The Church, AIDS and Africa

If we heard it once last week, we heard it a hundred times: the pope had a 'mixed legacy.'  Thank you, Eleanor Clift, Bill Clinton, et al.  When asking liberal-minded Roman Catholics from wealthy countries, the list of the Pope's shortcomings seems to revolve primarily around his failure to accomodate to their lifestyles by adjusting church doctrine to suit.  Occasionally, less provincial complaints are voiced and these concern the Church's attitude toward sexual mores, contraception and the spread of AIDS, especially in Africa where the Church is growing rapidly (apparently inspite of this same attitude- go figure.)

We were listening to a report about Catholicism in Africa on NPR's Morning Edition.  Reporter Ofaibea Quist Arcton introduced  the subject of the pope's more controversial stands, specifically the Church's strict prohibition of the use of condoms, "which some have characterized as criminal given the prevalence of AIDS on the continent."  Bishop Daniel Nlandu of Kinshasa responds, "The position of the Catholic Church is clear. You can't just assume that people cannot exert self control...People must adopt a more responsible attitude toward their sexual conduct."  The call to personal accountability is a universal one in Christianity but there is no denying that to exercise self-control is especially compelling in Africa where behavior alone is responsible for 99% of AIDS infections.  While liberals will characterize this attitude as "criminal,"  we offer this report from The World and I, an online magazine .  It details the remarkable progress that Uganda has had in stemming the incidence of HIV there.  Many factors contributed, but close cooperation between government, faith- based organizations and the health community was the key to success:

[President of Uganda] Museveni's policy allowed health professionals and religious leaders to sit at the same table. Key strategies disarmed the potential controversy:

• Religious leaders were not asked to jeopardize their theologies.
• Limited condom distribution, as a health concern, continued quietly under the Ministry of Health.
• Sexual abstinence and marital fidelity were emphasized as the primary solution to HIV/AIDS and stressed publicly.
• When the social marketing of condoms was permitted, it specifically targeted commercial sex traffickers.

The model for combating AIDS in Uganda has been called ABC: Abstinence, Be faithful and use Condoms (carefully and consistently).  In this model, A and B relate to primary behavior change (risk elimination) and C relates to risk reduction.  Edward C. Green of the Harvard Center for Population and Development Studies wrote the booklet for USAID Faith-Based Organizations: Contributions to HIV Prevention.  He sums up the central conflict between the "pragmatic" and the "moral" approaches:

...a conflict remains in many countries between taking a medical or 'realistic' approach to AIDS prevention . . . and taking a religious or 'moral' approach. The popular press and some AIDS literature pit medically enlightened progressives who recognize human behavior as it actually is against religious conservatives who moralize about how behavior ought to be. The former emphasize condom use and the treatment of sexually transmitted infections, whereas the latter emphasize abstinence and fidelity.

As we would expect from the cream of the intellectual elites at Harvard, the condom approach is touted by "enlightened progressives" who recognize "reality" against conservatives who "moralize" about behavior. Flying in the face of "enlightenment," Museveni's strategy was to emphasize the the 'A' and 'B' aspects of the model, and indeed he credits that with Uganda's success.  In this, he  enlisted the support of not only the Catholic Church, but all other Christian denominations and Muslims as well.  He approved the distribution of condoms in urban areas "so the prostitutes could save their lives"  but condemned their  "distribution to primary school pupils ...[as] dangerous and disastrous."   The success of this approach is undisputed: infection rates in Uganda have gone from more than 30% in the early 1990's to about 6% in 2003.

Christianity has a universal message of salvation, but for those of us fortunate enough to live in wealthy countries, that message is "relegated " to the intangible realm of spirit, an intellectual endeavor, and as such, not deemed necessary to well-being, spiritual or physical.  This accounts for our unfailingly patronizing attitude towards the very conservative churches growing apace in places like Africa  and South Asia.  For them, strict adherence to the moral discipline of the Church is not a mental game, but a matter of life and death.

Comments

[peter]

you are wrong on your statistics in regard to HIV/AIDS in Africa as it relates to condom use vs. abstinence. While both factors can be part of any harm reduction program, the successes in Africa (and elsewhere) in reducing HIV/AIDS are more pronounced in areas where the emphasis and access is more oriented to condom use vs. abstinence. In the US, as well, success rates of abstinence only sex ed has been both misrepresented and ineffective in regard to STD prevention, and in regard to unwanted pregnancy rates.

[bbmoe]

Peter: If you will read the post, you will notice that there are no statisitics with regard to condom use versus abstinence. The only statistics quoted are with respect to the rate of infection in Uganda. The background article details Uganda's approach and and its success speaks for itself.

Abstinence is effective in 100% of cases where it is used to prevent STD's and pregnancy. We note that you do not have any statistics to back your claim, but we aren't very impressed with statistics anyway unless they can be backed up rigorously and come from an excellent source.

[Dr Edward Green]

I am the one being quoted here.

There is actually no evidence in Africa that increased availablity or use of condoms has led to a decrease in HIV infection rates. There is however avidence that higher rates of partner fidelity and abstinence have led to decreases of HIV rates in at least Uganda, Senegal, Kenya and Zimbabwe

see my paper in progress:

Green, E.C. and A. Herling, A Primer on the ABC Approach to HIV Prevention Common Questions and Answers about the ABC Approach to HIV Prevention. Washington, DC: Christian Connections for International Health and Arlington, VA: Medical Service Corporation International, Jan. 2006.
http://www.ccih.org/Primer_on_ABC_Approach_1.15.06.pdf