The Catholic Church, Condoms, and HIV & AIDS in Africa

By Kathryn Joyce | Vol. XXXIII — No. 3  2012
Conscience Magazine

(Photo: Reuters)

In 2010, when Pope Benedict XVI opened the door to approve condom use to prevent the transmission of HIV, he opened it just a crack, in a statement so laden with conditions and insult that it was hard to tell whether this was the groundbreaking news many took it to be. Was it an historic change to the church’s longstanding ban on contraceptive use, or waffling rhetoric that altered little more than a headline?

At first, it seemed like big news when Benedict told German journalist Peter Seewald, in his book Light of the World: The Pope, the Church, and the Signs of the Times, that condoms might be permissible in limited situations. But the situations he had in mind were limited indeed: use by male sex workers, for whom trying to prevent HIV transmission could be “a first step in the direction of 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.” If the condemnation implicit in this statement wasn’t apparent enough, Benedict went further to suggest that illicit sexual relations weren’t quite human, and that condom use was only an option for those so debased that protected sex could constitute “a first step in a movement toward a different way, a more human way, of living sexuality.”

Benedict clarified further that condoms weren’t “really the way to deal with the evil of HIV infection. That can really lie only in a humanization of sexuality,” he said.

Even the further clarification to the news media by the Vatican’s spokesperson, Rev. Federico Lombardi, that the provision was not solely for male prostitutes, was less than fulsome. He said that condom use is “the first step of taking responsibility, of taking into consideration the risk of the life of another with whom you have a relationship. This is if you’re a woman, a man, or a transsexual. We’re at the same point.”

Conservative Catholics rushed to emphasize that Benedict had made no statement addressing condom use within marriage, and thus his statements had no bearing on most Catholics’ sexual lives—that the status quo still reigned. Nonetheless, headlines trumpeted the news as a revolution for the church. Two years later, what it has meant on the ground in countries dealing with epidemic levels of HIV & AIDS is far from clear.

HIV & AIDS advocates have long maintained that the Catholic ban on condom use, though largely ignored in the West, has led to devastating results in developing countries dependent on humanitarian aid, which is often filtered through Catholic or other religious groups. Because Catholic leadership discourages the use of condoms, or religious relief organizations block their distribution, hundreds of millions are left more exposed to disease. Just the year before Seewald’s book was published, in 2009, the pope himself asserted that condoms don’t solve the AIDS crisis, but make it worse by encouraging promiscuity. It’s an attitude shared by many other faith-based NGOs working on the ground in HIV & AIDS hotspots.

One development worker who has tracked the distribution of condoms in African countries, and who requested to speak off the record, illustrated what the ban can mean in countries like Zambia. There, a generalized AIDS crisis has left approximately 13.5% of the adult population HIV-positive according to 2009 estimates. In 2003, AIDS reduced the life expectancy of Zambians to the lowest in the world, at just 33 years old. While the recent availability of antiretroviral (ARV) medical treatment has been transformative, Zambia is still a country where public awareness campaigns note the obvious: every family is either “infected or affected” by the crisis.

But despite the scale of the epidemic, Catholic teachings hampered the availability of condoms in sometimes mysterious ways, said the development worker, whose job before 2010 was to track the supply chain of condoms donated by international aid agencies. If 50 million condoms were delivered to Lusaka, he found, too often they had disappeared by the time medical aid bundles, or “kits,” reached peripheral areas where people needed them—removed, many aid workers believed, by Catholics with a moral objection to their use. Other times, nuns or other religious NGO staffers working in local clinics simply refused to order condoms from the central authorities.

“There was a big mismatch between what was being sent to the country by donors and what was actually being distributed at the peripheral levels,” the source recalled.

It wasn’t only Catholic groups, either. This individual from the development sphere spoke to a Salvation Army employee in Zimbabwe who declared that they didn’t distribute condoms because their availability would encourage promiscuity and undercut efforts to promote abstinence. Zimbabwean sex workers reported to our source that, despite the government’s claim that there was universal access to condoms, they couldn’t find them at local clinics.

While this development worker’s experiences are several years old, Caroline Teti, a sexual and reproductive health advocate working with civil society initiatives in Kenya, says that not enough has changed. Despite the pope’s statement and the growing popularity of condom use in Kenya, says Teti, “challenges related to the supply chain abound.” Local Catholic officials still fail to consistently support condom use as a means to protect against HIV transmission.

In one case, a local diocese refused to receive rent from a prominent NGO working on HIV & AIDS—apparently because they were distributing condoms on Catholic-owned land—forcing the NGO to relocate. But even when there is support, too often it is tepid.

“Since the time the pope made a declaration supporting condom use, there is still fear and embarrassment on the issue, especially among Catholics,” says Teti. While the pope’s statements have made it somewhat easier to discuss condoms with Catholics, Teti says few Catholic leaders fully embrace their promotion, offering information alone. “This is not followed through to ensuring the commodity is available,” she asserts. “I have yet to see a condom promotion event by a Catholic or faith-based organization”—something she sees as a particular loss considering Catholics’ substantial health infrastructure.

It’s a lukewarm sort of change that hasn’t had enough impact on the ground, agrees Tyler Crone, coordinating director of the Athena Network, which addresses gender inequality and HIV & AIDS. Crone sees basic availability of condoms as a persistent problem around the globe: “While condoms are now a lot less contentious than they once were, there are still not enough of them out in the world.”

Indeed, Tony Simpson, an anthropologist at the University of Manchester who has worked on and off in Zambia for nearly 30 years, says that while the pope’s statement may have made headlines in Europe, in Zambia, they barely made any waves at all.

Part of the reason is that the church’s position on condoms isn’t the only factor in whether or not they are used. “Nobody ever told me that I don’t use a condom because of the pope, or because the church said I shouldn’t,” says Simpson, author of Boys to Men in the Shadow of AIDS: Masculinities and HIV Risk in Zambia. “They don’t use condoms because they don’t like condoms.” That echoes the conventional wisdom other development workers repeat: that “men don’t use condoms in Zambia”—as in many other African countries—for a variety of cultural factors, including personal preference, gender inequalities that prevent women from demanding condom use, and widespread homophobia that suppresses open discussion of gay health issues.

In the face of this ingrained opposition to condoms, the pope’s statement not only wasn’t revolutionary, it was all but ignored. “He opened the door so slightly,” says Simpson, “that I think it was hardly noticed in southern Africa.”

In the complex reality Simpson describes, Zambian men aren’t usually eager to use condoms, and Catholic leaders aren’t the only the force stopping them. Rather, in Simpson’s long work in the country, including 20 years teaching English at a Catholic boarding school, he has met Catholic priests who compare condom use to commonsense safeguards like wearing a seatbelt in a car. The bishops might still be saying the same things about condom use, but the people, including many priests, aren’t listening. “I think that’s very much the case of people who are not sitting in Rome somewhere, but are seeing the consequences of AIDS first hand,” Simpson says. It’s a reflection of the longstanding duality between Catholic teaching and Catholic practice when it comes to HIV & AIDS prevention: a lesser-of-two-evils contradiction that many Catholic aid workers have weighed for themselves, publicly adhering to doctrine while counseling life-saving condom use to those who need to hear it.

As HIV & AIDS advocate Calle Almedal told Conscience in 2010, “The doctrine is there, but then you have the pastoral care, which is about the reality that people live in. And that’s where those nuns were—out there in reality, and they gave realistic advice to people.”

Yet that realism has not translated to public advocacy among Zambia’s Catholic leaders, who Simpson says “don’t see any point in raising their heads above the parapet, because they know what the conventional teaching of the church is.”

In Zambia, however, the very human realities of complex sexual lives—including those of the clergy themselves—may have pushed that disconnect between doctrinal rhetoric and practice to its end point. In Zambia, the cultural imperative of childbearing is so important that it often outweighs church teachings on celibacy. Many priests and other Catholic religious leaders have sexual lives and families; sometimes they have HIV too. But the priests’ experience of living with HIV & AIDS, and accessing life-saving medicine, has been as veiled as their colleagues’ quiet support for condom use.

The result has been a church-wide open secret, as the church’s silence on HIV & AIDS, and the diverse realities of people’s sexual lives, combines with Zambia’s cultural emphasis on discretion—something Simpson’s students called “the African gift of silence”—particularly discretion around the affairs of high-status individuals like priests.

“A lot of parishioners see their priests suffering from HIV, or see that they have developed AIDS. They see the priest losing weight and going down, then suddenly gaining weight and getting strong again,” says Simpson. “We’ve all become AIDS experts—we look at people and we know.” But nothing is ever acknowledged, he continues. Priests are never seen lining up in hospitals for the ARV medication like other Zambians, so lay Catholics in the country assume that priests have their medications brought to them under cover of night, secretly. If disease prevails, the parishioners bury their priests without admitting what killed them, nor the widow and children he may have left behind.

That continued secrecy underscores the strong stigma and shame that still surrounds HIV & AIDS in Zambia, where the disease is still referred to euphemistically as “the disease of these days,” and some parents do not even reveal their HIV status to their children.

For Zambians who are trying to address the epidemic openly, there is a sense that they must adopt “European ideas” about disclosure and a nontraditional openness about sexuality. A principal at Simpson’s school suggested it would be powerful for teachers and other leaders to lead the way against stigma by self-disclosing their own use of ARV therapy.

In an environment like this, Simpson argues, a truly transformative step the church could take would be to admit the number of priests, nuns and bishops who are living because of ARV therapy—an option condemned in the past with the same language used to discourage condom use, when it was suggested that treatment, like contraceptives, could encourage careless promiscuity.

“The church could take the lead and say this is a thing that could happen to anybody,” says Simpson. “If it could happen to a priest, it could happen to anybody else.”

To do so would be an opportunity for the church to move beyond the obstructionism it has engaged in with regards to condom distribution to an actual position of advocacy, challenging stigma by refusing secrecy and even the tradition of principled duplicity within their own house. Acknowledging the truth about people’s lived sexuality—from the fact that people have sex outside marriage to the reality that clergy have sexual lives—could amount to a much more human understanding of sex than the pope has envisioned so far.

Kathryn Joyce is a journalist and author of Quiverfull: Inside the Christian Patriarchy Movement and The Child Catchers: Rescue, Trafficking and the New Gospel of Adoption, forthcoming in 2013. Her work has appeared in the Nation, the Atlantic, Mother Jones, Slate and many other publications.

In Sub-Saharan Africa more than 22 million people are living with HIV and 53 million women want to avoid pregnancy but cannot access contraception. “In One Place”, a new film by Population Action International shows why integrating family planning, reproductive health and HIV/AIDS is a priority for women and young people in this region.

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