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Beyond the condom taboo

Will a new document from the Vatican herald a new era in HIV prevention for the Catholic church? Christine Allen expresses a guarded optimism.

The recent UN conference on HIV and Aids ended with disagreements over prevention strategies and language. Such an outcome is no longer a surprise, even if it is a disappointment. Given the fact that HIV is largely (though not exclusively) transmitted through sex, it is no surprise that for many cultures and religions, it’s difficult to go beyond the taboos. I know from the work my organisation, Progressio, has done with Islamic religious leaders in Somaliland, how hard and painstaking it is even to discuss the issues involved. But as the scale of the pandemic grows ever larger, addressing the issues continues to be vital. Religious groups and leaders have a very important role in tackling HIV – it is well documented that the leadership from religious groups is a force for change – both positively and negatively.

Nowhere is this more evident than with regard to the Catholic church. The church has come under intense criticism for its implacable objection to condom use. The rigidity of its position on this matter becomes, I believe, a diversion, and actually undermines the excellent work the church (through many agencies) does on front line health and care services. The church has vital messages - on respect and fidelity in relationships - that are so important in the context of HIV, that never get the attention or respect they deserve because of this apparent intransigence that seems obsessed with the condom.

Despite the arguments and the fears, deaths and rate of infections continue to rise. In many parts of the world it is the church projects and agencies that provide the health care and other support services. The workers (often religious sisters) face a very difficult moral decision about the kind of advice and support they offer. These HIV and health care workers continue to struggle with the complex personal and moral dilemmas that individuals face – that can often seem a world away from the simple ideal that church teaching can espouse. In practice, these moral challenges are far from simple. Who would condemn the woman who faces being infected by a partner even though she has remained faithful? Or the woman forced by poverty to sell her body for food? I remember talking to a religious woman at an HIV project who struggled to broach the gap between her church’s ideal and the mess of everyday life. “If, whatever I say, the man is going to have sex and we all know he is HIV+, then I have to tell him to use a condom. He is killing people otherwise.” This surely is a sensible, and pro-life position, arising out of deep and considered thought, even if it seems to go against the official teaching.

Behind the media hype, the Catholic church has a good record with regard to pastoral care for people with HIV and has issued strong statements about the evils of stigma. Although the media has failed to appreciate it, there has been a debate and a plurality of opinions for some time on this issue and a growing call for change.

So, I was pleased to hear that the Vatican is considering a statement on HIV and condom use in particular. Pope Benedict has apparently asked the Vatican's council for health care to study the issue of prevention and it is expected that the Vatican will soon issue a document about the use of condoms ‘by persons who have grave diseases, starting with Aids’.

Part of the reason for the plurality of opinion within the church is that there isn’t a clear framework of teaching around HIV prevention. Official church teaching simply hasn’t kept up with the reality of HIV and Aids. The ban on condom use is based on preventing artificial methods of contraception hailing back to a document from 1968 – well before HIV was recognised. Whilst it is a relevant teaching on contraception (though in practice largely ignored by the catholic community), it simply doesn’t stack up when it comes to HIV. It is widely accepted that using a condom to prevent HIV transmission is not preventing life, rather it is preventing the transmission of death. The church leadership has, for too long, failed to understand the essential complexity and difference that the HIV/Aids pandemic represents. Whilst there has been a lot of thinking and writing on the issue from many experts, there is a lack of teaching explicitly on HIV from the hierarchy.

A new document is potentially historic. There is a growing voice calling for change, but there are also those who would be dismayed by any such change, seeing it as a weakness in the church’s moral stance. The battle between these factions is about the very nature of church – is it an institution that dictates and tells people what to do, or is it one that supports, encourages and empowers people in their daily and complex struggles.

Cardinal Carlo Martini, has recently added to the debate saying that with married couples, where one partner had HIV/Aids, the use of condoms was ‘a lesser evil’. Although retired, he is the most senior church leader to join the many people from all levels in the church seeking a change in the teaching on HIV prevention. His comments have increased expectation that this forthcoming document may be more liberal, or at least more understanding of complexities. Three principles are at play in the question of future teaching on the issue: that of lesser evil (the least damaging between two choices), that of double effect (where the purpose of preventing transmission of death also has the side effect of preventing conception) and the primacy of conscience (where individuals ultimately have to make considered and thoughtful choices). It is this final category that is most contentious for those people who see the authority of the church as the important thing!

The addition of Cardinal Martini to the voices – and the fact that he has not faced any public rebuke, adds to the expectation of a more liberal position – or at least some recognition of the coherence and strength to the argument that condoms have a role. Pope Benedict is a man of great intellect and strong theological prowess. I have no doubt that he sees the contradictions and inherent flaws in the vacuum that is current teaching. Although many liberals greeted his election to Pope with trepidation, perhaps it is only a conservative who could make this most liberal of changes.

No one should expect the church to say ‘condoms for all’! The insistence that abstinence is the only 100% effective prevention is right - but in such a matter people need support to make choices, not just instruction. HIV raises real questions about powerlessness, violence, vulnerability and poverty. For so many who are the poorest and the most vulnerable in the world, the issues of sexual violence, exploitation, stigma and the lack of access for treatment need addressing and fast. I hope that this document will have the courage to go beyond the totem of the condom and recognise that a diversity of methods of prevention are needed to respond effectively in what are complex situations. It is also time for the church to speak out about these structural injustices without its position on condoms acting as a deflection. It is time for the teaching to come up to date with the reality. A change is long overdue.

For those front-line workers on HIV, having some up to date, explicit teaching on HIV will provide a clearer framework in which they can support people in making complex and difficult moral choices. In so many respects the church encourages people to think for themselves in their life choices. Greater understanding and compassion will strengthen the church in this work. Closing up the condom cul-de–sac will enable a more realistic debate of the issues and will also mean that the fundamental message of the church – that of respecting human life and human dignity especially for the poor and powerless – can be shouted from the roof tops.

Christine Allen is the Director of Progressio, an independent Catholic organisation working for sustainable development. She is writing in a personal capacity. Go to www.progressio.org.uk for more information.