect does not apply. "Though it is true that sometimes it is lawful to tolerate a lesser evil to avoid a greater moral evil or in order to promote a greater moral good, it is never lawful, even for the gravest reasons, to do evil that good may come of it" (Humanae vitae, n. 14, cf. Rom. 3:8). When comparing greater or lesser evils, the comparison must be between evils of a similar nature. Risk of disease is a physical and not a moral evil, whereas intercourse with a condom is a moral evil. Some theologians hold that the risk of HIV infection is more evil than the use of a condom to reduce that risk. This statement is not doctrinally sound.

To advise or suggest evil is to induce evil and that is always a scandal. (1)

Msgr. Vincent Foy of Toronto (see his "A response to Fr. Michael Prieur's defence of the Winnipeg Statement," C.I., Sept. '05, p.37) states that in considering the question of the lesser evil, some distinctions must be made between homosexual intercourse and heterosexual intercourse and also between intrinsic and extrinsic factors.

"Homosexual intercourse: it is true that, intrinsically, homosexual intercourse with or without a condom are equivalent moral evils, even though they are not precisely the same act. In both there is sodomitical intent.

"Extrinsically, sodomy with or without a condom is not a moral equivalent. A condom must be obtained and obtaining a condom for sex is a moral evil, both in itself and by support of the condom industry. Obtaining a condom may or may not give scandal. Obtaining a condom makes the sin of sodomy more likely and its repetition more probable. Repetition can lead to a habit of perversion and a greater likelihood of loss of faith and damnation. It also leads to greater danger of the physical evil called AIDS. When one is told that condom use is the lesser evil, the advice may be perceived as undue toleration of evil and neglect of proper spiritual direction.

"Heterosexual intercourse: in heterosexual intercourse, and that means 95% of intercourse, the moral evil of using a condom is greater both intrinsically and extrinsically.

"Intrinsically the act is transformed from a natural one to an unnatural one even when contraception does not take place. Even spouses who are sterile may not use a condom to protect themselves from infection because the inherent unity and procreative nature of the conjugal act is destroyed. It becomes an act of mutual self-abuse. Intrinsically, there is a greater moral evil when the condom acts as a contraceptive. Contraception is an intrinsic evil and immoral whether in or out of marriage.

"Extrinsically, condom use brings its own train of evils. There is the act of obtaining or receiving a condom. Condom possession may be a constant temptation to sin as well as an instrument of seduction. It may lead to a habit of fornication and a contraceptive mentality that may destroy a future marriage. Another extrinsic possibility is the multiplication of malefactors, not only condom manufacturers and vendors, but school boards, or trustees, or teachers, or counselors, or chaplains, who advise condom use, or neglect the spiritual direction needed by the young. So in heterosexual intercourse, there are both intrinsic and extrinsic reasons to say that to use a condom is never the lesser sin." (2) It is clear that support for the use of the condom to prevent spread of HIV is in contradiction to Church teaching.

Medical facts about HIV/AIDS

The National Institutes of Health in 2001 investigated the world scientific literature relating to the ability of condom use to reduce the risk of the transmission of sexually transmitted disease. (3) The NIH found that the consistent and correct use of the condom reduced the risk of HIV transmission by 85%. A 15% risk remained. A more recent study, in 2003, concluded that consistent use of the condom results in only 80% reduction in HIV transmission. (4) Other circumstances such as rupture of a condom increase the risk. Liviana Calzavera, PhD, an epidemiologist at the University of Toronto, Faculty of Medicine, has stated that imperfect condom use probably offers as high a risk of transmitting HIV as does intercourse without the use of the condom. (5)

A key question remains. Does distribution of condoms lessen the spread or increase the transmission of HIV/AIDS? Dr. George Mulcaire-Jones, president and founder of Maternal Life International, who knows first-hand that condoms don't work because of his regular travels to Africa to work hands-on in the war against AIDS, says that condoms do little physically to prevent transmission of HIV and exacerbate the problem by promoting promiscuity where that behaviour is most deadly, in Asia and Africa. (6) Norman Hearst, professor at University of California, and Sanny Chen, an epidemiologist at the South Africa Health Department, state that in many sub-Saharan African countries, high HIV transmission rates have continued despite high condom use. They also said that no clear examples have emerged yet of a country that has turned back a generalized epidemic primarily by means of condom prevention, adding that the main cause of the falling incidence of HIV in Uganda was a substantial drop in the numbers of casual sexual partners and that measuring condom efficacy is nearly impossible. (7) Botswana, Zimbabwe, Kenya, and South Africa have the highest rates of HIV and also the highest availability of condoms. (8)

Until the late 1980s, Uganda had the highest rate of HIV/AIDS in the world. They then introduced a program to teach abstinence before marriage, and marital fidelity afterwards. They only reluctantly advised condoms for high- risk groups, like prostitutes, who they knew would not accept the other two approaches. In 1991, the prevalence rate of HIV was 15%. By 2001, it was 5%, the biggest reduction of HIV in the world. The rate among pregnant mothers in 1991 was 21.2%; by 2001, it was 6.2% and, at the same time, it was 15% in Kenya, 32% in Zimbabwe and 38% in Botswana, countries which focus on condom distribution. Their rates are still rising.

Dr. Edward C. Green, an anthropologist at the Harvard School of Public Health, who used to support condom distribution, was sent to Uganda by the U.S. Agency for International Development (USAID) to study the reasons for the success in Uganda. He reported that reduction in the number of sexual partners was probably the single most important behavioural change that resulted in prevalence decline. Abstinence was probably the second most important change. USMD, however, shelved Dr. Green's conclusions and enlisted a well-known condom advocate to write a new report.

Evidence for the success of Uganda's approach has come from USMD, the Joint United Nations Program on HIV/AIDS (UNMDS), the World Health Organization (WHO), the Harvard Center for Population and Developmental Studies, the Ugandan Government, and numerous independent studies. (9) Dr. Anne Paterson, assistant administrator for global health with the USAID, gave similar evidence about the effectiveness of abstinence and faithfulness in marriage in regard to efforts to stem HIV/AIDS. She reported this to the Subcommittee on African Affairs, on May 23, 2003. (10)

One more question. Is it reasonable to recommend the use of the condom to a married couple where one partner has HIV infection ? The condom does not abolish the risk of transmitting this horrible and ultimately fatal disease. Intercourse puts the uninfected spouse at great risk. There is therefore a doubt about taking the life of an innocent human being, a dubium facti, which as such, creates the same obligation as certainty. Self-sacrifice and abstinence are the only valid moral options. (10)

Sister Miriam Duggan (Franciscan Missionaries of Africa) and Sister Kay Lawlor (Medical Missionaries of Mary) run a major abstinence program in Uganda. Sister Duggan says that the main reason why AIDS has spread so much in Africa is because of a loss of traditional values. Polygamy was practiced, but virginity before marriage and fidelity within marriage were respected. Media and peer pressure has resulted in promiscuity. The sisters' program has shown that chastity is not pie-in-the-sky, but has very real positive results. (11) Dr. Mulcaire-Jones, who once believed that it would be impossible to get African men to understand natural family planning, or to adhere to a lifestyle of abstinence and sexual faithfulness in marriage, now says, "I have found tremendous willingness to hear and adhere to Church teachings about sexual morality ... we are having tremendous success ... the Catholic Church really does have the answer to this." (12)

Why is the focus only on HIV/AIDS?

Was it a focus on HIV/AIDS that caused the various bishops to recommend use of the condom to prevent its spread? It is true that it is a death-dealing disease. However, there are many other deadly sexually transmitted infections whose spread has not caused any Catholic clerical concern. Consider the following facts:

* Gonorrhea; reduction of infection rate by condom use was 13.7% in men and 2% in women, 62 million new cases annually, worldwide.

* Chlamydia: no proof of risk reduction, 89 million new cases annually, worldwide.

* Genital Herpes: no proof of risk reduction, 92 million new cases annually, worldwide.

* Human Papilloma Virus (HPV): no proof of risk reduction, 12 million new cases annually, worldwide.

* Syphilis: no proof of risk reduction, 12 million new cases annually, worldwide.

* Human immunodeficiency virus (HIV): risk reduction 85%, but only if the condom is consistently and correctly used. There are 5.3 million new cases annually, worldwide.

* Hepatitis B virus (HBV): no proof of risk reduction, 45 million new cases annually, worldwide. (13)

Serious complications of these infections:

* Gonorrhea: In women, tubal pregnancy, infertility pelvic pain, blindness in the newborn child.

* Chlamydia: In women, tubal pregnancy, pelvic pain, eye infection and pneumonia in newborn child.

* Genital Herpes: increased risk of HIV and death of newborn baby

* Syphilis: serious and fatal disease of the aorta, heart, and brain of the adult and death or congenital syphilis of the newborn baby.

* HPV: almost all cases of carcinoma of the cervix of the uterus are caused by this virus. Carcinoma of the uterus is the third most common cancer in women, worldwide. HPV, which is transmitted by anal receptive intercourse, also causes cancer of the anus.

* HBV: causes liver failure and cancer of the liver.

Conclusion

To recommend the condom as a protection against HIV gives a false sense of security, not only in regard to HIV,, but also in regard to many other serious diseases, where it provides little or no protection at all. The tendency of the clergy to cave in about the Church's teaching on the use of condoms is consistent with their failure to preach and the laity's failure to put into practice the Church's teaching on contraception. When Pope Paul VI published his encyclical Humanae vitae in 1968, he predicted that artificial contraception would lead to an increase in conjugal infidelity, a general lowering of morality, and, as is the case in China today, mandatory and arbitrary contraceptive measures. He could not have anticipated the tragic tsunami of sexually transmitted diseases that have occurred since his time. 'Safer-sex' is an oxymoron, and the most dangerous expression in the English language.

REFERENCES:

(1.) William B. Smith. Questions Answered: "A response", Homiletic and Pastoral Review, June, 2002.

(2.) Msgr. Vincent N. Foy, P.H., J.C.D., "AIDS, Condoms, and Catholic Education," Journal, a publication of the Canadian chapter of the Fellowship of Catholic Scholars, Spring, 2005. pp. 27-32.

(3.) National Institute of Allergy and Infectious Diseases, Workshop Summary, Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention, July 20, 2001.

(4.) S. Weller and K. Davis. "Condom Effectiveness in Reducing HIV Transmission," The Cochrane Library Issue 2. Oxford; update software (2003).

(5.) David Square, Medical Post, July 3, 2002. Vol. 38, Issue 36.

(6.) Wayne Laugeson, "Catholic Teaching Has the Best Way to Stop AIDS." National Catholic Register, Aug. 11-17, 2002.

(7.) Norman Hearst, and Sanny Chen, "Condom Promotion for AIDS Prevention in the Developing World: Is it Working?" Studies in Family Planning, March-June, 2004, Vol. 35, No. 1-2.

(8.) Testimony before Subcommittee on African Affairs, given May 23, 2003. Executive Summary: The White House Initiative to Combat AIDS: Learning from Uganda. Joseph Loconte, William E. Simon Fellow in Religion and a Free Society at the Heritage Foundation, Sept. 30, 2003.

(9.) Ibid.

(10.) Mauro Cozzoli, The Human Embryo: Ethical and Normative Aspects, The Identity and Status of the Human Embryo, Libera Editrice Vaticana, p. 271.

(11.) A D 2000, vol. 13, no.10, Nov 2000, p.7.

(12.) See reference 8.

(13.) See reference 3.

JOHN B. SHEA, M.D., FRCP(C)

John B. Shea, MD, FRCP(C), of Toronto is the author of The Safer-Sex Illusion, Toronto, Life Ethics Information Centre, 2001, pp. 48. The booklet is still available from Catholic Insight at $3.00 per copy plus shipping and handling and at reduced prices for ten or one hundred copies at a time. For Msgr. Vincent Foy's new book, see advertisement elsewhere in this issue.