Sign: Know your HIV status in Zambia, Africa. Commons

S.O.S. Africa

More than 24 million people infected by HIV live in sub-Saharan Africa today, presenting a global-scale problem. But prevention programs have been based almost exclusively on promoting the use of condoms. Here's another point of view...
Cristina Ravera, Giuliano Rizzardini, Filippo Ciantia, Alberto Bettinelli, Reproductive Health Study Group, and AVSI

More than 24.5 million people infected by HIV live in sub-Saharan Africa today. The HIV-positive rate in the adult population is now above 10% in at least 16 countries on the African continent. In South Africa and Zimbabwe, 20% to 25% of the population is infected by the virus. In some districts, such as Rakai, in Uganda, 73% of adult deaths can be attributed to the AIDS virus. In sub-Saharan Africa, 13.2 million children under the age of 16 have lost one or both of their parents because of AIDS. The economic impact of the epidemic is disastrous. In many rural areas of southern Africa, around 30% of the farmers are HIV-positive, with an estimated cost in terms of lost work time of $1,423 per year, per person, with a predicted increase of up to ten times as much in the next five years.

Scientific Falsehoods
These are just some of the dramatic statistics concerning the African continent contained in the recent report on the world HIV/AIDS situation prepared by UNAIDS (Joint United Nations Program on HIV/AIDS) and reported during the recent XIII World AIDS Conference, held in Durban last July. Early in the year, U.S. President Clinton repeated on more than one occasion that AIDS in developing countries is a problem on the world level and that it must therefore be faced up to by the world community. All this has stimulated various agencies and foundations, some pharmaceuticals companies, and some governments to appropriate funds for the fight against AIDS in the countries most affected by this plague. Unfortunately, yet once more all these funds will go to support projects that are constructed not only on ideological but above all scientific falsehoods. For years, heavily sustained by authoritative international agencies, many programs for prevention in Third World countries have been based almost exclusively on promoting the use of condoms. All this without taking into account the cultural differences and traditions of the countries involved, or the opinions of authoritative local leaders, and above all without calling the slightest attention to them in the press, to give public opinion a chance to raise doubts about the value of the proposals. Very few people, for instance, remember the speech made in 1992 in Florence during the World AIDS Congress by the President of Uganda, Museveni (whose secular position can hardly be in doubt): “I continue to extol a return to our proven traditions, which encouraged fidelity and condemned pre- and extra-marital sexual relations. I believe that the best answer to the threat of AIDS and other sexually transmitted diseases is to reaffirm publicly and openly the respect that each person owes to his neighbor. We must teach young people the virtues of abstinence, self-control, the ability to wait, and the capacity for sacrifice. Just as in the 1940s we were offered the magical solution of penicillin, our health experts now offer us condoms and ‘safe sex.’ In countries like ours, where a mother often has to walk 20 miles to find an aspirin for her sick child or five miles to find a little water, the practical issues of ensuring a constant supply of condoms or using them properly might never be solved. In the meantime, we are told that just a thin piece of rubber lies between us and the death of a continent. I feel that condoms have a role to play as a means of contraception, especially in HIV-positive couples, but condoms cannot be the principal means of containing and arresting the course of AIDS.”

Technical data
Some years ago, Medicina e Morale published some technical data about condoms, supported by scientific data, which however did not arouse the slightest echo in the spheres that deal with the problem of AIDS. The annual probability of pregnancy for a couple that uses condoms exclusively varies between 5% and 30%, with an average of 15%. We synthesize here some of the other data. The efficiency of condoms in preventing sexually transmitted diseases is in inverse relationship to the size of the pathogenic agent. While their use, in effect, determines a significant reduction (from two to ten times) of sexually transmitted bacterial diseases like gonorrhea, their effectiveness against viral infections (viruses are much smaller than bacteria) is greatly reduced. Condom failure can be divided into three categories:

· Technical failure (porosity, breakage, degradation of the rubber)
· Incorrect use
· Barrier by-pass (contamination before the condom is put on)

During the fifth AIDS conference in Montreal, it was shown that a significant number of condoms are permeable to microspores with a diameter greater than that of HIV (a virus that is 60 times smaller than the bacteria causing syphilis and 450 times smaller than sperm cells). Thus there is a theoretical possibility that the HIV virus in sperm can pass through the pores to infect the partner, and for this reason some researchers suggest using two condoms simultaneously (just as surgeons should use two pairs of rubber gloves to prevent infection from HIV). Leaks and breakage occur in 1.5% to 8% of cases. Furthermore, degradation of the rubber is proportional to the age of the condom. Epidemiological studies in recent years have demonstrated that condoms give some protection against viral infections, but this protection is far from absolute. In fact, the risk of infection with HIV with the use of condoms during sexual intercourse is around 15%. Once again, these data were not given prominence in scientific publications or the popular press. A provocative conclusion is offered by the author of the article published in Medicina e Morale: “When HIV/AIDS is involved, the risk of contracting the infection, even if reduced to 10% (while one thinks he is protected by a condom), is unacceptably high. What would we think if they told us that we had a 10% chance of crashing when we get on an airplane?”

Safety Belts
An interesting article appeared recently in Lancet, entitled, “Condoms and Seat Belts: the Parallels and the Lessons.” The authors reiterate once again the dubious efficacy of condoms as a means of prevention, especially in Africa: “Seat belts have not brought the beneficial effects that were hoped. The theory of risk compensation can explain why the obvious benefits of using seat belts are not necessarily transformed into real benefits when used by the entire population. If safety measures can cause compensatory modifications in the at-risk behavior of drivers, it is highly probable that measures taken to reduce risk to sexual health can modify at-risk behavior here too. We believe that those who plan and implement sexual health measures must be careful to take this phenomenon into consideration. We must ask ourselves why the promotion of condoms does not have a great effect in the majority of developing countries. We must also ask ourselves if there is a proper balance between messages promoting condoms and messages that encourage a reduction in the number of partners.”

Discreet and Effective
The Church, as Jacques Suaudeau has reiterated (“Prophylactics and family values: on the expansion of HIV/AIDS,” L’Osservatore Romano, English edition, April 19, 2000), has not remained indifferent to this situation. On the contrary, “since the epidemic began, she has been present with her hospitals, care centers, parishes, the service of religious, local organizations for aid to victims and attention to their needs, and has been on the front line in Africa in the fight against HIV/AIDS. We must keep in mind that the commitment of the Catholic Church has been, as always, discreet and efficient. We must acknowledge especially the admirable dedication and remarkable generosity of the many persons whom we have seen–in Uganda, Kenya, Tanzania, Ghana, Ivory Coast, Benin, Central African Republic, Burkina-Faso–visiting AIDS victims in their homes, bringing them human assistance, medical care, and often food and drink. To understand the reality of AIDS in these countries, we must follow the volunteers on their rounds, while they go into dark houses and with tender and compassionate gestures bend over a poor emaciated woman on the threshold of death, surrounded by three or four children who tomorrow will not have anything, not even their mother. “We must take into proper consideration the religious women who have taken in so many AIDS orphans, giving them a home, food, schooling, and vocational training, while being able to count only on a minimal amount of public aid and a very low contribution from the institutions responsible at the international level. We must consider the persons, lay men and women, often coming from other continents, who have managed to give hope, dignity, and food to the many women who have been infected by AIDS and rejected by everyone as ‘dirty.’ Here we have seen Christ suffering, Christ despised, stigmatized, rejected, Christ sick and unvisited, Christ dying of hunger and thirst. But we have also seen Christ visiting the sick, comforting the suffering, embracing the AIDS victim, taking responsibility for children who have been left orphans. Recalling the serene and smiling faces of so many men and women who are committed daily, without publicity, to this fight against the devastation wrought by the HIV/AIDS epidemic, we have been saddened by recent statements made in the press, with great sensation, by some people on the occasion of a brief trip to some African countries. In essence, they accuse the Catholic Church of ‘indifference’ in the face of the tragedy of AIDS in Africa, above all because of her position on the use of condoms in the prevention of sexual contamination.

Family Values
“The Pontifical Council for the Family has never ceased repeating the message of the Catholic Church on this difficult question of HIV/AIDS prevention. This message is based, essentially, on ‘family values.’ At issue here is a view of man and woman, their dignity, the meaning and significance of sex, as presented in the document on human sexuality prepared by this Council. Wherever there is a true education to the values of the family, marital fidelity, and the chastity of the spouses, to the proper significance of their reciprocal gift, and wherever the invasive forms of promiscuity can be overcome, man will achieve a human victory even over this terrible phenomenon. “The most radical prevention of HIV/AIDS, undeniably and absolutely the most effective, is sexual abstinence for adolescents before marriage, and conjugal chastity within marriage. Limiting our intervention to inviting adolescents to use a condom during their sexual experiences means continuing to feed the vicious sexual circle that underlies the gravity of the rampant epidemic in sub-Saharan Africa. It is an illusion to link the efficacy of the fight against HIV/AIDS to the number of prophylactics distributed among a population. In conclusion, we must point out some exemplary initiatives, among many others, created for the adolescents and young people of these countries. In Uganda, Tanzania, and Nigeria, youth groups have been formed by the religious, priests, and Catholic lay people who concern themselves with young people. These groups devote their efforts to the fight against HIV/AIDS and have meaningful names: ‘Youth Alive,’ ‘Youth for Life.’ In these informal groups, which are independent of any type of governmental organization, boys and girls between 16 and 18 years of age are committed to fight HIV/AIDS among the young people around them, starting with themselves, by making a commitment to sexual continence before marriage and conjugal chastity after marriage. These groups are not theoretical projections. They really exist, and have for years, with discretion and effectiveness. No one can deny that this is the model to follow; to be sure, it is not an easy model, but it is something that is fully human, based on faith and hope, and not on a piece of rubber to be given out. Today it seems that people prefer material to be distributed rather than efforts on the part of human beings. With the millions of dollars spent on the prophylactics industry, much more could have been done for the youth of Africa, their education, sustenance, and the effective prevention of infection from HIV/AIDS. “The Catholic Church believes in the value of the human being, in his resources. She believes that ‘man infinitely surpasses man,’ as Pascal said, because he is created in the image of God (Gen 1:27). In the field of HIV/AIDS, we have treated man as though he were an animal, forgetting about all the energy that he is capable of putting into motion when he is convinced that it is worth acting to obtain something that is necessary. We can understand the reasons that lead health officials to distribute condoms to prostitutes and their clients. However, HIV/AIDS prevention has to be more than this, it has to move onto another level and attack the true social, economic, political, and moral roots of the epidemic. This is not impossible, it is necessary simply to broaden our vision and ensure a greater respect for human beings. ‘Youth Alive,’ ‘Youth for Life,’ have made this choice. It is a choice for the future of a continent which could otherwise lose hope.”