Catholic Church and HIV/AIDS

The Catholic Church's position on HIV/AIDS prevention has attracted controversy due to its opposition to condom use. In 2010 Pope Benedict XVI said that the use of condoms could sometimes be considered a first step toward moral behavior, but a spokesperson for the church later clarified that the use of condoms was still considered immoral and that the pope had not intended to take a position "on the problem of condoms in general." In relation to the sexual transmission of the disease, the Church teaches that sexual abstinence before marriage, and monogamy inside marriage, are a better means of limiting the spread of the epidemic than the use of condoms. United Nations bodies have criticised the Church for its stance against condom use, on the basis that condoms are the best available means to prevent infections among sexually active people. UN bodies co-operate closely with the Church on the provision of patient care, and in eliminating infections in children. The Church provides approximately one quarter of all HIV treatment and care.

Following the election of Pope Francis in 2013, UNAIDS wrote that the Church "provides support to millions of people living with HIV around the world" and that "Statistics from the Vatican in 2012 indicate that Catholic Church-related organizations provide approximately a quarter of all HIV treatment, care, and support throughout the world and run more than 5,000 hospitals, 18,000 dispensaries, and 9,000 orphanages, many involved in AIDS-related activities." UNAIDS co-operates closely with the Church on critical issues such as the elimination of new HIV infections in children, and keeping their mothers alive, as well as increasing access to antiretroviral medication. Caritas Internationalis is the Church's main international aid and development body, operating in over 200 countries and territories, and is among the strategic partners of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Pope Paul VI issued the Humanae vitae Encyclical Letter on the Regulation of Birth in 1968, which outlined opposition to "artificial birth control" on the basis that it would open a "wide and easy a road... towards conjugal infidelity and the general lowering of morality". The AIDS epidemic emerged from the 1980s. In 2010, Pope Benedict XVI characterized condom use as not a "real or moral solution" to the spread of AIDS, but in the case of homosexual prostitution, a potentially lesser-evil "first step" in the direction of moralization and responsibility, when used with "the intention of reducing the risk of infection". A 2014 report by The U.N. Committee on the Rights of the Child called on the Church to "overcome all the barriers and taboos surrounding adolescent sexuality that hinder their access to sexual and reproductive information, including on family planning and contraceptives".

Globally, well over thirty million people have died from HIV/AIDS. The Church's condom ban was largely ignored in industrialised countries, in which public awareness campaigns encouraged condom use. The church's stance against condoms has been blamed for the prevalence of AIDS in Africa.

Background

The sexual revolution of the 1960s precipitated Pope Paul VI's 1968 encyclical Humanae Vitae (On Human Life) which rejected the use of contraception, including sterilization, asserting that these work against the intimate relationship and moral order of husband and wife by directly opposing God's will. It approved Natural Family Planning as a legitimate means to limit family size. Paul VI wrote that "artificial birth control" would open a "wide and easy a road... towards conjugal infidelity and the general lowering of morality". The assertion of Papal authority on this issue was an unusual departure from Conciliar authority which was the normal process of the Church Councils such as Vatican II.

HIV/AIDS emerged from Africa and became a global pandemic in the late 20th century.

Provision of care for AIDS patients

St Vincent's Hospital, New York, was one of many Catholic health institutions to pioneer AIDS treatment.

The Catholic Church is a world leader in the provision of care to victims of AIDS. According to UNAIDS, the Vatican estimates that Catholic Church-related organizations provide approximately 25% of all HIV treatment, care, and support throughout the world. In 2010, the Vatican reported that more than 5,000 hospitals, 18,000 dispensaries, and 9,000 orphanages, many involved in AIDS-related activities, were being supported by the Catholic Church. The World Health Organization has estimated that faith-based groups provide between 30% and 70% of all health care in Africa. UNAIDS established a strategic framework in 2009––to strengthen partnerships between UNAIDS and faith based organisations. Caritas Internationalis, a confederation of 164 Catholic relief, development and social service organizations operating in over 200 countries and territories worldwide, partners with UNAIDS as one of the organizations on the steering committee of the Global Plan to eliminate new HIV infections in children.

In 2008, the UK's Guardian newspaper reported that:

[T]he Catholic Church is the biggest private provider of AIDS care in the world, providing anti-retroviral treatment, home-care visits and counseling to one in four of the world's 33.3 million AIDS patients, according to the Catholic charity Caritas International. In 2008, members of the Catholic HIV and AIDS network spent 180 million euros (about $235 million) on assistance...

With the spread of the disease to North America, the Church in the United States established the National Catholic AIDS Network to provide care to AIDS patients, their families and loved ones. By 2008, Catholic Charities USA had 1,600 agencies providing services to AIDS sufferers, including housing and mental health services.

AIDS arrived in Australia in the 1980s. Soon after, the Sisters of Charity began to admit patients suffering from the mysterious new disease at St Vincent's Hospital, Sydney, in Sydney's inner city, which became a world leader in HIV research.

Much of the Church's aid effort is concentrated in developing nations - in Africa, Asia, and Latin America. According to PBS news, in 2011, there were "117,000 Catholic medical facilities, from clinics in the deepest jungle to large urban hospitals in the developing world, that are involved in treating both people that are already infected with AIDS and trying to prevent the transmission to at-risk populations".

In a 2 June 2006 address to the United Nations General Assembly High Level Meeting on HIV-AIDS, Cardinal Javier Lozano Barragan said that while in terms of prevention, the Church advocated "formation and education towards proper behaviour", in terms of health care, the church stressed "the formation of doctors and related medical personnel, of chaplains and volunteers. We fight the stigma, facilitate testing, counselling and reconciliation. We provide anti-retrovirals and drugs to stop the vertical transmission (mother to child), and also promote measures to stop the blood contagion."

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Catholic Relief Services has been active in the provision of care to AIDS orphans.

In the area of caring, the Cardinal said "we stress avoiding contagion and taking care of orphans, widows and persons with AIDS who are in prison. We are helping with the social reintegration of HIV-positive people, and collaborate with governments and other institutions both on the civil and ecumenical levels that are dealing with the pandemic."

In relation to economic aspects, Barragan cited the foundation of the Good Samaritan Foundation by Pope John Paul II.

Our work focuses on the training of health-care professionals as well as prevention, treatment, care and assistance. We accompany the sick and their respective families at every stage. Specifically, Caritas Internationalis is engaged in this important work in 102 countries. The Holy See has launched initiatives all around the world against the pandemic in 62 countries: 28 in Africa, 9 in America, 6 in Asia, 16 in Europe and 3 in Oceania

— Cardinal Javier Lozano Barragan, Address to United Nations, 2 June 2006

The Cardinal singled out a number of Catholic congregations heavily associated with HIV-AIDS related care: the Vincentians, Sant'Egidio, Camillians, Hospitaller Brothers of St John of God (Fatebenefratelli), Jesuits, Sisters of Mother Teresa, Bambino Gesù Hospital of the Holy See and Catholic pharmacists.

Church teaching on the use of condoms

Pope Benedict XVI, citing the case of homosexual prostitution, said it was a "first step" towards morality for the prostitute to use a condom "in order to diminish the risk posed to another person is intending to reduce the evil connected with his or her immoral activity. The Pope pointed out that the use of a condom 'with the intention of reducing the risk of infection, can be a first step in a movement towards a different way, a more human way, of living sexuality.' An action which is objectively evil, even if a lesser evil, can never be licitly willed. The pope did not say – as some people have claimed – that prostitution with the use of a condom can be chosen as a lesser evil."

The use of condoms to prevent disease is a controversial issue, with Catholic theologians arguing both sides. While a few dissenting theologians exist, the Church teaches that artificial contraception of all forms is intrinsically evil.

While condoms might serve as a largely effective barrier to the transmission of HIV during a single act of copulation, though perhaps not for sustained serial use in non-laboratory conditions, condoms also impermissibly impede the procreative aspect of the sexual act which is understood by the Church to have a deeply theological meaning. As such, their use is forbidden. Theology aside, Church officials argue that Church teaching (as Church teaching, and not, say, personal preference) against condom use would seem, self-evidently, unlikely to be followed by those same people who flout Church teaching on illicit sexual activity.

A common position of Church leaders is that officially or otherwise endorsing condom use as a method of reducing the likelihood of disease transmission could be interpreted as facilitating fornication, which degrades and debases sex, and possibly even counter-productive inasmuch as, over time, in a large enough population sample, disease transmission through condom-facilitated promiscuity is inevitable in a significant number of cases. A common counterposition is that, from a human rights perspective, human lives are the most important and universal value that we have; this value cannot possibly be compared with a culture-specific code of sexual practice. In response, the point is made that encouraged promiscuity and condom use (or not) will inevitably lead to the transmission of STDs and the otherwise avoidable deaths of many.

Condom controversy

While the condom is widely accepted by those in medical and administrative professions as the most reliable way to stop the spread of AIDS, it is also accepted by the same groups of people that the surest way to avoid HIV is abstinence. The Catholic Church instead emphasizes "education towards sexual responsibility", focusing on partner fidelity rather than the use of condoms as the primary means of preventing the transmission of AIDS. The Church's position is that all responsible sex must occur within the framework of a faithful, monogamous marriage. In addition, various members of the Church hierarchy have pointed out that condoms have a non-zero risk of transmitting AIDS.

Church officials argue that reliance on condoms to prevent transmission of AIDS can result in a false sense of security because of the problem of "leakage and breakage". In 2003, contrary to some manufacturers' empirical evidence, the president of the Vatican's Pontifical Council for the Family - "senior spokesman" Cardinal Alfonso Lopez Trujillo - claimed that condoms are permeable to the AIDS virus. He explained to BBC interviewers that "The AIDS virus is roughly 450 times smaller than the spermatozoon and can easily pass through the 'net' that is formed by the condom." These assertions (HIV 120 nm, Spermatozoon 55 µm, latex pore size 5 µm ) were echoed by an archbishop of Nairobi, as well as by Catholics as far as Asia and Latin America.

The Church is concerned that promotion of condom use will lead to irresponsible, risky sexual behavior (promiscuity and prostitution). Both individuals and governments could come to rely on condoms as the primary line of defense rather than emphasizing the need for "partner fidelity".

Pope John Paul II

John Paul II's position against artificial birth control, including the use of condoms to prevent the spread of HIV, was harshly criticised by doctors and AIDS activists, who said that it led to countless deaths and millions of AIDS orphans. Critics have also claimed that large families are caused by lack of contraception and exacerbate Third World poverty and problems such as street children in South America.

On 15 November 1989, John Paul II addressed the 4th International Conference of the Pontifical Council for the Pastoral Care of Health Care Workers in the following terms: it seems profoundly damaging to the dignity of the human being, and for this reason morally illicit, to support a prevention of AIDS that is based on a recourse to means and remedies that violate an authentically human sense of sexuality, and which are a palliative to the deeper suffering which involve the responsibility of individuals and of society. This was interpreted in May 1990 by the Roman Catholic bishops of Madagascar as a "solemn reminder" giving ground for their view that in the context of positions such as that of Cardinal Lustiger who stated that it was a "lesser evil", "the condom remains a 'moral evil'".

In September 1990, John Paul II visited the small town of Mwanza, in northern Tanzania, and gave a speech that many believe set the tone for the AIDS crisis in Africa. Being unequivocal, he told his audience that condoms were a sin in any circumstances. He lauded family values and praised fidelity and abstinence as the only true ways to combat the disease.

In December 1995, the Pontifical Council for the Family issued guidelines saying that parents must also reject the promotion of so-called "safe sex" or "safer sex", a dangerous and immoral policy based on the deluded theory that the condom can provide adequate protection against AIDS.

Pope Benedict XVI

In 1988 a debate within the Catholic Church over the use of condoms to prevent AIDS sparked an intervention from Rome. The Church in 1968 had already stated in Humanae Vitae that chemical and barrier methods of contraception went against Church teachings. The debate was over the different issue of whether or not condoms could be used, not as contraceptives, but as a means of preventing the spread of HIV/AIDS and other sexually transmitted diseases. In 1987, the U. S. Conference of Catholic Bishops issued a document suggesting that education on the use of condoms could be an acceptable part of an anti-AIDS program.

In response, Cardinal Ratzinger stated that such an approach "would result in at least the facilitation of evil" – not merely its toleration. For the full text of the letter, see: On "The Many Faces of AIDS" (See also Karol Wojtyla's Love and Responsibility). Critics argue that Ratzinger's approach would lead to increases in the frequency of HIV/AIDS infections, while many Catholics dispute this and emphasize the value of faithful relationships or chastity.

In 2005, the Pope listed several ways to combat the spread of HIV, including chastity, fidelity in marriage and anti-poverty efforts; he also rejected the use of condoms.

In March 2009, the Pope was sharply criticized after he stated that "if there is no human dimension, if Africans do not help [by responsible behaviour], the problem cannot be overcome by the distribution of prophylactics: on the contrary, they increase it" and reiterated his view that "the solution must have two elements: firstly, bringing out the human dimension of sexuality, that is to say a spiritual and human renewal that would bring with it a new way of behaving towards others, and secondly, true friendship offered above all to those who are suffering, a willingness to make sacrifices and to practise self-denial, to be alongside the suffering." In that same month, a senior research scientist at the Harvard School of Public Health, Dr. Edward C. Green, penned an article entitled "The Pope May Be Right" (in another publication "The Pope Was Right") in which he stated that while "in theory, condom promotions ought to work everywhere...that's not what the research in Africa shows." The writer also indicated that strategies that worked in Africa were "Strategies that break up these multiple and concurrent sexual networks -- or, in plain language, faithful mutual monogamy or at least reduction in numbers of partners, especially concurrent ones."

In response to the Pope's comments, an editorial was published in the Lancet, which said that "the Pope has publicly distorted scientific evidence to promote Catholic doctrine on this issue." It also pointed out that the pope's statement had provoked "an unprecedented amount of international condemnation," including by the president of the International AIDS Society.

In 2010 comments the Pope made in an interview with journalist Peter Seewald regarding condom use attracted attention in the media. In the context of an extended discussion on the help the Church is giving AIDS victims and the need to fight the banalization of sexuality, and in response to the charge that "It is madness to forbid a high-risk population to use condoms", Pope Benedict stated:

There may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a moralization, a first assumption of responsibility, on the way toward recovering an awareness that not everything is allowed and that one cannot do whatever one wants. But it is not really the way to deal with the evil of HIV infection. That can really lie only in a humanization of sexuality. She of course does not regard [the use of condoms] as a real or moral solution, but, in this or that case, there can be nonetheless, in the intention of reducing the risk of infection, a first step in a movement toward a different way, a more human way, of living sexuality.

. This explanation was interpreted by many as a change of tack by the Vatican which necessitated a clarification from the Vatican that "the pope does not morally justify the disordered exercise of sexuality, but maintains that the use of the condom to diminish the danger of infection may be “a first assumption of responsibility”, as opposed to not using the condom and exposing the other person to a fatal risk." As John Haas, the president for the American National Catholic Centre for Bioethics, noted, Pope Benedict did not address the issue of whether condoms are effective at preventing HIV transmission. The new statement from the pope was criticized by conservative Catholics such as Jimmy Akin, who described the pope's statements as "private opinions" as opposed to "official Church teaching."

Episcopal conferences

A number of episcopal conferences have suggested that condom use may be acceptable in some circumstances to prevent AIDS. One of the first episcopal conferences to take such a stance was the French Bishops Council which asserted in 1989 that, "The whole population and especially the young should be informed of the risks. Prophylactic measures exist." In 1996, the Social Commission of the French Bishops' Conference said that condom use "can be understood in the case of people for whom sexual activity is an ingrained part of their lifestyle and for whom [that activity] represents a serious risk." In 1993, the German Bishops Conference noted: "In the final analysis, human conscience constitutes the decisive authority in personal ethics... consideration must be given...to the spread of AIDS. It is a moral duty to prevent such suffering, even if the underlying behavior cannot be condoned in many cases...The church...has to respect responsible decision-making by couples."

Dissent in the Church

Carlo Maria Martini

In April 2006, in response to a very specific question from the bioethicist Ignazio Marino, Cardinal Carlo Maria Martini opined that in certain cases, the usage of condoms might be allowable stating, "The use of condoms can, in certain situations, be a lesser evil". He stressed the particular case of married couples where one has HIV or AIDS. But he quickly noted that it's one thing the principle of the lesser evil in such cases, and quite another the subject who has to convey those things publicly, thus it is not up to the Church authorities to support condom use publicly, because of "the risk of promoting an irresponsible attitude". The Church is more likely to support other morally sustainable means, such as abstinence.

Godfried Danneels

Cardinal Godfried Danneels is seen as one of the leaders of the "reformist party" within the Church. For instance, he has said that, although abstinence is preferable, condoms are acceptable as a means of preventing AIDS. In an interview with the Dutch Catholic broadcaster RKK, he said: "When someone is HIV positive and his partner says 'I want to have sexual relations with you', he doesn't have to do that, if you ask me. But, when he does, he has to use a condom, because otherwise he adds to a sin against the sixth commandment (thou shalt not commit adultery) a sin against the fifth (thou shalt not kill)." He added: "This comes down to protecting yourself in a preventive manner against a disease or death. It cannot be entirely morally judged in the same manner as a pure method of birth control."

Jean-Marie Lustiger

Although he fully endorsed John Paul II's views on bioethics, Cardinal Jean-Marie Lustiger considered the use of condoms to be acceptable if one of the partners had HIV.

Kevin Dowling

Bishop Kevin Dowling believes that the Catholic Church should reverse its position on the use of condoms to prevent HIV transmission.

Dowling first announced his position on condom use in 2001, in a response to a question by a Catholic news agency reporter during a bishops' conference in southern Africa. After stating that the bishop's conference had not taken a position on condom use, Dowling was asked for his personal opinion, and said that he believed condoms should be used to prevent the spread of HIV.

Following this, he received a number of rebukes from the South African papal nuncio. The bishop's conference condemned his words, describing condoms as "an immoral and misguided weapon" in the fight against HIV, and argued that condom use could even encourage the spread of HIV by promoting extramarital sex.

Catholics for Choice

Catholics for Choice maintains that condom use will prevent the spread of AIDS, since couples will have sex despite Vatican prohibition. Two bishops share the beliefs of Condoms4Life, and have come out in support of condom use when one partner has AIDS, arguing the Roman Catholic Church's official position on this issue is unconscionable.

Criticism

The Church's stance has been criticized as unrealistic, ineffective, irresponsible and immoral by some public health officials and AIDS activists.

Empirical evidence suggests that, although condoms do not prevent STD transmission in all cases, condoms reduce the numbers of those who are infected with an STD. Other studies have focused more on HIV/AIDS and have consistently found that fewer than 20% of those who would otherwise have been infected contract HIV. Some researchers claim that the primary challenge is getting people to use condoms all the time.

Some researchers claim that abstinence-only sex education does not work, and comprehensive sex education should be used instead. For instance, it is claimed that abstinence only education fails to decrease people's risks of transmitting STDs in the developed world.

UNAIDS has collaborated with the Roman Catholic Church, especially Caritas Internationalis, in the fight against AIDS, something which many people only realised after a December 2005 message by Pope Benedict XVI. However, it indicated in a 2009 communiqué that it did not agree that condoms were unhelpful in AIDS prevention.

In 2003, the WHO criticised statements by the Roman Curia's health department.

However, according to Edward C. Green, director of the AIDS Prevention Research Project at the Harvard Center for Population and Development Studies: "We have found no consistent associations between condom use and lower HIV-infection rates, which, 25 years into the pandemic, we should be seeing if this intervention was working." James Shelton, of the US Agency for International Development, said that one of the ten damaging myths about the fight against AIDS is that condoms are the answer. "Condoms alone have limited impact in generalised epidemics [as in Africa]," Shelton wrote.

See also

• Drug Resources Enhancement against Aids and Malnutrition (DREAM) promoted by the Community of Sant'Egidio
• Islam and AIDS
• Religion and AIDS

External links

• Vatican.va: Family values Versus Safe Sex: A Reflection by His Eminence, Alfonso Cardinal López Trujillo
• Caritas Internationalis: HIV & AIDS

Catholics for AIDS Prevention and Support http://www.caps-uk.org/ a UK based Charity 'Positive Catholics' http://www.positivecatholics.com/ a catholic community of support for people living with HIV