Crusading for change

BMJ 2005; 330 doi: (Published 21 April 2005) Cite this as: BMJ 2005;330:926
  1. Sophie Arie
  1. Rome

    As 115 cardinals began voting for a new pope on Monday, some Catholic organisations and priests working in AIDS ravaged areas called for the church to change its stance on condoms. Sophie Arie reports

    For Luyanda Ngonyama, like the rest of his generation of South Africans, AIDS is part of every-day life. But condoms are not. One in five South Africans is living with HIV or AIDS, more people than in any other country.

    For years, working for the South African Catholic Bishops Council AIDS programme, Mr Ngonyama,aged 32, saw fellow Catholics grapple with the moral dilemma over whether to use all available methods of protection. “What about my religion?” they would ask. “If I have sex [outside marriage]and use a condom, I'll be committing a double sin.”

    Mr Ngonyama became so uncomfortable with the Catholic church's official line on condoms—that they “promote immoral behaviour” and don't help protect from AIDS—that he gave up his job as HIV coordinator in the council programme. He now works for Treatment Action Campaign, the country's most influential AIDS activist group and a prominent pro-condom voice.

    “I don't ever push Catholics to use condoms. But they must be free to choose. Any interventionon AIDS that doesn't include condoms is meaning-less,” Mr Ngonyama says. Mr Ngonyama is just one of count-less Catholics around the world who have concluded that, where condoms are concerned, Pope John Paul II was out of touch.

    When Karol Wojtyla became pope in 1978, AIDS had not yet raised its ugly head. In the time that he occupied the Holy See, the disease became a global epidemic, eventually killing more than 3.5 million people a year. But the pope continued to ban all forms of contraception right up until his death. The Catholic church's footsoldiers around the world spread the myth that condoms do not prevent the spread of disease because they are full of little holes. The message confused and intimidated many believers, gave reluctant condom users a perfect excuse, and inspired ultra-Catholic governments to ban or withdraw funds for distribution of condoms or information about them.

    In the Philippines, where almost 85% of the population are Catholic, Juan Flavier, a health minister who launched a campaign promoting condoms in the 1990s, was denounced as an “agent of satan” by former Archbishop of Manila Cardinal Jaime Sin. Cardinal Sin issued a pastoral exhortation in 2001 stating that “the condom corrupts and weakens people… destroys families and individuals… and spreads promiscuity.”

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    One of the first things a new pope should do, when he succeeds Pope John Paul II (above), should be to save lives, says Frances Kissling, president of Catholics for a Free Choice


    Today, the government of President Gloria Macapagal-Arroyo does not allow the use of government funds to supply condoms, and local authorities and prominent politicians, such as the mayor of Manila, have banned state health centres from handing them out.

    In Chile, leading Catholic television channels have refused to air AIDS programmes that advisethe use of condoms. In Kenya, Archbishop Ndingi Mwana a'Nzeki told his flock that condoms actually give people AIDS, and, in Zambia, the government of President Levy Mwanawasa has banned the distribution of condoms in schools. South Africa's Cardinal Wilfrid Napier attacked the government earlier this year for its latest condom awareness campaign.

    Health and non-governmental organisations, Catholic or not, find that the Vatican's anti-condom message has created a kind of cultural minefield that they must tiptoe around. Although many Catholics choose to ignore the message, in developing countries, such as in Africa, where Catholicism is recruiting new and fervent believers faster than anywhere else in the world, the church appears to be working directly against public health workers. “It has complicated things and made the task of getting information to people who need it much harder,” says Ben Plumley, spokesman forUNAIDS in Geneva.

    Smaller aid agencies and human rights campaigners are more blunt. They describe being intimidated by government or church officials in countries such as Kenya, Nicaragua, Zimbabwe, and Nigeria, and express the belief that John Paul II's stance on condoms has contributed to the deaths of many thousands of people.

    “If people are not keen on using condoms and you give them another excuse, that may cost them their life,” says Annabel Kanabus, director of UK based AIDS charity AVERT. “If the Church does not change its line, more people will die.”

    Some of the greatest criticism in recent years has come from Catholic aid agencies and Catholic priests working in AIDS ravaged areas, many of whom have openly distributed condoms and demanded that the church revise its position.

    “What's really ironic is that Catholic organisations provide about 25% of care for all HIV/AIDS victims,” said one member of an international Catholic aid group. “And yet it is controversial for us to hand out condoms to try to slow the spread of the disease.”

    According to US based Catholics for a Free Choice, most Catholics, even in the church's most traditional heart-land of Latin America, think that it is time condoms were given the green light.In Mexico, 91% are in favour; in Bolivia 79%.

    Frances Kissling, president of Catholics for a Free Choice, believes a pope is going to have to give in. “John Paul II was a great believer in the slippery slope argument. He took the authoritarian father attitude,” says Ms Kissling. “But he was not at the top of his game in the last five years. Had the question been explored at a time when he was more functional, I'm sure he would have been able to see the point. One of the first things the new pope should do is save lives. It's doable. It's going to happen.”

    In recent years, voices have been heard higher and higher in the Catholic church, calling for recognition of the power of condoms to save lives. Just months before John Paul II's death, the Spanish bishops conference, the body representing all the Spanish bishops, issued a statement saying that condoms have a place in the global prevention of AIDS.

    Within weeks, Georges Cottier, theologian of the pontifical household, told the Italian news agency Apcom that “the use of condoms in some situations can be considered morally legitimate.”

    “The virus (HIV) is transmitted during a sexual act, so at the same time as [bringing] life there is also a risk of transmitting death,” Mr Cottier says. “And that is where the commandment ‘thou shalt not kill’ is valid.”

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