Saturday, 11 October 2003
Do Condoms Cause AIDS?
Do condoms cause or contribute to the spread of HIV and AIDS? The Catholic church has concluded that they do — in the face of overwhelming epidemiological and public health evidence to the contrary. Two days ago, the news agency Reuters reported that the Catholic church has announced a "clinical" finding that condoms are responsible for the fast spread of AIDS throughout the world. Cardinal Alfonso Lopez Trujillo, president of the Vatican's Pontifical Council for the Family, explains that condoms are not 100% effective at blocking sperm and that the HIV virus is 450 smaller than sperm. HIV can permeate the condom's barrier more easily than sperm, so condoms are ineffective at blocking HIV. Meanwhile, Trujillo argues, experts promote condoms as an effective tool for blocking HIV infection, inspiring false confidence in the public and causing more people to become sexually active than would otherwise have sex. When their condoms fail to block HIV transmission, these people become infected.
What is wrong here?
The World Health Organization (WHO) has studied the epidemiology of HIV/AIDS perhaps more than any other entity on this planet, and its research has repeatedly reaffirmed the scientific basis for condoms' effectiveness in combating the spread of the disease. WHO has initiated or promoted condom distribution programs in many developing countries, where HIV has reached epidemic levels of infection. Why? Because it has determined that condoms are a singularly effective tool for fighting the spread of the disease. Responding to the Catholic Church's position, WHO called it "dangerous when we are facing a global pandemic which has already killed more than 20 million people, and currently affects at least 42 million." While condoms do occasionally break and can permit the passage of semen, they reduce "the risk of infection by 90 percent and [are] certainly secure enough to prevent passage of the virus if not torn." (Source) True, this is not 100% effectiveness, but it is far better than zero.
What does the Catholic church get out of this? To be sure, the church has never been shy in its opposition to artificial contraception of all kinds. Traditionally, it has grounded this position in religious and moral reasoning (the merits of which I cannot discuss as a good skeptic). Now, however, the church purports to advance a scientific — or at least empirical — basis for its position. Unfortunately, Trujillo's argument on behalf of the church does not address the root cause of its opposition to condoms. This opposition most likely remains rooted in an interpretation of scripture, not modern science. That scripture was fixed in rougly its current form centuries ago, in a manner that prevents it from growing and adapting to modern scientific findings that cast doubt on its teachings. (This says nothing, of course, of the church's ability to reinterpret scripture in light of modern knowledge or international politics — something the current Pope has shown more willingness to do than his predecessors.)
All that said, the Catholic church may be softening its stance on condoms. Although this week's announcement seems to be an attempt to bolster the church's traditional position with science, it may also represent a fundamental shift in what the church perceives as the rules of the debating game. The church may finally be prepared to debate public health issues properly in terms of science, rather than scripture and morality. While reasonable people may disagree on the implications of most scientific studies, it is important that the church has finally joined the rest of the world at the debating table. We should take the church seriously on this issue and, to the extent that it continues to speak the language of science, on other issues as well. Having set the terms for public health debates, perhaps now we can work on the church's data interpretation skills — which have much room for improvement after this week. While this may be a good first step, we must be wary of a possible attempt by the church to "cherrypick" science — that is, to adopt data it likes for political or religious reasons and ignore data it dislikes for those reasons. Time will tell.