Research may support Pope's comments against condom use in Africa, opinion piece says

Mar 30 2009

Pope Benedict XVI "set off a firestorm of protest" earlier this month when he commented that condom distribution "isn't helping, and may be worsening" the spread of HIV/AIDS in Africa, but "in truth, current empirical evidence supports him," Edward Green, a senior research scientist at the Harvard School of Public Health, writes in a Washington Post opinion piece.

The condom has become a "symbol of freedom and -- along with contraception -- female emancipation," Green writes, adding that those who "question condom orthodoxy are accused of being against these causes." Members of the HIV/AIDS and family planning communities "take terrible professional risks if we side with the pope on a divisive topic such as this," Green writes, noting that his comments "are only about the questions of condoms working to stem the spread of AIDS in Africa's generalized epidemics -- nowhere else."

According to Green, several research articles published in 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." He adds that condom promotion "has worked" in countries such as Cambodia and Thailand, where HIV is transmitted primarily through commercial sex. "In theory, condom promotions ought to work everywhere," Green writes, adding that this is "not what the research in Africa shows."

Green writes that "people think they're made safe by using condoms at least some of the time" and they "actually engage in riskier sex." In addition, many people in Africa rarely use condoms in stable relationships "because doing so would imply a lack of trust," Green continues, adding that it is "those ongoing relationships that drive Africa's worst epidemics" where most HIV cases occur in general populations rather than high-risk groups like commercial sex workers, men who have sex with men or injection drug users. "And in significant proportions of African populations, people have two or more regular sex partners who overlap in time," creating an "invisible web of relationships through which HIV/AIDS spreads," Green writes. What has proven effective in Africa are "[s]trategies 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," Green writes, adding, "'Closed' or faithful polygamy can work as well."

Green says that he is "not anti-condom," adding, "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." In addition, "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," Green continues, concluding, "Surely it's time to start providing more evidence-based AIDS prevention in Africa" (Green, Washington Post, 3/29).