Thursday, March 19, 2009

AIDS in Africa

This is what Pope Benedict said a couple days ago, in Cameroon, with regard to the AIDS crisis and how to solve it.

"If there is no soul, if Africans do not help themselves, the scourge of AIDS cannot be resolved by the distribution of prophylactics: to the contrary, the risk is to augment the problem. The solution can be found only in twin labors: the first, a humanization of sexuality, that is a spiritual and human renewal that brings with it a new way of behaving with one another, and second, also a true friendship most of all for suffering people, the availability, also with sacrifices, with personal renouncements, in order to be with the suffering."

Naturally, the American mass media, which gets the vapors when anyone makes any kind of challenge- from the right or the left- to the cosmopolitan culture of late-capitalist liberal civilization of which it sees itself as the foremost defender, got the vapors at this too. "The Pope forbids the use of condoms to fight AIDS" they have been saying. With the implication, of course, that this shows what an outmoded, benighted reactionary Benedict XVI is. Surely nowadays, the knowing and worldly readers of the New York Times have moved beyond such medieval prejudices. We know that sex is just a fun pastime, like bowling only messier. Lobbing a few condoms around will make it good, clean fun for everyone, and what could be the harm? The more the merrier. We are educated people of the 21st century. Who needs things like fidelity and restraint? We are smart enough to invent technical fixes to our problems. Insecticides to get rid of insect plagues, and condoms to get rid of AIDS.

Well, no. First of all, I should start by saying that the mass media's misquotation of Benedict XVI is beyond misleading- in a just society it would be considered criminally libelous. (Whether it was libelous out of malice or ignorance I don't know, but probably the latter). Of course Benedict XVI opposes condoms, in general, on the grounds that they separate the unitive and procreative aspects of the sex act, and thus do violence to nature. The Catholic church has taken a firm stand against artificial birth control since its inception (a stand that, for reasons I've made clear in the past, I disagree with). But what he didn't say, in the quote attributed to him, is that condoms do nothing to prevent the transmission of disease. Read the line once again.

He's saying that the heart of any effective effort to counter HIV in Africa must focus on behavior change. And he's correct. I've lived in Madagascar, and from what I hear from people who have lived or spent time in Africa, the sexual mores are not that different. Which is to say, deeply in crisis. Men who are traveling away from their wives for as little as a weekend often go to a prostitute to entertain themselves. Men will have one or two wives and a couple of girlfriends, all concurrently. Girls often enter sexual relationships with older men when they're only in their early teens. Prostitution is widely socially accepted. Women lack the social power to insist on birth control. Sex is often considered as casually as shaking hands. And so on.

You don't have to be a believer in the strict Catholic position on sexual morals (I'm not) to think this is deeply problematic. Let's leave aside the emotional and spiritual damage this kind of promiscuity does to the people involved: from a disease prevention point of view, it's really, really unhealthy. Even if condoms have only a 1% failure rate, if one sleeps with enough people then the chances of getting a disease are not insignificant. The best ways to prevent STDs, it should be obvious, are by reducing one's number of partners.

It would be different if we were talking about a country like Sweden, or somewhere in Latin America. Those societies are far from traditionalist Catholic sexual morals, but they're also far from the kind of promiscuity that characterizes many African societies. In the African context, however, behavior change is the sine qua non of any effective effort to reduce HIV incidence. As long as sexual behavior remains unchanged, throwing condoms into the mix will simply make little difference. It's like throwing a band-aid on a deep wound, and at worse, if it encourages more promiscuity, it could actually increase disease transmission. Remember when everyone thought abortion would decrease illegitimacy rates? It actually accomplished the opposite.

Let me be clear here. I disapprove somewhat of condoms, as I think they're qualitatively different than hormonal birth control, but I don't have any problem with the Pill. The Pill was designed to mimic the natural hormonal changes following pregnancy, and it suppresses fertility through hormonal mechanisms in a similar way to how lactation does. Moreover, it does not impose a physical barrier between a couple- the man and woman are still sharing their entire bodies with each other. Condoms are different, as they interpose a physical barrier and thus detract not simply from the procreative but also from the unitive aspect of sexuality. They are thus, 'against nature' in a sense that birth control pills aren't (and, it must be said, they also facilitate casual liaisons, which the Pill doesn't). I also disapprove, of course, of casual sex. While I don't think a couple needs to be married in order to licitly have intercourse, they should be in a long-term, loving, monogamous relationship. If a relationship is characterized by 'caritas' as well as by 'eros', then it seems to me that it can legitimately be a locus for the sexual act. However, casual liaisons are right out.

This is my understanding of what Christ would have us do; it's of course a liberal interpretation of Christian sexual morals by any historic interpretation, but I believe on reflection that it's the true one. However, if you insist on breaking even this attenuated code, based on natural law and my understanding of scripture and my interpretation of tradition, then in my opinion you're doing something wrong. It would be better not to add another wrong (risking the spread of disease) to the first wrong, and so in such circumstances I would suggest that if you ARE going to have casual sex, then you should use condoms. But the better rule is not to have casual sex in the first place. Stay within the context of serious relationships- not necessarily procreative marriages, but at least open to flowering into procreative marriages- and use a combination of the pill, natural family planning, or both- and your risk of disease will be minimal. I don't think this is an inconsistent message: "Don't have casual sex, but if you do, then use condoms." Many vegetarians would say the same, for example, about chickens: "Don't kill chickens for food, but if you must, then at least don't keep them in horrible factory-farm conditions beforehand."

In short, behavior change has to come first. Condoms can serve as a third-best option for those who refuse to follow what, I think, natural law suggests. But the best alternative is to have sex only in the context of serious relationships, and to be faithful to your partner. For young people under 18 or so, of course, the best alternative is not to have sex at all. I don't think morality requires us to abstain till marriage. But I do think that you should abstain until you are a legal adult. That is why the anti-HIV programs in Africa that have WORKED, stress abstinence first, then fidelity, and then condoms.

It should be clear from all this that in part I disagree with Pope Benedict, but in part I also agree with him. If there is no soul, i.e. if we approach sexuality first and foremost as a health issue rather than a moral and spiritual issue, then we will get neither health nor spirituality: all we will do is make the problem worse. One doesn't need to be a Catholic or to agree with traditionalist Catholic sexual morality to accept this. Even though Benedict is wrong about some things, his opponents among the liberal establishment are much wronger. It is their Eden of casual sex which exists in Africa right now, and that's precisely the problem.

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