Bashing the bishop


Pope Benedict XVI’s imminent visit to the UK has provoked considerable comment, particularly in relation to his role in the cover up of child abuse scandals, the cost of his visit to the UK taxpayer, and his position on the role of condoms in HIV prevention. The Guardian’s Bad Science columnist Ben Goldacre describes the Pope’s pronouncements on condoms – for instance that they aggravate the problem of HIVas sabotaging the global response to HIV

There’s no doubt in my mind that the negative stance of the Catholic church toward condoms is profoundly unhelpful to HIV prevention efforts. Supporters of his view – many of whom have commented on the Goldacre article cited above – have pointed out that if Catholics follow church doctrine in relation to extra-marital sex, then indeed condoms are not necessary for HIV prevention – a nice idea but one that fails to acknowledge that people, even Catholics do have extramarital sex, all the time.  Others point out that it is absurd to think that the same individual will dogmatically follow doctrine on condoms while disobeying doctrine on extramarital sex.  Having worked on HIV prevention for over ten years, in a range of countries, I have frequently been given the impression that this is precisely what some people do.  It is also clear that a lot of peoples’ avoidance of condoms has very little to do with what their leaders tell them. Countless surveys show that the reasons people give for not using condoms are often more to do with lack of availability, with dislike of condoms, and with low perception of the risks of unprotected sex, than with religious scruples.

Others still point out that HIV prevalence is not necessarily higher in countries with a higher proportion of Catholics.  This is an ecological fallacy: assuming that an association means a meaningful correlation, and assuming that correlation is causation. 

What strikes me most though is that discussions on the pope, Catholics, condoms and AIDS generally seem to focus on whether or not individual Catholics do what their spiritual leaders tell them.  But it’s a bit more complicated than that.  In sub-saharan Africa, Catholic organisations (including international NGOs) are among the biggest providers of health care and services – in many countries they even run state facilities.  They generally have policies that preclude them from promoting and distributing condoms.  So the local populations they serve – whether they are Catholics or not – consequently don’t have access to one of the most important tools for preventing HIV (not to mention other STIs and unwanted pregnancies).   

It’s not even just about condoms.  Conservative attitudes to sexuality and sexual health don’t just mean people are told not to use condoms or that they can’t get hold of them.  They also mean that people don’t receive the sexual and reproductive health education and advice that they need to take decisions about their sex lives whether before marriage or in marriage – including decisions about relationships, when and whether to have sex, what type of sex to have. Consequently many people start their sex lives from a position of influence ignorance, more likely to be influenced by what their peers or their partners do than by what they want to do.  Conservative attitudes also mean stigma and exclusion of sexual minorities, in particular sex workers, men who have sex with men, women who have sex with women and transgender people – and anyone else not having “vanilla”, procreative sex or fitting the moral norm.  And yet there is increasing recognition that even in countries with generalised AIDS epidemics, people in these groups are disproportionately affected.

Also, it’s not just Catholics.  In meetings with faith leaders, I’ve heard Muslims and non-Catholic Christians say the same things about condoms that the Pope does, and I’ve even seen non faith-based health centres avoiding condom distribution.  Criticising the Pope for what he says about condoms does not mean that the Catholic church has the monopoly on stupid in HIV prevention, and sexual and reproductive health – and in fact this is another reason why it is absurd to dismiss criticisms by saying “hang on, but all Catholics don’t have AIDS…”.

All of these things play out on a bigger scale too: politicians and senior civil servants, averse to the risk of being publicly criticised by church leaders for taking a progressive approach, avoid setting up or endorsing programmes that will rock the boat. The single biggest HIV/AIDS programme in the world – the US government’s Presidential Emergency Plan for AIDS Relief – prioritised non-evidence based approaches such as “abstinence only” prevention programming, put strict limits on how it funded condom distribution and sexual and reproductive health programming, and even stricter restrictions on programmes with sex workers.

The Pope and his cardinals and bishops do of course hold a unique position – no other religion or Church has such a powerful, centralised authority; and there are an awful lot of Catholics in the world. But the power is where the real issue lies.  While a lot of people may or may not pay that much heed to what he says about extramarital sex, if someone with the Pope’s authority came out in support of condoms and of sexual and reproductive health education, and of acknowledging sexual diversity; and if programmes with the financial influence of PEPFAR supported these things, it would make a huge difference. Not just to individual Catholics, but to other individuals, and to service providers, and to programmes.  So the problem isn’t just about sabotage, it’s also about the failure to lead.  An increasingly common theme of my blog posts…  

(23 Sept. The post was hastily written and I have just been through it to re-edit some sections).