AIDS Challenges Religious Leaders
By Karen DeYoung, Washington Post
WashPost: Condoms, Africa, & the Catholic Church
When southern Africa's Roman Catholic bishops held their
semi-annual meeting in Pretoria, South Africa, last month, the
issue at the top of the agenda was a proposal to approve the use
of condoms for AIDS prevention.
The bishops--from South Africa, Botswana and Swaziland--were
well aware that the Vatican bans condoms, regardless of whether
their intended use is contraception or disease prevention. But
with more than 25 million Africans now infected with HIV/AIDS,
many at the meeting felt "we have to be able to say something,"
said Cape Town Auxiliary Bishop Reginald Cawcutt. "We need the
wisdom of Solomon. And we know--we're really, really aware--that
the world is waiting for us. So is the Vatican."
In the end, the bishops gave the Vatican no cause for concern.
After five days of closed-door debate, they pronounced the
"widespread and indiscriminate promotion of condoms . . . an
immoral and misguided weapon in our battle against HIV-AIDS." By
undermining abstinence and marital fidelity, they said, "condoms
may even be one of the main reasons for the spread of HIV-AIDS."
But the bishops face a dilemma that is not unique to southern
Africa, and that is only likely to intensify. As AIDS deaths
mount, the pandemic is challenging the world's mainstream
religions as much as any event in modern history, seemingly
setting at odds their core missions of assuaging human suffering
and perfecting human morality.
Nowhere is the conflict more intense or its implications more
significant than within the Catholic Church.
Roman Catholicism has been a crucial player in virtually all
aspects of the global response to AIDS since the disease was
identified 20 years ago. Through its hospices and hospitals,
orphanages and parish outreach, the Catholic Church provides
more direct care for people with AIDS and their families and
communities, particularly in Africa and Latin America, than any
The Vatican has been at the front of demands for increased
international spending on AIDS care and treatment. Pope John
Paul II has called the prices charged by major pharmaceutical
companies for AIDS drugs "excessive [and] sometimes even
exorbitant" and has said the patent and intellectual property
rights defended by the companies and the U.S. government are
morally inferior to "every individual's right to health."
But the Vatican also has been the world's loudest and most
consistent voice in opposition to what the United Nations, most
governments and the vast majority of international organizations
involved in the AIDS fight say are the most realistic and
effective ways to slow the spread of HIV, the human
immunodeficiency virus that causes AIDS.
Church doctrine condemns the use of condoms as twice sinful-both
as contraceptives and as promoters of promiscuity. Much to the
consternation and disagreement of public health experts, Vatican
spokesmen also regularly question whether condoms prevent sexual
transmission of the virus.
The Vatican has rejected prevention campaigns that pay special
attention to those at highest risk of HIV infection, including
gay men and lesbians, prostitutes and people who inject drugs,
saying that such recognition would imply approval of immoral
acts. As a result, activists say, the Catholic Church
contributes to the widespread stigma and discrimination against
people with AIDS.
Among world religions, Roman Catholic leaders are hardly alone
in their approach to preventing the spread of AIDS. Warnings
that AIDS-related sex education and condom promotion will
undermine individual morality and lead to societal destruction
have come from Islamic leaders in Pakistan and evangelical
Protestants in Jamaica.
In January, the Council of Islamic Clerics in Nigeria's northern
Kano state condemned a planned seminar on HIV/AIDS prevention as
violating Islamic law. Imam Ibrahim Umar Kabo called it a
Western "gimmick to spread immorality in our society."
Zambian President Frederick Chiluba, who has proclaimed
Christianity the state religion, has called condoms "a sign of
weak morals." Early this year,Zambian health officials canceled
ads prepared for state-run TV and radio after religious leaders
said their promotion of condoms would lead to promiscuity.
When the Kenyan government announced plans last month to import
300 million condoms to prevent the spread of AIDS, Sheik Mohamed
Dor of the Council of Imams and Preachers said the country was
"committing suicide" and encouraging sexual experimentation
among young people. Bemoaning the expense, President Daniel arap
Moi suggested that all Kenyans instead abstain from sex for two
Reaction was once similar among religious leaders in the United
States, who were forced to confront AIDS much earlier than their
counterparts in Africa, Latin America and Asia. "My experience
today, reaching out to faith-based organizations in Africa, has
a similar quality of 10 years ago in this country," said Jason
Heffner of the U.S. Agency for International Development. "You
could not get the major [U.S.] leaders to sit down around a
table . . . [and] we didn't have the leadership we needed. Now,
we see the religious community on board in many ways."
The explosion of AIDS in the developing world has also begun to
change some minds. Uganda's Islamic Medical Association was
behind a prevention campaign that has become a model. In Niger,
Islamic leaders this year recommended that Muslim teachers learn
to teach about AIDS and that couples receive premarital HIV
In Senegal, where more than 90 percent of the population is
Muslim, the spread of HIV slowed dramatically after Islamic and
Christian leaders joined a government AIDS-prevention campaign
advocating condoms along with abstinence and fidelity. "Sixteen
years ago, people didn't talk about AIDS," Senegalese Imam
Ousmane Gueye said during a U.N.-organized visit there last
month. "Islam forbids all evil and fornication" as well as
condoms, he said, but that teaching has been adapted for people
with AIDS to prevent the spread of infection.
"AIDS is . . . not a divine curse," Gueye said. "It is a disease
and there is no cure, but you must not run away from people with
South Africa's Anglican Archbishop Njongonkulu Ndungane has been
instrumental in promoting clerical AIDS education and prevention
campaigns, including condom use. The World Council of Churches,
representing 342 Protestant and Orthodox Christian churches
around the world, is an outspoken supporter of all forms of
UNAIDS, the umbrella organization of U.N. and World Bank AIDS
programs, has produced an HIV-prevention video with quotes from
the Koran for Islamic religious leaders. "Our approach has been
to work with those church leaders who are open to it," said
Peter Piot, executive director of UNAIDS.
USAID, the U.S. foreign assistance program, has developed an
AIDS outreach program for African religious leaders. But one
agency official acknowledged that there are limits to
cooperation: "I don't think we're going to, as USAID or the U.S.
government, change the position of the Catholic Church."
speech at a three-day U.N. session on AIDS in June was given by
the delegate from the Vatican, who made it clear that the Holy
See's participation in the session, which included discussions
of homosexuality and prostitution, should not be interpreted as
acceptance of immoral behavior.
Moreover, he said, "The Holy See wishes to emphasize that, with
regard to the use of condoms as a means of preventing HIV
infection"-a method strongly endorsed in a U.N. General Assembly
declaration just moments before -- "it has in no way changed its
But others in the church are not as sure where the high moral
"What we are seeing now is that there is a debate going on in
the Catholic Church," Piot said. "Clearly, there are many Roman
Catholics who feel uncomfortable with the current official
Although the theological debate over AIDS now extends to
parishes and dioceses around the world, it began years ago in
the more esoteric confines of essays in clerical magazines and
quiet conversations among Catholic ethicists.
debate centers on the "lesser evil" principle. Moral theologian
Rev. Richard A. McCormick, quoted in a recently published
collection of essays titled "Catholic Ethicists on HIV/AIDS
Prevention," used drunk driving as an illustration. "We say,
'Don't drive while drunk; let someone else drive.' But
supporting the designated driver doesn't mean we support
over-drinking. It simply means that we don't want the
A number of Catholic theologians have questioned whether condoms
should be permitted in some cases-for example, by an
HIV-positive man to avoid infecting his wife. Such permission,
the theologians argue, does not mean acceptance of the man's
In Brazil, the world's largest predominantly Catholic country,
government condom distribution and sex-education programs to
combat a high infection rate have provoked the sharpest public
disagreements within the church hierarchy since the decades-old
battles over liberation theology.
When Eugenio Rixen, the Belgian-born bishop of the diocese of
Goias, near the capital, Brasilia, shook the national meeting of
the Brazilian Pastoral Health Commission last year by calling
condom use to prevent HIV a "lesser evil," he was rebuked by the
Vatican and by Sao Paulo Archbishop Claudio Hummes, who called
such arguments "unacceptable."
"The one thing everyone in the church agrees on is that the
problem is very grave, but there are differences in the way in
which we think the situation should be handled," said the Rev.
Ricardo Rezende, a parish priest in the Brazilian state of
Parana and a leading voice on social justice issues. "The church
is offering its assistance through programs to those infected
with the disease, but the ongoing debate is how to reconcile
Vatican doctrine with the realities of modern Brazil."
The church's position on contraception was spelled out in July
1968 by Pope Paul VI's Humanae Vitae, an encyclical prompted in
part by the new availability of birth control pills. In it, the
pope repeated prohibitions on sex outside marriage and said that
every marital act must remain open to the production of
children. "Every action" that served to interfere with possible
conception was banned, regardless of its intent. It specifically
stated that the "lesser evil" concept justified no exceptions,
"even for the gravest reasons . . . even when the intention is
to safeguard or promoteindividual, family or social well-being."
When AIDS appeared in the early 1980s, its concentration among
gay men raised no challenges to the doctrine. Homosexual acts
were already considered sinful, with or without condoms. But by
the 1990s, when AIDS started to spread like wildfire among
heterosexuals and in the poorest parts of the world, doctrines
began to collide on "a series of issues where social justice
teaching cut across bioethics teaching," said the dean of
Harvard Divinity School, J. Bryan Hehir, a Roman Catholic priest
with long experience in human rights and humanitarian work.
"Before, you could pursue most of the social justice and not run
into these tensions."
Archbishop Javier Lozana Barragan, the Vatican's chief spokesman
on AIDS, said he sees no dilemma. "Is it possible to use
condoms?" he asked at a December news conference. "Of course.
Many people use them. But if you ask whether they are allowed
according to Catholic doctrine, the answer is no because they
are not ethically permissible."
pastoral level, where Catholic shepherds face members of their
flock in private, priests can be found at the doctrinal edges
and beyond on questions involving AIDS, according to interviews
and the writings of a number of Catholic ethicists.
The Rev. Richard Albert, an American who has been a parish
priest in Kingston, Jamaica, for two decades, operates a hospice
serving people with AIDS. He does not question the Vatican's
condemnation of condoms or sex outside marriage. "I honestly
believe my moral responsibility is to challenge them to moral
living," Albert said of those he ministers to, and it is what he
regularly preaches from the pulpit.
But when asked what he counsels on a pastoral level, he says, "I
deal with them where they are at."
Piot, of UNAIDS, recounted a visit to a group of Catholic nuns
working with orphans and AIDS education in Ivory Coast.
"Suddenly, the mother superior showed me a flip chart with a
condom on it. I said, 'My goodness, Mother, you're promoting
condoms.' She told me: 'When I show this, I speak as a woman and
not as a nun.' "
As long as a priest does not deviate from doctrine in public
statements, "the chance that [he's] going to get in trouble is
very slim," one Catholic cleric said. "This sounds at certain
levels like hypocrisy, but at the people level, it's always been
Organizations like UNAIDS that would like to expand their
collaboration with religious institutions care as much about
what the church does not say in public as what it does. "What
we've asked of the churches, particularly the Catholic Church,
is that if you can't say anything nice about condoms, don't say
anything at all," said Paul Delay, who heads AIDS programs for
USAID. "Concentrate on [abstinence and fidelity] . . . but don't
say that condoms don't work or they've got holes in them or they
will break. Don't give misinformation."
Piot said finding common ground with religious institutions "has
definitely become easier" since he took over UNAIDS five years
"But not with everybody," Piot said. "There is a group in the
church that puts, let's say, the dogma before saving lives. And
there are hard-liners everywhere.
"Churches have an enormous impact on people's attitudes and
morality, although it's not totally effective; otherwise, we
wouldn't have an AIDS epidemic," he said. "It's important that
they're on board, that they're part of the solution."
Correspondent Anthony Faiola in Buenos Aires contributed to this