Let's not condemn condoms in the fight against AIDS

A South African bishop who daily faces the 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 a 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 become 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 have we 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 over 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 becomes perhaps 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.

In passing, 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 results 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.

Kevin Dowling, C.Ss.R., is the bishop of the Diocese of Rustenburg, South Africa. This article appeared in the November 2003 (Volume 68, Number 11) issue of U.S. Catholic. All active news articles