AIDS, condoms and grass-roots reality: Cardinal's words may indicate moral trickle-up from health workers

National Catholic Reporter, Feb 25, 2005 by Stacy Meichtry

Say the words "Catholic church" and "AIDS," and most people automatically think "condoms." In the media and on the street, the Catholic church's response to the global HIV/AIDS crisis is identified with a resounding "No" to the device many public health experts see as an essential element of any anti-AIDS strategy.

This perception led many in the media in January to cast Jesuit Fr. Juan Antonio Martinez Camino, secretary general for the Spanish Bishop's Conference, as an outspoken condom proponent--a role, they said, that put him at odds with the Vatican.

Following a Jan. 18 meeting with Spain's health minister Elena Salgado, Martinez told reporters in Madrid that "the time has come for a joint strategy in the prevention of such a tragic pandemic as AIDS, and contraception has a place in the context of the integral and global prevention of AIDS." A day later, however, the conference issued a statement indicating that Martinez's comments were not to be interpreted as a challenge to church teaching.

As it turns out, this is one of those areas where "church teaching" is not quite as clear as it seems.

Martinez was backing a health program known as ABC, which stands for "Abstinence, Be faithful and Condoms," and promotes monogamy as the best way to prevent the spread of AIDS. In cautiously supporting the program, Martinez joined other clerics who believe there are limited circumstances in which condom use can be justified without endorsing contraception.

Exactly what these circumstances might be, however, is a matter of interpretation. So far the onus of identifying social contexts that obviate the condom ban has fallen to the church's network of health care workers.

Through dioceses, religious orders, lay movements and individuals, the Catholic church runs a prodigious network of hospices, orphanages, clinics and think tanks. In one hard-to-verify but telling statistic, the Pontifical Council for Health Pastoral Care asserts that 27 percent of all AIDS relief worldwide is administered by the Catholic church.

Facing disparate resources and unpredictable working conditions, segments of the network are no longer waiting for instruction. Instead they've taken it upon themselves to hammer out moral criteria for dealing with condoms. And, as the Martinez flap demonstrates, their ideas have begun to trickle up.

In 2003, according to statistics from the U.N. World Health Organization, 35.7 million adults and 2.1 million children were living with HIV/AIDS. This is more than 50 percent higher than the figures for 1991. In sub-Saharan Africa alone, there are 25 million adults and children living with HIV/AIDS (7.5 percent of the total population). In 2003, there were 2.2 million deaths of adults and children from AIDS in Africa.

On the frontlines, Catholic relief workers have emerged as an authoritative voice. They have drawn the attention of their secular counterparts for breaking ground in rural communities where the pandemic has hit hardest.

"I have to say that as I travel around Africa, the work of the Catholic church is extremely impressive," Stephen Lewis, the U.N. envoy to Africa, said in an interview with NCR.

The condom ban, Lewis said, may be definitive in Rome, but it is an open question on the ground. "In my experience, without naming names, many of the grass-roots Catholic leadership do not pay attention to that side of church teaching. They just don't honor it. Condoms are available."

The teaching Lewis has in mind is especially associated with the Pontifical Council for the Family, which last year declared condoms unsafe as a form of AIDS prevention. In an interview with the BBC, council president Cardinal Alfonso Lopez Trujillo, a Colombian, claimed the HIV virus is small enough to "easily pass through" latex. Lopez also asserted that condoms encourage promiscuity, which he deemed among the root causes of the pandemic.

But church thinking tends to vary according to who is doing the talking. The Pontifical Council for Health Pastoral Care, for example, has taken a softer line--one that closely reflects the realities facing the health care workers it advises.

Cardinal Javier Lozano Barragan, a Mexican who heads the health council, told NCR in a recent interview that he opposes the distribution of condoms, because he believes it institutionalizes promiscuity. On the other hand, he finds the use of condoms acceptable when abstinence is not an option.

"If an infected husband wants to have sex with his wife who isn't infected, then she must defend herself by whatever means necessary," he said.

This position, Barragan said, is consistent with the tenets of Catholic moral theology, which teaches that acts of self-defense can extend to killing in order to not be killed. "If a wife can defend herself from having sex by whatever means necessary, why not with a condom?" he said.

Barragan said this belief informs his decisions as head of the health care council, but added that his views are personal and that he does not speak for Pope John Paul II. "The Holy Father has never spoken explicitly on the subject," Barragan said.