Harry Knox, Pope Benedict, and the Debate On Condoms in Africa

by Christopher Gross and Patrick Looby

It is rare that philosophical arguments can be resolved by simply appealing to empirical data.  In many instances, participants in the dispute may agree on the facts but disagree about the implications of those facts or how much weight should be given to them.  However, there are rare cases where a thorough examination of the evidence proves one side is correct and the other side clearly wrong.  The “debate” between Harry Knox and Pope Benedict is one of those rare instances.

As you may know, Harry Knox, who serves on President Obama’s faith-based advisory council, said earlier this week that he stood by a statement he made last year concerning the Pope.  According to Knox, the Pope is “hurting people in the name of Jesus,” because the Holy Father has suggested that promoting condom use in Africa will not end the suffering caused by the AIDS epidemic there and in fact increases the spread of HIV/AIDS.  The problem with Knox’s position, despite his appeal to the ‘science,’ is that the empirical evidence does not support his attack.  It actually favors the Pope. 

Almost one year ago, Edward Green, a senior research scientist at the Harvard School of Public Health who at one time supported condom distribution in Africa to fight AIDS, wrote an op. ed. piece in the Washington Post about the Pope’s comments.   There he points out that numerous independent studies have reached the same conclusion as the Pope.  He writes, “In 2003, Norman Hearst and Sanny Chen of the University of California conducted a condom effectiveness study for the United Nations’ AIDS program and found no evidence of condoms working as a primary HIV-prevention measure in Africa. UNAIDS quietly disowned the study (The authors eventually managed to publish their findings in the quarterly Studies in Family Planning.) Since then, major articles in other peer-reviewed journals such as the Lancet, Science and BMJ have confirmed that condoms have not worked as a primary intervention in the population-wide epidemics of Africa. In a 2008 article in Science called “Reassessing HIV Prevention” 10 AIDS experts concluded that ‘consistent condom use has not reached a sufficiently high level, even after many years of widespread and often aggressive promotion, to produce a measurable slowing of new infections in the generalized epidemics of Sub-Saharan Africa.’”

In fact, the most surprising finding in many of these studies was a clear demonstration that a rise in condom use can actually increase the rate of AIDS infection in certain populations, just as Pope Benedict predicted.  In Botswana, condom use tripled from 1993 – 2004, and in that same time the rate of AIDS infection almost doubled.    In South Africa, free condom distribution rose from 6 million to nearly 190 million.  Yet the daily deaths from AIDS has risen sharply from 870 to 1370 according to a study released in 2005.  In fact, the rate of death from AIDS in the 15-49 age group (the most sexually active and therefore with the highest condom use) more than doubled.  And the numbers are just as disturbing for places like Cameroon and Zimbabwe that have also focused on condom distribution to fight the spread of AIDS.  Instead of a drop or even leveling off, we see a sharp rise in the rate of infection.

How does one explain these results?  In scientific terms, Dr.Green calls it a phenomena known as “Risk Compensation”.  In laymans terms it is simply the fact that when people feel safer while they participate in risky behavior they are more likely to increase the risky behavior.  Add to that the failure rates of condoms due to human error, long shelf life, etc., and you have a recipe for disaster – like we have seen since these condom distribution campaigns started in the 1990’s.

But this is only one half of the debate.  The evidence clearly shows that increased condom use in Africa has increased infection rates, but does it also show that alternative prevention programs that focus on fidelity and abstinence are effective?  Again, the answer is clear.

The clearest (though not only) example is in Uganda.  In that country abstinence and fidelity,and not condom use, were the focus of prevention methods and produced astonishing (astonishing to people like Knox, that is) results.  According to Matthew Hanley of Catholic Relief Services, “actual changes in patterns of sexual behavior have led to the most significant reductions in HIV prevalence. Take the well-known case of Uganda, where the prevalence rate dropped from 15% in 1991 to a little over 5% in 2001. Behavior change was so thorough in Uganda that by the mid-1990s, 95% of adults in that country said they had only one partner or none at all. But it is not only Uganda.”  And over the past few years many groups, including UNAIDS who first disregarded such findings, have had to admit that of the three methods of prevention – encouraging abstinence, promoting fidelity to one sexual partner for life, and distributing condoms – ‘distributing condoms’ is ranked last for effectivness in the fight against AIDS in Africa and has actually been shown to make the problem worse. 

This may come as a surprise to many Americans (including Knox), because we are repeatedly told from grade school through adulthood that using condoms equals safe sex, i.e. no STDs and no pregnancy, and that abstinence education is wishful thinking.  Unfortunately, as Green notes, in Africa, condoms have increased risky behavior.  Feeling safer with condoms, people actually engage in riskier sexual behavior.  In addition, despite the millions of dollars in foreign aid that has been poured in promoting condom use in Africa, people in ongoing relationships have been unwilling to use condoms, because that communicates a lack of trust in one’s partner. 

According to Green and the data, the only thing that has proved to be successful in Africa at controlling the spread of HIV/AIDS has been campaigns with messages focusing on fidelity.  Messages, such as “Loving Faithfully” and “Sticking to One Parnter,” produced results in countries such as Uganda. 

What does all this mean for the “debate” between Knox and the Pope?  Well, first it seems clear that the Pope’s position is not “hurting people in the name of Jesus” as Knox claimed but actually backed by empirical evidence and in the best interest of the people of Africa.  Second, this evidence also makes it clear that Knox should resign not just because he is anti-Catholic, but because he is a government official who had an entire year to get clear on the facts and failed to do so.  Please do not misunderstand me.  Mistakes are going to happen; they are part of being human.  What we cannot tolerate is people in government who are unwilling to do their homework,and then in their ignorance lash out at those they disagree with.  We do not tolerate it from our children, why should we tolerate it from adults, who are leading our country.

And now that we have examined the evidence, let’s listen once again to what the Pope actually said about the situation in Africa and see who sounds more in line with ‘the science.’

“I would say that this problem of AIDS cannot be overcome with advertising slogans. If the soul is lacking, if Africans do not help one another, the scourge cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem. The solution can only come through a twofold commitment: firstly, the humanization of sexuality, in other words a spiritual and human renewal bringing a new way of behaving towards one another; and secondly, true friendship, above all with those who are suffering, a readiness — even through personal sacrifice — to be present with those who suffer. And these are the factors that help and bring visible progress.”

Mr. Gross is a doctoral candidate in moral theology/ethics at Catholic University of America, and also holds a B.A. in political science and religion from Hampden-Sydney and M.T.S. from Harvard Divinity.

–  Mr. Looby is a graduate of Wadhams Hall Seminary and has been teaching Theology and Philosophy for 13 years.  In addition, he is a freelance writer and speaker on issues pertaining to the Catholic faith.

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