Despite being discovered three decades ago, AIDS continues to be a leading cause of death throughout Africa. Research by UNAIDS estimates that there are 42 million people in the world currently diagnosed with HIV, with about 15,000 new infections per day.⁽²⁾ Africa is the continent with the highest rates of infection, with studies indicating that those rates are climbing. Due to both biological and structural factors, women account for over half of those infected, and are considered to be more vulnerable to the virus.⁽³⁾

AIDS became a hot topic in the early 1980s, with the medical field struggling to explain the mysterious deaths of patients whose immune systems seemingly shut down for no reason. It became evident that unprotected sexual intercourse, in both heterosexual and homosexual interactions, was the most common source of infection.⁽⁴⁾ Other modes of viral transmission were found to be non-penetrative sexual contact, intravenous drug use, blood transfusions, and pregnancy or breast milk from an infected mother. However, intercourse remained the most prevalent on a global level.⁽⁵⁾ In 1983, the use of condoms was advocated in an attempt to establish ‘safe sex’ practices; this continues to be the primary HIV-prevention message worldwide, yet three decades later, the majority of cases still stem from unprotected sexual contact.⁽⁶⁾

Given the popularity of Catholicism throughout Africa, and the fact that 25% of HIV/AIDS patients worldwide are being treated at Catholic facilities,⁽⁷⁾ the Vatican’s doctrines and speeches have significant impacts on the continent. In particular, the debate over the use of condoms as HIV/AIDS prevention has been a matter of heated debate within the Church and amongst non-governmental organisations (NGOs) and activists alike. With that in mind, this CAI paper discusses the impact of the Catholic Church upon the AIDS situation in Africa, particularly on women.

Condom controversy

Without question, the disease is at its most virulent in Africa, particularly sub-Saharan Africa, where roughly 70% of the global population of HIV/AIDS patients reside.⁽⁸⁾ A precise count of people living with HIV/AIDS is impossible to acquire, due to the danger of revealing one’s infected status. Dr. Eunice Kamaara, senior lecturer of religion at Moi University, insists that the social ramifications of AIDS are often what make the disease lethal. “The stigmati[s]ation of people living with HIV/AIDS is a sad reality in Africa. It is practiced in various forms such as social discrimination, denial of services, use of facilities and ofopportunities; neglect, desertion, discard and at worst, murder.”⁽⁹⁾ This stigma arises from a fear of contagion and from the assumption that the infected person did something socially unacceptable—homosexual sex, prostitution, drug use, etc.—that resulted in infection. Indeed, the stigma is such that many avoid the risk of taking a test through Voluntary Counselling and Testing (VCT), a service that is drastically under-used in Africa.⁽¹⁰⁾ This implies that many sexually active Africans are unaware of their HIV status, and therefore, have not taken measures to protect themselves and others from infection.

NGOs and AIDS activists have been struggling, since the discovery of the disease, to educate the public on preventative measures. The key tool in this arsenal has always been the advocating of condom use. However, these campaigns come up against not only public resistance, but a global bureaucracy in the form of the Catholic Church. The Church teaches that sex should only take place between heterosexual couples within a monogamous marriage, and that any form of contraception beyond family planning (i.e. scheduled abstinence) is sinful in its interference with procreation.⁽¹¹⁾ Therefore, some Catholics interpret this doctrine as a message that the use of condoms is just as morally wrong as extramarital sex—multiple partners, cheating on one’s spouse, etc. They may continue to do the latter, but seek to alleviate their guilt by obeying the condom ban, which results in many unfaithful spouses bringing infection home to their partners.⁽¹²⁾

This results in a contradiction of foci within the debate. Catholic leaders insist that the problem is promiscuity, and that the prevention message therefore must be one of morality and adherence to abstinent living.⁽¹³⁾ NGOs, AIDS activists, and some of the more liberal Catholic leaders argue that human beings will continue to practice their sexuality regardless of religious condemnation, and that condom use must be encouraged in order to save lives.⁽¹⁴⁾ Gary Dowsett, associate professor with Columbia University, writes, “[r]eligion is clearly not adequate protection from a virus,” and the right-wing religious leaders simply refuse to recognise human sexuality as “fluid, mutable and incomprehensible within that simplistic binary of heterosexual or homosexual—as something that will not lend itself so readily to political and moralistic control.”⁽¹⁵⁾

However, this is not to say that the Catholic Church has turned its back on those who are infected with HIV/AIDS. The Church is one of the main providers of healthcare for HIV/AIDS patients, with more than 117,000 facilities worldwide.⁽¹⁶⁾ As a result, Governments—particularly throughout sub-Saharan Africa—have come to depend on help from the Catholic Church in dealing with this epidemic.⁽¹⁷⁾ This, in turn, makes them less likely to challenge the Church’s approach, for fear of losing that assistance.

The Catholic Church’s official approach to AIDS in Africa can be summed up in the speech repeatedly given by the late Pope John Paul II as he toured the continent in 1990. In his addresses to desperate communities, who often did not understand why so many people were dying, he preached that condoms were a sin in all situations. He hailed abstinence and marital fidelity as the way to fight AIDS, appearing “seemingly ignorant of many traditional practices such as wives marrying the brothers of deceased husbands, a form of security in countries with no social services.”⁽¹⁸⁾ As AIDS activists watched his speech erode more than a decade of campaigning, the Pope declared, “The Church is convinced that without a resurgence of moral responsibility and a reaffirmation of fundamental moral values any programme of prevention based on information alone will be ineffective and even counterproductive.”⁽¹⁹⁾

His comments about the counter-productiveness of condoms caused widespread controversy in suggesting that they were more a causal factor than a preventive one. The Church argues that not only is the use of condoms irreconcilable with Catholic values, but that they are also scientifically ineffective. Anti-condom leaders within the Church have cited various studies showing that condoms are not 100% effective at preventing infection,⁽²⁰⁾ and pointed out that many sexually active individuals fail to ensure regular use of condoms.⁽²¹⁾ The main protest, however, appears to be their claim that condom distribution endorses promiscuity: “The use of condoms does not only give false security and fake freedom to the youth, but the use of contraceptives to expose the youth to many immoral and social dangers such as loss of self-control, vulnerability to guilt and irresponsible sex.”⁽²²⁾ It is through these arguments that the Catholic Church equated condoms to evil, and used its considerable influence to discourage the use of condoms in Africa.

Impact on women

Not only have HIV/AIDS statistics indicated particularly high levels of fatality in Africa, they have also shown a gender preference. In 2002, Kofi Annan, Secretary General of the United Nations at the time, wrote that in Africa, “AIDS has a woman’s face.”⁽²³⁾ He was referring to women comprising 58% of AIDS patients in Africa, and to the subsequent loss of women’s contribution to farming, familial support, and development on the continent. Research has shown that women become infected by the HI virus faster than men, with infection in Africans aged 15-24 being four times higher for women.⁽²⁴⁾ This phenomenon is biological, social, and structural.

The biological basis is due to the vaginal tract being more susceptible to the HI virus than the penis.⁽²⁵⁾ It has a larger exposed area and is more prone to tears, especially for young women or in cases of forced sex. Furthermore, semen has a higher viral load than vaginal fluid, and is likely to remain in the vaginal tract for an extended time.⁽²⁶⁾ Therefore, intercourse without the use of a condom automatically puts a woman at higher risk.

Beyond biology, the virulence of the disease for both Africa and women can be attributed to structural causes, the first being widespread poverty. Malnutrition and poor living conditions help foster diseases and make immune systems susceptible to infection. Furthermore, poverty often results in inaccessible or inadequate healthcare, including attempts by untrained civilians to provide their own medical care for infected family members. This was the case in Kenya, where over 50% of hospital beds were allocated to HIV/AIDS patients in 2001, sometimes with patients even having to share beds.⁽²⁷⁾ As a result, the Government of Kenya encouraged home-based care, but given the lack of medical expertise and supplies within the homes, this heightens the risk of the caretakers being infected. Social factors result in those caretakers being female family members. As journalist Clay Maganda points out, “The burden of caring for sick family members and neighbours…falls more often on women and girls than on men. This increases their workload and reduces their income-generating and schooling opportunities.”⁽²⁸⁾ Therefore, this situation not only imperils the caretakers physically, but endangers their future development and economic potential, thereby maintaining the chronic poverty that exacerbates the spread of the disease.

Another contributing factor is the socialised encouragement for men to have multiple sexual relationships at one time, often in secret from their partners.⁽²⁹⁾ Throughout many areas of Africa, having heterosexual sex with multiple partners—even if married—is considered an attribute of true masculinity.⁽³⁰⁾ There is, of course, no singular form of African masculinity, not even one for each specific country. As a social construct, masculinity is host to a range of cultural definitions as to what forms the ideal man. However, it is generally accepted throughout Africa—and in many countries worldwide—that sexual initiation is the doorway to manhood.⁽³¹⁾ This leads to the equation of masculinity with sexual prowess, which can be proven through acquisition of multiple partners. To compound the situation, this cultural construct of African masculinity precludes the use of condoms. As one man in South Africa anonymously attested, despite the well-known risk of AIDS, no real African man would resort to condoms. “They are living a true African. They say, ‘I'm an African. I won't use - I won't use a condom.’”⁽³²⁾

Structurally, women are hampered as a result of their subordinate status in society, with economic access unequal to that of males. Consequently, women are hardly ever in a position to challenge the construct of African masculinity, to demand that their male partners get tested, remain faithful, etc. As AIDS researchers Julia Kim and Charlotte Watts warn, “Refusing sex, inquiring about other partners, or suggesting condom use have all been described as triggers for intimate partner violence; yet all are intimately connected to the behavioural cornerstones of HIV prevention.”⁽³³) Opposite the constructs of African masculinity are equally pervasive ones for African femininity, which tend to emphasise faithfulness, nurturing, and “acceptance of male sexual aggression and dominance.”⁽³⁴⁾ The unequal economic access, on the other hand, refers to limited rights for women to ownership or inheritance, access to credit, and ability to independently support herself and possibly children. The impact of this inferior financial status is all the more weighted within a continent of widespread poverty. This leaves some impoverished women powerless, resorting to sex work for survival or tolerating sexual violence from a partner out of financial dependence.⁽³⁵⁾ In the slums of Nairobi, for instance, many young women are taught to exchange sexual services for money and gifts to meet their daily needs, or in an attempt to find a long-term provider.⁽³⁶⁾ Resorting to transactional sex leaves women particularly vulnerable to HIV infection, especially when they are frequently offered higher payment to have sex without condoms.

Of course, condoms are not only used to prevent the transmission of HIV. They are also intended as a means of birth control, another area in which women are disproportionately affected due to biological, social, and structural reasons. However, pregnancy, the rearing of children (which also entails the threat of mother-to-child transmission), and the effects these have on women in particular are beyond the scope of this paper.

Therefore, due to the high risks and vulnerabilities that women face, and their overrepresentation amongst AIDS patients, it seems clear that current prevention techniques are insufficient. As Kim and Watts assert, “The prevention messages, whether urging women to abstain, be faithful, or use condoms, often fail to reflect the reality of women’s lives and, in particular, the broader social forces that contribute to their risk.”⁽³⁷⁾ This failure is exacerbated when Catholic doctrine comes into play, labelling sex workers as sinners and condoms as evil.

Moving forward

The current Pope, Benedict XVI, initially echoed this stance, both as Pope and in his three decades as Cardinal Ratzinger. In 1988, he argued that advocating condom use within educational programmes “would result in at least the facilitation of evil.”⁽³⁸⁾ He railed against Africa’s “contraception mentality”⁽³⁹⁾ in 2005, reiterating that the Church’s traditional teachings were the proper way to combat AIDS.⁽⁴⁰⁾ On a trip to Africa four years after that, he referred to AIDS as “a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which even aggravates the problems.”⁽⁴¹⁾ This referred once again to the association of condoms with encouragement of immorality. Under Benedict, the Church appeared to prioritise tradition and chastity, as opposed to the search for realistic life-saving measures. Rebecca Hodes, a director within South Africa’s Treatment Action Campaign, declared that Benedict’s “opposition to condoms conveys that religious dogma is more important to him than the lives of Africans.”⁽⁴²⁾

However, in 2010, Benedict seemed to make a sudden about-face. In an interview with journalist Peter Seewald, the Pope maintained that the solution to AIDS lies in fighting the “banali[s]ation of sexuality,”⁽⁴³⁾ but that certain situations allowed for the use of condoms in order to protect others. “There may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a morali[s]ation, a first assumption of responsibility, on the way toward recovering an awareness that not everything is allowed and that one cannot do whatever one wants.”⁽⁴⁴⁾ Meaning, the use of condoms is acceptable not in preventing potential life, but in preventing potential death—a lesser evil than risking passing HIV on to one’s partner. Benedict did not say anything that would condone the use of condoms as pregnancy prevention, only as an attempt to protect someone else from infection.

This does not equate to an official change within Catholic doctrine, but given the established influence of the Pope’s word, it is highly significant. Father Gabriel Dolan of Mombasa believes this could be the beginning of a new stance within the Church. “Once you make a small concession like this it's like taking a brick out of the Berlin Wall.”⁽⁴⁵⁾ Benedict’s shift in stance could signify future shifts within the overall Church, a relaxing of rigid doctrine in order to save lives. As Elena Curti, editor of the Catholic newspaper The Tablet, points out, the Pope “let the genie out of the bottle. Once you do that it's very difficult to put it back in. In allowing this chink of light in—despite the careful language he uses—it does open up the debate."⁽⁴⁶⁾

Concluding remarks

The Catholic Church prides itself on its long history and widespread power, with an estimated 158 million Catholics in Africa alone.⁽⁴⁷⁾ That power comes with an obligation to its followers. HIV/AIDS is wreaking destruction throughout Africa, with ramifications that are physical (debilitating illnesses and fatalities), social (widespread stigmatisation, isolation and overflow of patients, the struggle to care for AIDS orphans), and emotional (coping with the loss of family members or one’s own infection, betrayal from one’s sexual partner, etc.). Women, in particular, are falling victim to this disease in staggering numbers, and rarely have access to the resources necessary to protect themselves. Many African Catholics look to their Church for guidance and aid, and the unflinching order of abstinence (and in turn, the condemnation of condoms) does nothing to help.

Benedict’s attempt to compromise could be indicative of the Catholic Church showing a novel willingness to bend. This reflects a potential transfer of official priorities from the rulebooks to the people, especially those in desperate need. However, this unofficial compromise should not lead to a relaxing of efforts to oppose the Church’s stance on condoms, not until that compromise finds its way to the rulebooks as well.

Written by Mandy Noonan ⁽¹⁾

NOTES:

(1)Contact Mandy Noonan through Consultancy Africa Intelligence’s Public Health Unit (public.health@consultancyafrica.com).
(2) Nwaigbo, F., 2004. The HIV/AIDS pandemic: A crucial task for the Church in Africa. AFER: African Ecclesial Review, 46(1), pp. 2-22.
(3) Dowsett, G.W., 2003. Some considerations on sexuality and gender in the context of AIDS. Reproductive Health Matters, 11(22), pp. 21-29.
(4) Boyce, P., et al., 2007. Putting sexuality (back) into HIV/AIDS: Issues, theory and practice. Global Public Health, 2(1), pp. 1-34.
(5) Ibid.
(6) Epidemic Update 2005. UNAIDS and WHO: Geneva.
(7) ‘Pope Benedict on the use of condoms: Book excerpt’, BBC News,20 November 2010, http://www.bbc.co.uk.
(8) Kamaara, E., 2004. Stigmatization of persons living with HIV/AIDS in Africa: Pastoral challenges. AFER: African Ecclesial Review, 46(1), pp. 35-54.
(9) Ibid.
(10) Ibid.
(11) Pope Paul VI, ‘Humanae Vitae’, Vatican, 1968, http://www.vatican.va.
(12) Nwaigbo, F., 2004. The HIV/AIDS pandemic: A crucial task for the Church in Africa. AFER: African Ecclesial Review, 46(1), pp. 2-22.
(13) Ibid.
(14) Joshua, S.M., 2010. The Dowling controversy, the “message of hope” and the principle of oikonomia: A historical-critical reflection on the South Africa Catholic Church's stance on the use of condoms in HIV prevention between 2000 and 2005. Journal of Theology for Southern Africa, 137, pp. 4-27.
(15) Dowsett, G.W., 2003. Some considerations on sexuality and gender in the context of AIDS. Reproductive Health Matters, 11(22), pp. 21-29.
(16) ‘Vatican maintains stance on condoms at HIV/AIDS summit: Transcript’, PBS News Hour, 30 May 2011, http://www.pbs.org.
(17) Ibid.
(18) Clayton, J., ‘John Paul’s 1990 speech “sentenced millions to die”’, The Times, 18 March 2009, http://www.timesonline.co.uk.
(19) Pope John Paul II, ‘Address of his Holiness John Paul II to the heads of mission and diplomatic personnel accredited to the government of Tanzania’, Vatican, 1990, http://www.vatican.va.
(20) Muula, A.S., 2010. “I can’t use a condom, I am a Christian:” Salvation, death, and…naivety in Africa. Croatian Medical Journal, 51(5), pp. 468-471.
(21) Nwaigbo, F., 2004. The HIV/AIDS pandemic: A crucial task for the Church in Africa. AFER: African Ecclesial Review, 46(1), pp. 2-22.
(22) Ibid.
(23) Annan, K., ‘In Africa, AIDS has a woman’s face’, New York Times, 29 December2002, http://www.nytimes.com.
(24) Tigawalana, D. ‘Why African women are more vulnerable to HIV/AIDS’, Rwanda News Agency, 19 September 2010, http://www.rnanews.com.
(25) Schoepf, B.G., 1998. ‘Inscribing the body politic: Women and AIDS in Africa’;Lock, M. and Kaufert, P.A. (eds.), Programatic Women and Body Politics. Cambridge University Press: Cambridge.
(26) Tigawalana, D. ‘Why African women are more vulnerable to HIV/AIDS’, Rwanda News Agency, 19 September 2010, http://www.rnanews.com .
(27) Kamaara, E., 2004. Stigmati[s]ation of persons living with HIV/AIDS in Africa: Pastoral challenges. AFER: African Ecclesial Review, 46(1), pp. 35-54.
(28) Muganda, C., ‘Women bearing the brunt of AIDS’, Daily Nation, 14 January 2004, http://allafrica.com.
(29) Muula, A.S., 2010. “I can’t use a condom, I am a Christian:” Salvation, death, and…naivety in Africa. Croatian Medical Journal, 51(5), pp. 468-471.
(30) Boyce, P., et al., 2007. Putting sexuality (back) into HIV/AIDS: Issues, theory and practice. Global Public Health, 2(1), pp. 1-34.
(31) Barker, G. and Ricardo, C., 2005. Young men and the construction of masculinity in sub-Saharan Africa: Implications for HIV/AIDS, conflict, and violence. The World Bank: Washington, D.C.
(32) ‘Vatican maintains stance on condoms at HIV/AIDS summit: Transcript’, PBS NewsHour, 30 May 2011, http://www.pbs.org .
(33) Kim, J.C. and Watts, C.H., 2005. Gaining a foothold: Tackling poverty, gender inequality, and HIV in Africa. British Medical Journal, 331(7519), pp. 769-772.
(34) Boyce, P., et al., 2007. Putting sexuality (back) into HIV/AIDS: Issues, theory and practice. Global Public Health, 2(1), pp. 1-34.
(35) Dowsett, G.W., 2003. Some considerations on sexuality and gender in the context of AIDS. Reproductive Health Matters, 11(22), pp. 21-29.
(36) Boyce, P., et al., 2007. Putting sexuality (back) into HIV/AIDS: Issues, theory and practice. Global Public Health, 2(1), pp. 1-34.
(37) Kim, J.C. and Watts, C.H., 2005. Gaining a foothold: Tackling poverty, gender inequality, and HIV in Africa. British Medical Journal, 331(7519), pp. 769-772.
(38) Ratzinger, J., ‘On “The Many Faces of AIDS”’, New Advent, 29 May 1988, http://www.newadvent.org.
(39) ‘Pope rejects condoms for Africa’, BBC News, 10 June 2005, http://news.bbc.co.uk.
(40) Ibid.
(41) Butt, R., ‘Pope claims condoms could make African Aids crisis worse’, The Guardian, 17 March 2009, http://www.guardian.co.uk.
(42) Ibid.
(43) ‘Pope Benedict on the use of condoms: Book excerpt’, BBC News, 20 November 2010, http://www.bbc.co.uk.
(44) Ibid.
(45) Hooper, J., Rice, X. and Bowcott, O., ‘Catholic church tries to clear confusion over condom use’, The Guardian, 23 November 2010, http://www.guardian.co.uk.
(46) Ibid.
(47) Donadio, R. ‘On Africa trip, pope will find place where Church is surging amid travail’, New York Times, 16 March 2009, http://www.nytimes.com.