pontification & pragmatism
Well, his holiness Pope Benedict XVI is on the African continent this week, first in Cameroon and then in Angola. He was in Yaounde on Tuesday, which is unfortunate because that means he missed out on the capitol's bizarre Sunday afternoon phenomenon: multiple Chinese restaurants that host major buffets at which expats while away the humid days, week after week, month after month, on and on and on until it feels like Yaounde is your own private, hot, humid, miserable purgatorio.
But I digress. The pope made headlines upon his arrival into the city on Tuesday for his claims regarding the relationship between the spread of HIV/AIDS and condom use. "You can't resolve it with the distribution of condoms," he said on the way into town. "On the contrary, it increases the problem." Benedict went on to say that changes in attitudes about morality & sexual activity would do more to fix the problem.
I'll give the pope some credit here. He's certainly right that getting men to stop cheating on their wives en masse - as is the custom in many African ethno-linguistic groups, especially those in which having sex with a nursing mother is a cultural taboo - would certainly abate the spread of HIV. As would ending the practices of polygamy, marrying off twelve-year-old girls, and the use of rape as a weapon of war.
But the pope doesn't know what he's talking about. Only someone who's never set foot in an African hospital would claim that condom use doesn't help fight the HIV/AIDS epidemic. Because it does. It works. When a country increases access to information about and reduces the cost of condoms, its HIV rate goes down. This is not in dispute. It works especially well when you hand out condoms in conjunction with campaigns that encourage teenagers to abstain and husbands to be faithful to their wives. But access to condoms is a key part of the strategy.
Most health workers in Africa - often the most deeply religious ones - are much more pragmatic than their theologians. Unlike the pope, they realize that changing cultural norms is an enormous, sometimes impossible task. The religious health workers I've interviewed believe their job is to care for the population according to Christian ideals of unconditional love. Love in this view means helping people who don't have good choices. That's why the Catholic hospital in Monrovia was rumored to be the only place anyone could get condoms during Liberia's wars. That's why conservative Protestants in the eastern Congo will give a morning-after pill to an eleven-year-old who's been gang raped. The reality of the situation pushes aside ideals and pontifications from on high. It forces an immediate, imperfect response to an impossible situation.
It would be great if the pope's vision of fidelity replaced the need for condom distribution in much of sub-Saharan Africa. The cost-prohibitive nature of all forms of contraception and disease-prevention mean that these programs are almost completely dependent on donor financing. That money won't last forever. There will have to be long-term, local solutions to these problems. But those kinds of cultural changes take a lifetime to implement. Given that there is no evidence that condom distribution increases promiscuity - or the HIV/AIDS seropositive rate - in sub-Saharan Africa, it's ridiculous to claim that these programs do more harm than good. And the at-risk people of Cameroon and Angola and Kenya and the Congo can't wait for norms to shift. I wonder if the pope thought of that.
UPDATE: Here's a post that does a good job of explaining something I should've mentioned before, namely, that the simple presence of condoms doesn't reduce the HIV/AIDS rate. As Bill Easterly points out, the issue is getting people to use condoms when they're available. It's a huge problem for which I didn't adequately account in my claims about the effectiveness of condom distribution above. But the pope is still completely wrong that condoms exacerbate the HIV/AIDS problem.