August 13, 2001
WashPost: Condoms, Africa, & the Catholic Church

AIDS Challenges Religious Leaders
By Karen DeYoung, Washington Post

When southern Africa's Roman Catholic bishops held their semi-annual meeting in Pretoria, South Africa, last month, the issue at the top of the agenda was a proposal to approve the use of condoms for AIDS prevention.

The bishops--from South Africa, Botswana and Swaziland--were well aware that the Vatican bans condoms, regardless of whether their intended use is contraception or disease prevention. But with more than 25 million Africans now infected with HIV/AIDS, many at the meeting felt "we have to be able to say something," said Cape Town Auxiliary Bishop Reginald Cawcutt. "We need the wisdom of Solomon. And we know--we're really, really aware--that the world is waiting for us. So is the Vatican."

In the end, the bishops gave the Vatican no cause for concern. After five days of closed-door debate, they pronounced the "widespread and indiscriminate promotion of condoms . . . an immoral and misguided weapon in our battle against HIV-AIDS." By undermining abstinence and marital fidelity, they said, "condoms may even be one of the main reasons for the spread of HIV-AIDS."

But the bishops face a dilemma that is not unique to southern Africa, and that is only likely to intensify. As AIDS deaths mount, the pandemic is challenging the world's mainstream religions as much as any event in modern history, seemingly setting at odds their core missions of assuaging human suffering and perfecting human morality.

Nowhere is the conflict more intense or its implications more significant than within the Catholic Church.

Roman Catholicism has been a crucial player in virtually all aspects of the global response to AIDS since the disease was identified 20 years ago. Through its hospices and hospitals, orphanages and parish outreach, the Catholic Church provides more direct care for people with AIDS and their families and communities, particularly in Africa and Latin America, than any other institution.

The Vatican has been at the front of demands for increased international spending on AIDS care and treatment. Pope John Paul II has called the prices charged by major pharmaceutical companies for AIDS drugs "excessive [and] sometimes even exorbitant" and has said the patent and intellectual property rights defended by the companies and the U.S. government are morally inferior to "every individual's right to health."

But the Vatican also has been the world's loudest and most consistent voice in opposition to what the United Nations, most governments and the vast majority of international organizations involved in the AIDS fight say are the most realistic and effective ways to slow the spread of HIV, the human immunodeficiency virus that causes AIDS.

Church doctrine condemns the use of condoms as twice sinful-both as contraceptives and as promoters of promiscuity. Much to the consternation and disagreement of public health experts, Vatican spokesmen also regularly question whether condoms prevent sexual transmission of the virus.

The Vatican has rejected prevention campaigns that pay special attention to those at highest risk of HIV infection, including gay men and lesbians, prostitutes and people who inject drugs, saying that such recognition would imply approval of immoral acts. As a result, activists say, the Catholic Church contributes to the widespread stigma and discrimination against people with AIDS.

Among world religions, Roman Catholic leaders are hardly alone in their approach to preventing the spread of AIDS. Warnings that AIDS-related sex education and condom promotion will undermine individual morality and lead to societal destruction have come from Islamic leaders in Pakistan and evangelical Protestants in Jamaica.

In January, the Council of Islamic Clerics in Nigeria's northern Kano state condemned a planned seminar on HIV/AIDS prevention as violating Islamic law. Imam Ibrahim Umar Kabo called it a Western "gimmick to spread immorality in our society."

Zambian President Frederick Chiluba, who has proclaimed Christianity the state religion, has called condoms "a sign of weak morals." Early this year,Zambian health officials canceled ads prepared for state-run TV and radio after religious leaders said their promotion of condoms would lead to promiscuity.

When the Kenyan government announced plans last month to import 300 million condoms to prevent the spread of AIDS, Sheik Mohamed Dor of the Council of Imams and Preachers said the country was "committing suicide" and encouraging sexual experimentation among young people. Bemoaning the expense, President Daniel arap Moi suggested that all Kenyans instead abstain from sex for two years.

Reaction was once similar among religious leaders in the United States, who were forced to confront AIDS much earlier than their counterparts in Africa, Latin America and Asia. "My experience today, reaching out to faith-based organizations in Africa, has a similar quality of 10 years ago in this country," said Jason Heffner of the U.S. Agency for International Development. "You could not get the major [U.S.] leaders to sit down around a table . . . [and] we didn't have the leadership we needed. Now, we see the religious community on board in many ways."

The explosion of AIDS in the developing world has also begun to change some minds. Uganda's Islamic Medical Association was behind a prevention campaign that has become a model. In Niger, Islamic leaders this year recommended that Muslim teachers learn to teach about AIDS and that couples receive premarital HIV testing.

In Senegal, where more than 90 percent of the population is Muslim, the spread of HIV slowed dramatically after Islamic and Christian leaders joined a government AIDS-prevention campaign advocating condoms along with abstinence and fidelity. "Sixteen years ago, people didn't talk about AIDS," Senegalese Imam Ousmane Gueye said during a U.N.-organized visit there last month. "Islam forbids all evil and fornication" as well as condoms, he said, but that teaching has been adapted for people with AIDS to prevent the spread of infection.

"AIDS is . . . not a divine curse," Gueye said. "It is a disease and there is no cure, but you must not run away from people with AIDS."

South Africa's Anglican Archbishop Njongonkulu Ndungane has been instrumental in promoting clerical AIDS education and prevention campaigns, including condom use. The World Council of Churches, representing 342 Protestant and Orthodox Christian churches around the world, is an outspoken supporter of all forms of prevention.

UNAIDS, the umbrella organization of U.N. and World Bank AIDS programs, has produced an HIV-prevention video with quotes from the Koran for Islamic religious leaders. "Our approach has been to work with those church leaders who are open to it," said Peter Piot, executive director of UNAIDS.

USAID, the U.S. foreign assistance program, has developed an AIDS outreach program for African religious leaders. But one agency official acknowledged that there are limits to cooperation: "I don't think we're going to, as USAID or the U.S. government, change the position of the Catholic Church."

Debate Within Church

The final speech at a three-day U.N. session on AIDS in June was given by the delegate from the Vatican, who made it clear that the Holy See's participation in the session, which included discussions of homosexuality and prostitution, should not be interpreted as acceptance of immoral behavior.

Moreover, he said, "The Holy See wishes to emphasize that, with regard to the use of condoms as a means of preventing HIV infection"-a method strongly endorsed in a U.N. General Assembly declaration just moments before -- "it has in no way changed its moral position."

But others in the church are not as sure where the high moral ground lies.

"What we are seeing now is that there is a debate going on in the Catholic Church," Piot said. "Clearly, there are many Roman Catholics who feel uncomfortable with the current official position."

Although the theological debate over AIDS now extends to parishes and dioceses around the world, it began years ago in the more esoteric confines of essays in clerical magazines and quiet conversations among Catholic ethicists.

The debate centers on the "lesser evil" principle. Moral theologian Rev. Richard A. McCormick, quoted in a recently published collection of essays titled "Catholic Ethicists on HIV/AIDS Prevention," used drunk driving as an illustration. "We say, 'Don't drive while drunk; let someone else drive.' But supporting the designated driver doesn't mean we support over-drinking. It simply means that we don't want the irresponsibility doubled."

A number of Catholic theologians have questioned whether condoms should be permitted in some cases-for example, by an HIV-positive man to avoid infecting his wife. Such permission, the theologians argue, does not mean acceptance of the man's presumed infidelity.

In Brazil, the world's largest predominantly Catholic country, government condom distribution and sex-education programs to combat a high infection rate have provoked the sharpest public disagreements within the church hierarchy since the decades-old battles over liberation theology.

When Eugenio Rixen, the Belgian-born bishop of the diocese of Goias, near the capital, Brasilia, shook the national meeting of the Brazilian Pastoral Health Commission last year by calling condom use to prevent HIV a "lesser evil," he was rebuked by the Vatican and by Sao Paulo Archbishop Claudio Hummes, who called such arguments "unacceptable."

"The one thing everyone in the church agrees on is that the problem is very grave, but there are differences in the way in which we think the situation should be handled," said the Rev. Ricardo Rezende, a parish priest in the Brazilian state of Parana and a leading voice on social justice issues. "The church is offering its assistance through programs to those infected with the disease, but the ongoing debate is how to reconcile Vatican doctrine with the realities of modern Brazil."

The church's position on contraception was spelled out in July 1968 by Pope Paul VI's Humanae Vitae, an encyclical prompted in part by the new availability of birth control pills. In it, the pope repeated prohibitions on sex outside marriage and said that every marital act must remain open to the production of children. "Every action" that served to interfere with possible conception was banned, regardless of its intent. It specifically stated that the "lesser evil" concept justified no exceptions, "even for the gravest reasons . . . even when the intention is to safeguard or promoteindividual, family or social well-being."

When AIDS appeared in the early 1980s, its concentration among gay men raised no challenges to the doctrine. Homosexual acts were already considered sinful, with or without condoms. But by the 1990s, when AIDS started to spread like wildfire among heterosexuals and in the poorest parts of the world, doctrines began to collide on "a series of issues where social justice teaching cut across bioethics teaching," said the dean of Harvard Divinity School, J. Bryan Hehir, a Roman Catholic priest with long experience in human rights and humanitarian work. "Before, you could pursue most of the social justice and not run into these tensions."

Archbishop Javier Lozana Barragan, the Vatican's chief spokesman on AIDS, said he sees no dilemma. "Is it possible to use condoms?" he asked at a December news conference. "Of course. Many people use them. But if you ask whether they are allowed according to Catholic doctrine, the answer is no because they are not ethically permissible."

'Moral Responsibility'

At the pastoral level, where Catholic shepherds face members of their flock in private, priests can be found at the doctrinal edges and beyond on questions involving AIDS, according to interviews and the writings of a number of Catholic ethicists.

The Rev. Richard Albert, an American who has been a parish priest in Kingston, Jamaica, for two decades, operates a hospice serving people with AIDS. He does not question the Vatican's condemnation of condoms or sex outside marriage. "I honestly believe my moral responsibility is to challenge them to moral living," Albert said of those he ministers to, and it is what he regularly preaches from the pulpit.

But when asked what he counsels on a pastoral level, he says, "I deal with them where they are at."

Piot, of UNAIDS, recounted a visit to a group of Catholic nuns working with orphans and AIDS education in Ivory Coast. "Suddenly, the mother superior showed me a flip chart with a condom on it. I said, 'My goodness, Mother, you're promoting condoms.' She told me: 'When I show this, I speak as a woman and not as a nun.' "

As long as a priest does not deviate from doctrine in public statements, "the chance that [he's] going to get in trouble is very slim," one Catholic cleric said. "This sounds at certain levels like hypocrisy, but at the people level, it's always been recognized."

Organizations like UNAIDS that would like to expand their collaboration with religious institutions care as much about what the church does not say in public as what it does. "What we've asked of the churches, particularly the Catholic Church, is that if you can't say anything nice about condoms, don't say anything at all," said Paul Delay, who heads AIDS programs for USAID. "Concentrate on [abstinence and fidelity] . . . but don't say that condoms don't work or they've got holes in them or they will break. Don't give misinformation."

Piot said finding common ground with religious institutions "has definitely become easier" since he took over UNAIDS five years ago.

"But not with everybody," Piot said. "There is a group in the church that puts, let's say, the dogma before saving lives. And there are hard-liners everywhere.

"Churches have an enormous impact on people's attitudes and morality, although it's not totally effective; otherwise, we wouldn't have an AIDS epidemic," he said. "It's important that they're on board, that they're part of the solution."

Correspondent Anthony Faiola in Buenos Aires contributed to this report.


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