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The Pope May Be Right: Condom/HIV discussion continues

By Edward C. Green

Sunday, March 29, 2009; Page A15

When Pope Benedict XVI commented this month that condom distribution isn’t helping, and may be worsening, the spread of HIV/AIDS in Africa, he set off a firestorm of protest. Most non-Catholic commentary has been highly critical of the pope. A cartoon in the Philadelphia Inquirer, reprinted in The Post, showed the pope somewhat ghoulishly praising a throng of sick and dying Africans: “Blessed are the sick, for they have not used condoms.”

Yet, in truth, current empirical evidence supports him.

We liberals who work in the fields of global HIV/AIDS and family planning take terrible professional risks if we side with the pope on a divisive topic such as this. The condom has become a symbol of freedom and — along with contraception — female emancipation, so those who question condom orthodoxy are accused of being against these causes. My comments are only about the question of condoms working to stem the spread of AIDS in Africa’s generalized epidemics — nowhere else.

In 2003, Norman Hearst and Sanny Chen of the University of California conducted a condom effectiveness study for the United Nations’ AIDS program and found no evidence of condoms working as a primary in HIV-prevention measure in Africa. UNAIDS quietly disowned the study. (The authors eventually managed to publish their findings in the quarterly Studies in Family Planning.) Since then, major articles in other peer-reviewed journals such as the Lancet, Science and BMJ have confirmed that condoms have not worked as a primary intervention in the population-wide epidemics of Africa. In a 2008 article in Science called ” Reassessing HIV Prevention ” 10 AIDS experts concluded that “consistent condom use has not reached a sufficiently high level, even after many years of widespread and often aggressive promotion, to produce a measurable slowing of new infections in the generalized epidemics of Sub-Saharan Africa.”

Let me quickly add that condom promotion has worked in countries such as Thailand and Cambodia, where most HIV is transmitted through commercial sex and where it has been possible to enforce a 100 percent condom use policy in brothels (but not outside of them). In theory, condom promotions ought to work everywhere. And intuitively, some condom use ought to be better than no use. But that’s not what the research in Africa shows.

Why not?

One reason is “risk compensation.” That is, when people think they’re made safe by using condoms at least some of the time, they actually engage in riskier sex.

Another factor is that people seldom use condoms in steady relationships because doing so would imply a lack of trust. (And if condom use rates go up, it’s possible we are seeing an increase of casual or commercial sex.) However, it’s those ongoing relationships that drive Africa’s worst epidemics. In these, most HIV infections are found in general populations, not in high-risk groups such as sex workers, gay men or persons who inject drugs. And in significant proportions of African populations, people have two or more regular sex partners who overlap in time. In Botswana, which has one of the world’s highest HIV rates, 43 percent of men and 17 percent of women surveyed had two or more regular sex partners in the previous year.

These ongoing multiple concurrent sex partnerships resemble a giant, invisible web of relationships through which HIV/AIDS spreads. A study in Malawi showed that even though the average number of sexual partners was only slightly over two, fully two-thirds of this population was interconnected through such networks of overlapping, ongoing relationships.

So what has worked in Africa? 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. “Closed” or faithful polygamy can work as well.

In Uganda’s early, largely home-grown AIDS program, which began in 1986, the focus was on “Sticking to One Partner” or “Zero Grazing” (which meant remaining faithful within a polygamous marriage) and “Loving Faithfully.” These simple messages worked. More recently, the two countries with the highest HIV infection rates, Swaziland and Botswana, have both launched campaigns that discourage people from having multiple and concurrent sexual partners.

Don’t misunderstand me; I am not anti-condom. All people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship. This was a key point in a 2004 “consensus statement” published and endorsed by some 150 global AIDS experts, including representatives the United Nations, World Health Organization and World Bank. These experts also affirmed that for sexually active adults, the first priority should be to promote mutual fidelity. Moreover, liberals and conservatives agree that condoms cannot address challenges that remain critical in Africa such as cross-generational sex, gender inequality and an end to domestic violence, rape and sexual coercion.

Surely it’s time to start providing more evidence-based AIDS prevention in Africa.

The writer is a senior research scientist at the Harvard School of Public Health

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Filed under: AIDS, Personal Reflections, Politics

Role of Conscience and Magisterium: The Spirit. Reflection by Preacher of Papal Household

“It is just as deadly to try to forego either of the two guides of the Spirit. When the interior testimony is neglected, we easily fall into legalism and authoritarianism; when the exterior, apostolic testimony is neglected, we fall into subjectivism and fanaticism….

“When everything is reduced to just the personal, private listening to the Spirit, the path is opened to a unstoppable process of division and subdivision, because everyone believe they are right. And the very division and multiplication of denominations and sects, often contrasting each other in their essential points, demonstrates that the same Spirit of truth in speaking cannot be in all, because otherwise he would be contradicting himself…. “We should recogonize however that there is also the opposite risk: that of making the external and public testimony of the Spirit absolute, ignoring the internal testimony that works through the conscience enlightened by grace. In other words, it is the risk of reducing the guidance of the Paraclete to only the official magisterium of the Church, thus impoverishing the variegated action of the Holy Spirit.

“In this case, the human element, organizational and institutional, can easily prevail. The passivity of the body is fostered and the doors are opened to the marginalization of the laity and the excessive clericalization of the Church. “Even in this case, as always, we should rediscover the whole, the synthesis, that is truly ‘catholic.’ It is the ideal of a healthy harmony between listening to what the Spirit says to me, as an individual, and what he says to the Church as a whole and through the Church to individuals.”

–Raniero Cantalamessa OFM Cap. Preacher of the Papal Household Lenten Reflection

27 March 2009

Filed under: Spirituality

Cardinal Says Moral Education Needed To Fight AIDS

Notes Contributions of Religions in Senegal

DAKAR, Senegal, MARCH 26, 2009 (Zenit.org).- The archbishop of Dakar is emphasizing that in order to combat AIDS in Africa, education in values is the most important necessity.

Cardinal Théodore-Adrien Sarr explained Tuesday to Vatican Radio that since 1995, at the request of former President Abdou Diouf, Christian and Muslim religious communities have been engaged in the struggle against AIDS.

He noted: “We said we could preach and exhort in favor of abstinence and fidelity, and we have done so, both Christians as well as Muslims. And if today the rate of AIDS infection in Senegal is still low, I believe it is thanks to the religious communities, which have emphasized morality and moral behavior.”

“Given that I don’t think that condoms can eradicate AIDS,” he affirmed, “I believe our appeal for abstinence and fidelity, in other words, for moral values and the observance of sexual customs, continues to be truly valid.”

The cardinal acknowledged that there could be difficulties in some countries of the continent “because there are different customs.” However, he stated “that it is necessary to know that Africa is very varied and that there are African societies that know the concept of abstinence and fidelity very well and cultivate it” and that it “is necessary to help them to continue to cultivate it.”

Speaking about Senegal’s situation, he expressed the fear that “if they start to distribute condoms massively to our young people, this will not help them and it will be very much more difficult for them to control themselves and to remain faithful until marriage.”

“I think that to help people through education to make the effort to control themselves continues to be a valid contribution for the prevention of AIDS,” he noted.

Papal visit

Cardinal Sarr observed, “It is a pity that instead of reflecting on how the Pope was received and especially all that he experienced with the peoples of Cameroon and Angola, some of the media put the accent almost exclusively on the question of condoms and abortion.”

“There were beautiful things on this trip that must be transmitted,” he continued. “Instead some found nothing better to do than fuel controversies which, moreover, were magnified, excessive as regards the rest of the content” of the Papal visit.

The cardinal asserted that “it is increasingly necessary that the West and Westerners stop thinking that they alone are the depositories of truth, that only what they conceive as the way of seeing and behaving is valid.”

Making a personal reflection on the Papal trip, the prelate said that “if the Pope put these two problems on the table, that of abortion and condoms, perhaps it is to remind us Africans, and especially Africa’s bishops, that it is better to think with our own heads and for ourselves; to live the Gospel and its values and to promote them for ourselves, to foster those values that don’t always seems to be our own.”

“In any case,” he concluded, “I have committed myself to work so that we can express ourselves and demonstrate that we have ways of seeing and acting that are valid, even if they are different from those that some propose to us.”

Filed under: Culture, healthcare, Medical Ethics, Social Doctrine

RESPONSIBILITY, SOLIDARITY and SUBSIDIARITY THINK THE G8 IN CONNECTION WITH THE DOHA CONFERENCE

Statement by the

“Cardinal Van Thuân International Network”

on the occasion of this year’s G8

Underway over the last few years has been a substantial crisis of the model of global governance of the economy and finance founded on institutions that were either unable or unwilling to delve deeply into the issues of development, fair competition, and tax evasion. In fact, affirmed on one hand have been new “fora of power” – such as, for example, the G7/G8 – where there is a real possibility of having an impact on political and economic developments on this planet, while, on the other hand, the attributions of the United Nations and its agencies have lost much of the influence and effectiveness they have on paper.

During an economic and financial phase of blatant crisis when under discussion and review are the selfsame foundations of the dominant model of development, it appears essential to take a close and critical look at the mechanisms of global governance so they may implement not just stopgap measures needed to defend the status quo – and all its evident inequalities – but rather a new policy pursuing human development.

In this sense it is necessary to look with attention and hopefulness upon preparations for the G8 meeting scheduled to take place this July on La Maddalena Island (Italy), and in particular the meeting of the G20 due to take place in London at the very beginning of April.

A renewed global governance of the economy – as well as taxation and finance – must necessarily originate from three fundamental principles: responsibility, solidarity and subsidiarity .

In the light of evidence during the first part of this III millennium, clamorously timely are the prophetic words of Paul VI in Populorum Progressio : “Humanity is advancing along the path of history like the waves of a rising tide encroaching gradually on the shore. We have inherited from past generations and we have benefited from the work of our contemporaries: for this reason we have obligations towards all, and we cannot refuse to interest ourselves in those who will come after us to enlarge the human family” (n°17).

Therefore, the governance of the global economy must begin from individual and community mutual responsibilities so often disregarded in the itineraries of economic growth embarked upon by many countries now considered to be developed: responsibility towards economic systems having made less progress, towards the poorest of the poor, towards new generations, etc.

Responsibility which means consideration for the interdependence of action undertaken by the “big nations” with respect to global equilibrium, but also with respect to the equilibrium proper to other countries. A clear stand was taken in this sense by the British Prime Minister Gordon Brown, who, during his official visit to Benedict XVI, wrote the following in the Osservatore Romano: “This crisis has shown us that we cannot permit problems to worsen in one country, because the echo of their impact will be felt by one and all. It is therefore our common duty to see to it that the requirements of the poorest countries do not become secondary considerations embraced out of moral compulsion or feelings of guilt. The time has come to see developing countries included in the international solutions we need. And it is fundamental for these international solutions to take developing countries into consideration”. This is an ethical imperative, but it is likewise an economic opportunity. As Sollicitudo rei socialis sustains, the poor are a resource to be enhanced and not a burden to be shouldered. The failure of economic-financial policy relative to development and the fight against poverty will remain much of a failure if it is not based on the principle of responsibility.

Hand in hand with this, governance must then be reformulated through a larger democratic participation in decision-making processes – and hence responsibility as well – of all actors and stakeholders: the governments of developed countries, the major international financial institutions and international organizations, as well as the governments of developing countries, professional organizations of workers and entrepreneurs, and all the way to the full involvement of civil society. New rights to participate can be called only after the assumption of the duty to respect human rights and democracy.

Delicate indeed are the issues on the table because they involve not only the regulation of the international market of finance and related products – a problem as urgent as it is delicate – but also the inclusion of the less developed countries in international commercial circuits, fair international competition that would put an end to phenomena of speculation on the cost of labor and working conditions, transparent access to capital and financial product markets, or, in other words, a revisiting of so-called tax havens, the reduction of the volatility of capital whereby poor countries finance rich ones, and the battle against corruption. The recovery includes all this, and all this is unfeasible if it is not done together with the poor countries. Working for them means working for everyone.

During times as critical as these, international organizations and individual nations must do their own part, ever mindful of the need, however, for their endeavors to pursue the revival of subsidiarity. This does not preclude “providing aid”, and indeed so requires, but always with the end purpose of enhancing active participation and involvement at the grassroots level. Participation such as this constitutes the basic assumption for authentic human development, and this in economic terms as well. The risk inherent in sudden and ill pondered decisions to set public accounts aright is that of a ‘domino effect’ all the way down to the existential conditions of smaller scale expressions and realities of daily life: public administrations are not to download budget cuts on to civil society, but first attend to their own reform; states are only to step in with a spirit of indirect rather than direct replacement; the inclusion of poor countries is to entail the enhancement of their resources, including human resources.

We therefore trust and hope that the current series of international encounters coming to an end at La Maddalena (Italy) this July will ensure well structured linkage between concerns regarding both renewed financial stability and the economic recovery in developed countries and the sense of the Final Declaration of the Doha Conference on development financing held last December, as well as the Note of the Pontifical Council of Justice and Peace issued on 18 November 2008 precisely with a view to the Doha Conference.

Rt. Rev Giampaolo Crepaldi

CARD. VAN THUÁN INTERNATIONAL NETWORK

International Observatory Cardinal Van Thuân

for the Social Doctrine of the Church Verona (Italy)

Center of Social Catholic Thought, UCSP, Arequipa (Peru)

Paul VI Foundation, Madrid (Spain)

Filed under: Economic Policy, Market Place, Social Justice

A FUTURE NOT OUR OWN


Archbishop Oscar Romero
(Assassinated, 24 March 1980)

It helps, now and then, to step back
and take the long view.
The kingdom is not only beyond our efforts,
it is beyond our vision.

We accomplish in our lifetime only a tiny fraction of
the magnificent enterprise that is God’s work.
Nothing we do is complete,
which is another way of saying
that the kingdom always lies beyond us.

No statement says all that could be said.
No prayer fully expresses our faith.
No confession brings perfection.
No pastoral visit brings wholeness.
No program accomplishes the church’s mission.
No set of goals and objectives includes everything.

This is what we are about:
We plant seeds that one day will grow.
We water seeds already planted, knowing that they hold future promise.
We lay foundations that will need further development.
We provide yeast that produces effects beyond our capabilities.

We cannot do everything
and there is a sense of liberation in realizing that.
This enables us to do something,
and to do it very well.
It may be incomplete, but it is a beginning, a step along the way,
an opportunity for God’s grace to enter and do the rest.

We may never see the end results,
but that is the difference between the master builder and the worker.
We are workers, not master builders,
ministers, not messiahs.
We are prophets of a future not our own.

Filed under: Spirituality