RALEIGH — The Catholic Church has been castigated in the press lately for its refusal to promote condoms as a tool to slow the spread of HIV in developing nations. The church has even been accused of contributing to the HIV pandemic, but such an accusation raises a question; why would the same church that has cared for the sick for 2,000 years reject a tool to prevent more sickness? Why would the same church whose saints served the ill and dying allow seemingly unnecessary illness and death?
This paradox and the ongoing castigation of the Catholic Church call for an articulation of why the church opposes condom use in the fight against HIV. Two key points must be conveyed: first is the underlying value that the Catholic Church upholds by rejecting condoms, and second is the unexpectedly poor effectiveness of condoms when used as a population-wide tool to slow HIV transmission in developing nations.
At the surface level, the church is rejecting condoms, but at a deeper level it is proclaiming a vision of human sexuality in its full splendor; at the heart of Catholic teaching on sexuality is that the physical union between a husband and a wife is meant to be the fullness of the giving of selves between the spouses.
On my wedding day I gave myself totally to my wife; I gave her my friendship, my spiritual support, my fidelity, my future - all committed to her in the sacrament of our marriage. During the physical intimacy between a husband and wife, all of these gifts are encapsulated and they are completed by the physical gift of spouses' bodies to one another. In the Catholic vision of sexuality, this model of loving by totally giving oneself to one's spouse is modeled on the way God loves totally, giving His very life to us.
Seen in this light, the church's opposition to condoms to decrease the risk of HIV transmission takes on deeper meaning; a condom stands as a barrier between the husband and wife, physically separating them from one another in the moment that ought be their closest union. Just as I could not stand at the altar on my wedding day and intentionally hold back part of my pledge to my wife, neither could I give a truly total gift of myself when I have put a physical barrier between myself and my wife.
Whatever value condoms might have in reducing the risk of HIV transmission, they are irreconcilable with the true dignity of human sexuality, through which we strive to make a complete and total gift of ourselves. Thus, the church's prohibition against condoms is not an issue of a behind-the-times hierarchy, but rather of faithfulness to the true dignity and meaning of human sexuality.
What then about the second point, the issue of effectiveness? Condoms clearly decrease the risk of HIV transmission in any given sexual encounter, but yet experience in Africa has demonstrated that those countries that employed a policy of widespread condom distribution failed to slow the spread of the infection.
Meanwhile those countries that instead employed a policy of partner reduction and fidelity did see infection rates decline; i.e., it was not condoms that reduced HIV transmission, but changes in behavior (c.f. Science, May 9 2008, p. 749-750).
How does this counter-intuitive finding make sense? At least part of the answer lies in a concept called "risk compensation;" in short, risk compensation is the idea that if a risky behavior is made safer, people "compensate" by taking more risks and thereby reduce the safety gains.
For example, improved football helmets decrease the risk of head injuries but allow football players to hit even harder and thereby offset the increased head protection from the helmet. It seems that the same phenomenon in Africa has offset the protection afforded by condoms; though a condom may decrease the risk of infection in any one sexual encounter, when an entire population is made to feel safe from HIV, risk-taking increases and HIV transmission can continue unabated.
Taken together, these points illuminate the church's stance; by proclaiming a message of sexuality that is true to the human person, the church promotes real human dignity - and human health.
Patrick O'Connell is a physician in Raleigh and is president of the Triangle Guild of the Catholic Medical Association.