The Vatican's new insights on condoms for H.I.V. prevention

Monsignor Jacques Suaudeau of the Pontifical Council for the Family recently published “Prophylactics or Family Values? Stopping the Spread of HIV/AIDS” in the weekly edition of L’Osservatore Romano (4/19). Here we find important signals of what many have suspected all along: that while individual bishops and archbishops have occasionally repudiated local H.I.V. prevention programs that include the distribution of prophylactics (more commonly referred to as condoms), the Roman curia is more tolerant on the matter.

Monsignor Suaudeau reports that the Catholic Church has been accused of “lacking a sense of reality and of being irresponsible about the H.I.V.-AIDS epidemic in Africa because of its position regarding the use of prophylactics to prevent sexual contamination.” In response, Suaudeau introduces a distinction between prevention (attacking a problem at its roots) and containment (interventions to lessen the impact of a problem). Against malaria, for instance, containment efforts have been of limited success because truly preventive efforts (such as eliminating all mosquito larvae) are so difficult. In contrast, in the case of typhoid fever, prevention was achieved because public health officials aimed to correct the mistaken attitude that care did not need to be taken about sources of drinking water.

With that distinction in mind, Suaudeau advances his thesis regarding prevention: “Family values guarantee true human victory. Wherever there is true education in the values of the family, of fidelity, of marital chastity, the true meaning of the mutual gift of self...man will achieve a human victory, even over this terrible phenomenon.” He adds: “If people really want to prevent AIDS, they must be convinced to change their sexual behavior, which is the principal cause of the infection’s spread. Until a real effort is made in this regard, no true prevention will be achieved. The prophylactic is one of the ways to ‘contain’ the sexual transmission of H.I.V.-AIDS, that is, to limit its transmission.”

After citing apparently conflicting data about the reliability of prophylactics, the author backs away from the issue and claims, “In any case, the church’s position on the prevention of H.I.V.-AIDS is not at this technical health care level.” Instead, he argues, the church is concerned about the root of the problem, that is, respect for human sexuality. Here he also mentions the “condition of women” as well as poverty, political instability, unemployment, the growth of prostitution, the condition of refugees, civil wars and urban crowding of the poor as critical factors that fuel the transmission of H.I.V. in the developing world.

After a strong endorsement of sexual abstinence, the author applies his distinction to two very important populations: commercial sex workers in Thailand and the general population of Uganda. He notes that in Thailand “the use of condoms had particularly good results for these people with regard to the prevention [we would have thought he would have written “containment”] of sexually transmitted diseases.” He adds, “The use of prophylactics in these circumstances is actually a ‘lesser evil,’ but it cannot be proposed as a model of humanization and development.” He wonders, therefore, why authorities did not examine why there was growth in the Thai prostitution industry in the first place. He calls attention to more comprehensive approaches in Uganda. While recognizing that “sexually active men and women use prophylactics more frequently,” the factors he finds more important include a delay in the age of first intercourse among both men and women and a decrease in sexual relations outside of marriage.

Monsignor Suaudeau’s article conveys important insights about Vatican curial thinking on H.I.V. prevention. First, the article is not simply disseminated in the Pontifical Council’s own newsletter. Publication in L’Osservatore, the official newspaper of the Curia, is a sign that the article represents a broad constituency of curial thinking. Second, it rightly endorses abstinence and the proper understanding of Christian sexuality as the evidently most safe and most human preventive approach against H.I.V. transmission. Third, it does not attack the endorsement, promotion, distribution or use of prophylactics. Rather, it introduces a distinction between containment and prevention and claims only that prophylactics alone are inadequate prevention. Fourth, while noting that further studies regarding the adequacy of prophylactic usage for H.I.V. prevention are still needed, it does not categorically deny their effectiveness. Fifth, it acknowledges the positive function that prophylactics have played in two populations critically affected by the H.I.V. epidemic. Sixth, it recognizes the use of prophylactics as a lesser evil, an important principle used to describe morally permissible though regrettable action. Finally, it concludes by recognizing the need for more fundamentally human, life-enhancing programs to prevent H.I.V. transmission.

While many readers may be surprised by the article’s tolerance, we are not. Admittedly, the Vatican has intervened otherwise, as in 1988, when the Congregation for the Doctrine of the Faith raised questions about the U.S. Catholic Conference’s pastoral letter The Many Faces of AIDS: A Gospel Response (1987), and again in 1995, when the same congregation acted against a resource pack on H.I.V. education published with an imprimatur by the archbishop of St. Andrews and Edinburgh. However, health care workers and moral theologians have encountered an implicit tolerance from the Roman Curia when they have first asserted church teaching on sexuality and subsequently addressed the prophylactic issue. For instance, more than 25 moral theologians have published articles claiming that without undermining church teaching, church leaders do not have to oppose but may support the distribution of prophylactics within an educational program that first underlines church teaching on sexuality. These arguments are made by invoking moral principles like those of “lesser evil,” “cooperation,” “toleration” and “double effect.” By these arguments, moralists around the world now recognize a theological consensus on the legitimacy of various H.I.V. preventive efforts.

Without known interference, the Vatican has allowed theologians to achieve this consensus. Vatican curial officials now seem willing publicly to recognize the legitimacy of the theologians’ arguments. Hesitant local ordinaries will in turn, we hope, note Monsignor Suaudeau’s tolerant signals and more easily listen to the prudent counsel of their own health care and pastoral workers and their moral theologians.

Jon D. Fuller, S.J., M.D., is an associate professor of medicine at Boston University School of Medicine and assistant director of the Adult Clinical AIDS Program at Boston Medical Center. James F. Keenan, S.J., is a p