The Church, AIDS and Africa, Cont.

My comments on the question of Pope Benedict's culpability for mass suffering and death in Africa has generated quite a lot of reader email, as you might expect. Here's a representative note, from a reader who works for a "leading global health organization":

... while I probably wouldn't accuse the Pope directly of causing "massive death and suffering," here are some facts: many, if not most, Catholic hospitals and dispensaries in Africa refuse to give out condoms. Their staff, both Africans and Westerners, constantly promote the myths, half-truths and outright falsehoods about birth control that perpetuate early births, poor family planning, a whole host of STIs (including HIV) and, by extension of all this, crushing, grinding poverty and maternal and child mortality. This is fact in every African country I have worked in.

That the Catholic Church provides - through its hospitals, clinics, schools and organizations like Catholic Relief Services - many other incredibly valuable services to people in the developing world, including Africans, makes it deserving of praise; but equally, it does not excuse the Church from knowingly doing direct harm to public health efforts in the region of the world most affected by HIV/AIDS.

And here's another:

It seems that your main source of frustration is the hyperbolic - these comments will result in "massive death and suffering" - reaction to Pope Benedict's comments.  I wonder what you think about the more subtle assertion that Pope Benedict's comments may contribute to confusion and misperception about how HIV/AIDS is transmitted, whether or not condoms are effective in preventing transmission, and to what extent that confusion may counteract or negate the work of public health officials attempting to reduce the rate of transmission. Both here at home, and in Africa, providing education and accurate information about how HIV is transmitted is an important part of the battle ... Clearly the Pope has the obligation to advocate Catholic principles and dogma, but need that advocacy come at the expense (potentially) of established science/medicine?  Would it not have been possible to advance the Catholic position preferring abstinence without intimating that condoms are not an effective tool in preventing the spread of HIV? 

It seems to me that much of the anger directed at the Pope's comments is a response to something new (condoms are not the solution) as opposed to something old (we prefer abstinence).  I wonder whether a statement that ignored the condoms issue entirely would have been received as negatively, and attacked as ferociously.

I agree with the second emailer that the Pope would have been well-served to confine himself to remarks promoting monogamy and fidelity, and shouldn't have waded into social-science-y pronouncements about the overall efficacy of condom-promotion efforts. But the anger that Benedict's remarks generated isn't a new thing by any stretch. John Paul II may have been more circumspect in his criticisms of the prophylactic approach to AIDS-fighting than his successor, but he was regularly accused of having "killed millions" of helpless, hopeless Africans even so.

And I agree with the first emailer: Catholics have absolutely no business spreading misinformation, cherrying-pick data and otherwise exaggerating the dangers of condom use. I'm sure that these kind of ideological blinders are a serious problem for public-health efforts in Africa. I'm just less sure that they're the only kind of ideological blinders that we should be worried about.

I should note that I don't pretend to be an expert on this topic, and my own conservative and Catholic biases have no doubt shaped the reading that I've done about AIDS-fighting strategies. But it's my impression - created, in large part, by reading Helen Epstein's The Invisible Cure (and if there's a devastating rebuttal to her arguments, please send it my way) - that an awful lot of the money poured into condom-promotion over the years would have much been better spent promoting "partner reduction" in cultures inclined to promiscuity and de facto polygamy instead. This isn't the same as promoting abstinence exclusively, and indeed, Epstein is witheringly critical of some of the abstinence-only programs that American dollars have funded in the Bush era. But "partner reduction" is a lot more consonant with the Catholic Church's longstanding position - that it's better to promote monogamy and fidelity than to take promiscuity as a given and make it as safe as possible - than you'd think from the overheated talk about how the Vatican's flat-earth position on condoms has cost millions of lives.

What's more, I have a hard time believing that the public-health and foreign-aid community's longstanding preference for condom promotion has nothing to do with ideological biases of their own. Yes, the Catholic Church's conservative position on sexual morality determines which public-health interventions the Vatican willing to support, and limits the willingness of Catholic institutions to simply follow the data wherever it leads. But what's true of Catholics is true of other groups as well. And when you read Epstein on how slow the AIDS establishment was to acknowledge the importance of partner-reduction - or when you read about Bill Gates getting booed at an international AIDS conference when he mentioned abstinence and fidelity - it's awfully hard to escape the conclusion that the combination of a liberationist view of sexual ethics and a post-colonial unwillingness to critique existing African patterns of sexual behavior has seriously hampered the international community's efforts to curb the spread of HIV.

This doesn't mean that conservative Catholics should turn around and suggest that the AIDS establishment has blood on its hands for privileging condom distribution over cultural change. That kind of rhetoric is inappropriate and stupid, period. All I'm suggesting is that there are many more shades of gray to this story than you'd think from the way that the media likes to cover it.