A dose of realism at the Vatican
During the 1930s, as Protestants began their swift retreat from opposition to birth control, Anglican Bishop Albert Augustus David of Liverpool spoke for the holdouts. The sexual relationship, he said, "even in marriage must be regarded as a regrettable necessity. . . . Except where children are desired, married persons should remain celibate after marriage, as before."
There is no recorded response from Mrs. David (if there was one) or of his flock, which doubtlessly nodded piously, went home and promptly ignored him. There is a difference between seeking the improvement of human behavior and declaring war on human nature. In that conflict, human nature is likely to win.
This example came to mind when Pope Benedict XVI recently said that condom use might be permissible, or at least morally understandable, under some circumstances to prevent the transmission of HIV/AIDS. In an extended book interview, the pope insisted that the "sheer fixation on the condom implies a banalization of sexuality." But he continued: "There may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, when this can be the first step in the direction of a moralization, a first assumption of responsibility." Vatican leaders later downplayed the statement but did not retract the argument.
This condom trial balloon (given the infinite, excruciating possibilities for double entendre and bad puns on this topic, I will try to refrain) is a welcome and necessary shift. African Catholic leaders of my acquaintance have long understood that a complete prohibition of condom use is unrealistic. Among discordant couples - one HIV-positive, one negative - the use of condoms is a requirement. It is not reasonable, along with Bishop Albert, to expect abstinence within marriage. And the regular use of condoms by sex workers is essential to public health.
As usual, the pope locates his statement within a sophisticated theological argument. He seems to be saying that there is a moral aspect even to acts the church considers immoral. The use of a condom, in this case by a prostitute, can be an early, incremental sign of ethical awakening, showing concern for the welfare of another human being. Such personal responsibility in sexual relationships is not sufficient, but it is preferable and important. Without conceding the moral ideal, the pope is accommodating human failures for the sake of human life, in the hope of further moral transformation.
Religion deals with ideals of human behavior. Public health deals with likely human behavior - a very different category. Both should respect the role played by the other. Public health officials are paid to assume that men and women will follow their passions and to mitigate the consequences. They put a bowl of condoms on the table, just in case.
But the prevention of disease always involves some element of ethical behavior, even when it comes to condoms. Their use during high-risk sexual activity is always good for an individual, since condoms are about 90 percent effective in preventing HIV transmission. But the effectiveness of condoms as a social strategy is determined by the rate and consistency of their use. Studies have found condoms to be successful in preventing the spread of HIV in brothels and among men who have sex with men. But for the general public in Africa, the consistent use of condoms has been more difficult to achieve. Progress in reducing the prevalence of HIV has often come from reductions in the number of concurrent sexual partners and from delaying the sexual debut of young people, especially girls.
No effective AIDS prevention strategy can ignore the role of condoms - or the role of behavior change that is often related to religion. Both are necessary because human beings are neither angels nor beasts, as Christian theology would attest. People need institutions that oppose the banalization of sexuality, as well as institutions that recognize and accommodate the realities of sexuality and disease.
During a visit to South Africa, I asked a very conservative Christian pastor engaged in an HIV/AIDS ministry how he views the condom issue. "When I'm dealing with 10- and 12-year-old girls," he answered, "I tell them to respect themselves and delay sex. When I'm dealing with sex workers, I give them condoms, because their lives are at stake."
The best AIDS prevention programs are idealistic about human potential and realistic about human nature. This seems to be where the pope is heading. Given his unquestioned standing as a theological conservative, perhaps only he could make the trip.