UNDER THE MICROSCOPE:Acquired Immune Deficiency Syndrome (Aids), caused by the Human Immunodeficiency Virus (HIV), continues to be a major global public health problem. Sub-Saharan Africa has two-thirds of the world's HIV/Aids cases and three-quarters of global Aids deaths in 2007 were in this region, where some 22 million people are infected with HIV.
Extensive efforts are afoot to combat Aids in Africa. On a visit to Africa in March 2009, Pope Benedict XVI generated media headlines worldwide when he said that condoms were not the answer to Aids in Africa and could make the problem worse. In this article, I will discuss the issue of condoms and Aids.
First of all, a personal note in the interest of transparency. I am a Christian, specifically a Catholic. The Catholic Church is opposed to artificial contraception, including condoms. I sympathise with the Church’s concerns about the negative repercussions of separating the reproductive function of sex from the pleasurable aspect, but I do not agree with its overall argument. On the other hand, I accept Church teaching on sexual fidelity within marriage and on promiscuous sexual behaviour generally. And I appreciate that many non-religious people also accept these latter standards.
When two people, one of whom is HIV-positive, have sexual intercourse there is a significant risk, in the absence of effective precautionary measures, that HIV will be transmitted to the HIV-negative person. Will a condom prevent the transmission of HIV? Yes, there is scientific consensus that a latex condom, properly used, will prevent transmission of the virus and many studies have shown that the wall of the condom provides an effective barrier. Of course, a condom may tear during use, thereby allowing the virus through, but this happens in less than 1 per cent of cases.
The most convincing results for the effectiveness of condoms come from studies of sero-discordant couples, ie where one partner is HIV-positive and the other isn’t. When condoms are always used, 99 per cent of uninfected partners remain uninfected. These data mainly cover vaginal, oral and manual sex. Data on the effectiveness of condoms in protecting anal sex is not as extensive.
Now, I’m sure that Pope Benedict hasn’t carried out independent experiments showing that latex is full of holes, so he must mean something else when he says that condoms are not the answer to Aids but can actually make it worse.
The Catholic Church teaches that sexual intercourse should be restricted to marriage. If this teaching were followed universally, sexual transmission of Aids would effectively cease. The Church believes that to ignore this advice and to rely primarily on condoms to combat Aids in Africa only makes the problem worse. The Church believes that advocating condoms promotes promiscuous and risky sexual activity which, combined with lackadaisical adherence to optimum condom use anyway, leads to an overall worsening of the situation.
The Pope got unexpected support recently from Dr Edward Green, director of the HIV prevention research project at Harvard University, in an interview broadcast by BBC Radio Ulster. Green, a non-Catholic, spoke about condoms only in the sense of “what has been found to work and not work”. He said: “We now see HIV going down in about eight or nine African countries and in every case we see a decrease in the proportion of men and women who report having more than one sex partner in the past year. So, when the Pope said that the answer really lies in monogamy and marital faithfulness, that’s exactly what we found empirically.” And: “Instead of seeing this – condom availability and levels of condom use – associated with lower HIV infection rates, it is actually associated with higher HIV infection rates. Part of this is because the people using condoms are the people who are having risky sex.” Many experts disagree with Green and the UN vigorously promotes condoms.
Promiscuous unprotected sexual activity lies at the root of African Aids. Sexual abstinence outside marriage or widespread correct use of condoms would have a major positive effect, but unfortunately chaotic conditions on the ground are conducive to neither solution employed on its own. The UN condom approach has been operating for some time now, but this policy alone is not getting a grip on things.
From a simple, logical point of view, it seems to me that the best way to avoid/minimise the spread of Aids would be for everyone to avoid sexual intercourse except with one faithful partner. If one partner is HIV-positive and the other is not, condoms should always be used. If one partner, against advice, has sex with several others, condoms should always be used. The use of the condom here is strictly a public health measure whose primary purpose is to preserve rather than prevent life.
William Reville is associate professor of biochemistry and science awareness officer at University College Cork – http://understandingscience.ucc.ie
