A New York Times editorial today condemns Pope Benedict XVI for saying at the beginning of his current trip to Africa that condom distribution makes the African AIDS epidemic worse. His exact words were that AIDS was “a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which even aggravates the problems.”
The Pope was completely right on the first two phrases in this sentence. Indeed the Condom Mafia, who are going through orgies of ritual abuse of the Pope today after this statement, have much to answer for themselves for obsessively pushing the Give Everyone a Condom model long after it became clear that it wasn’t working in Africa. The work of Daniel Halperin, Helen Epstein, and many others have made it clear that campaigns to reduce the number of concurrent sexual partners is probably a much more effective strategy than simply flooding Africa with condoms (the latter has been done already in many high AIDS countries like Botswana with seemingly no effect). If the Pope can help on the multiple lovers problem with some old-fashioned preaching about sexual fidelity, more power to the Pope.
Where the Pope got into trouble was with the last phrase, that condoms make AIDS worse. From the standpoint of the individual, this is obvious nonsense, you are much less likely to get AIDS if you use a condom. The reason that mass condom distribution has not worked is that far too many people don’t use the condoms. One among the many possible reasons that people don’t use condoms is that religious leaders like the Pope tell them not to, or they believe unscientific statements like the Pope’s that “condoms aggravate the problem.” So it is tragically circular for the Pope to condemn the condom campaigns for not working, when one reason they don’t work is that the Pope has previously condemned condoms.
22 Comments
I think the pope’s statement ought to be taken as a whole. Religion is always a difficult issue because of the fact that beliefs override facts. And if the pope was talking exclusively about his beliefs, I would have no interest whatsoever in whatever he says, let alone the NYtimes.
He distorts facts in order to gain grounds on his beliefs and that is wrong. Using condoms might be a sin on HIS moral ground. I wonder what lying is on the same principles. The pope is not ignorant, he knows the facts, therefore he most likely lied in his statement.
Of course there are possible scenarios where condoms make AIDS worse.
Distributing condoms change habits of the recipients (as in the classic example of the introduction of belts in cars, which lead to more aggressive driving manners).When using condoms, there is no point in limiting the number of sexual partners – at least, condoms are a disincentive to reducing sexual activity. But what to do if condoms are not available or too expensive over a longer period? Is everyone rational enough to change established habits and abstain from sex? I would say no, but is there any empirical evidence?
It should be clear that the best protection from AIDS -and many other diseases- is to have as few sexual partners as possible. I didn’t know there are effective campaigns spreading this simple truth – no info about that in German media, just criticism on the old-fashioned position of the pope. (says a protestant)
To reference economist Dwight Lee’s response to the relationship between AIDS and condom use: “it all depends on elasticity.”
The pope’s claim is not “obvious nonsense.” In this context, the prevalence of AIDS depends on the safety of sexual encounters and the number of sexual encounters. Condoms can decrease the risk of getting AIDS in the former, but in doing so, increase the rise of the latter. Because the price of having sex falls (from safer sex via condoms) people will have more sex. The spread of AIDS depends, as Prof. Lee argues, upon the elasticity of demand. Is the change in the quantity of sex consumed more or less proportional than the change in price?
That’s an empirical question, for which I don’t know the answer. Obviously, I’m not attributing this logic to the Pope. From the economic perspective, however, his claim is not obvious nonsense.
Empowerment of the African women is the answer through education, employment and sound government policies governing rape, early marriages and providing sound economic development. As for the Pope, he has no business talking on points on which he has no experience on. Let him stick to Godly issues and let Africa deal with its HIV/AIDs issues.
Ryan Anderson, over at the First Things blog, points out that there is indeed research supporting the pope’s disputed claim.
He then excerpts a First Things article from a year ago, in which Edward C. Green (director of the AIDS Prevention Research Project at the Harvard Center for Population and Development Studies) and Allison Herling Ruark (a Center fellow) clearly explain the reason.
Here’s Anderson’s post, which also links to Green and Ruark’s original article: http://www.firstthings.com/blog/2009/03/18/the-pope-condoms-and-aids/
I think William Easterly makes a valid point. However I was going to add an important caveat but I see that Christian has already made the point so I will just register my support of his/her comment
Yes the elasticity should be considered. However you must remember that having sex with a condom greatly reduces HIV transmission. So even if the elasticity were outrageously high, and you doubled your number of sexual partners per year it is most likely that HIV transmission will be reduced. Consider these numbers I took from the CDC, “Condoms and Their Use in Preventing HIV Infection and Other STDs.” Atlanta, GA: CDC, 1999.
According to a 2-year study (of people with one HIV+ partner) the HIV transmission rate for those using condoms regularly was 2%. For those who used condoms infrequently or not at all it was 12% (note for not using condoms at all this is a lower bound estimate).
This means that, approximately, a person would have to increase their number of sexual partners by 6 times (wearing condoms), to match the HIV transmission rate from not wearing a condom. This is a ridiculously high elasticity, so it is quite safe to say that the Pope’s claim is obvious nonsense.
Come on people.
Where in the world is condom usage high? In the West.
Where in the world is HIV/AIDS rates low? In the West.
Any correlation anyone?
Where in the West where condom usage low?
Among Homosexuals.
What happened to the HIV/AIDS rate among homosexuals? It soared. Is it still high? Yes, but declining. Have they started to use condoms? Yes, many have.
Any correlation, perhaps?
Last question: Do we tend to have more or fewer sex partners in the West than other, more HIV/AIDS prevalent places? I bet we don’t have a lot less, at least not on average.
Bill’s statement is obvious and correct, and the “caveat” posted by Christian appears to be insignificant, if not nonsense, to me.
Caveat? You can have economic theory or theories for almost anything, we know that. That is why economists are best at explaining why they got it wrong.
Here I believe we are talking about facts and basic common sense.
Hypotheses can be empirically tested, thats what economists do. So far, I am not convinced by Tords argumentation.
First, he doesn’t give an answer to my scenario, in which access to condoms is interrupted. This will rarely happen in Western countries, where condoms are nearly everywhere availible, and most people are able to afford them. There, persistent sexual habits are no problem.
It’s maybe another story in countries that suffer from high rates of absolute poverty, a bad infrastructure (non-integrated markets) and/or civilðnic&intercountry conflicts – and depend on more or less stable condom deliveries channeled through aid agencies. Persistent sexual habits ARE a problem when condoms are not affordable/available over a longer period.
Second, simple correlations cannot be trusted because of püssible confounding variables. I think of faithfulness. Homosexuals may face higher AIDS rates because they on average have more sexual partners than heterosexuals.
AIDS rates may latterly decline among homosexuals because they have slowly been changing their habits and increasingly limit the number of sexual partners due to the AIDS threat.
It seems to me that these faithfulness-hypotheses are as plausible as the condom-hypotheses of Tords. Only more comprehensive regression analyses can tell what the main drivers behind high but declining AIDS rates among homosexuals really are. Are there such analyses?
@boutagy thanks for support
It is hard to calculate the consequences of condoms because human behavior is complex. If you only look at the issue through an abstract level then I can see how the Pope’s statements can seem like “obvious nonsense”. A barrier of latex between someone and infected body fluid is going lower the risk of getting HIV. But if you look at all the complex variables, then it’s not so clear if passing out thousands of condoms really lowers HIV in the long term. Condoms being readily available is going to have an element of risk compensation. People are going to act more risky because they feel more safe while using condoms. Does the protective benefit of condoms offset the risky behavior? I really don’t know and there is no scientific data provided on this blog that would make this question “obvious”.
The other variable that I think the Pope was trying to get at and which the author of this post was trying to separate from the popes comments is the question of whether people are actually going to consistently use condoms. This is the real issue.
The truth is that asking people to use condoms every time they have sex is like asking a fat person to have salad for every meal. It just not going to happen. Sure people will do it a couple times but in the long run using condoms get old. Using condoms is just not that fulfilling. So to sum up, condoms increase risky behavior but over the long term the average person is not going to use condoms consistently. This leads me to believe that what the Pope is saying has a lot of truth to it. And it’s not because the Pope says that condoms are wrong, but because using condoms suck.
Why do some of you keep pretending that humans, especially those who inhabit the African continent, are rational actors when it comes to sex? This flies in the face of everything we know about human nature, and especially everything we know about Africa’s modern history.
“The truth is that asking people to use condoms every time they have sex is like asking a fat person to have salad for every meal. It just not going to happen.”
And to extend your analogy, asking people to abstain is like asking a fat person to stop eating, period. I’m sure that’ll work out much better than the salad.
I’d rather take my chances with an increase of sexual activity due to condoms than blind faith in abstinence without condoms.
“And to extend your analogy, asking people to abstain is like asking a fat person to stop eating, period. I’m sure that’ll work out much better than the salad.”
You seem to be ignorant of what the Pope is proposing. The Pope is not asking for abstinence but really the opposite. He is just saying that when you do have sex it’s within marriage. I have been married for 9 years and I have never cheated on my wife. This commitment is doable. Now asking me to use a condom every single time I have sex. This is a lot harder and a more frustrating task.
Peter said: ‘Why do some of you keep pretending that humans, especially those who inhabit the African continent, are rational actors when it comes to sex? This flies in the face of everything we know about human nature, and especially everything we know about Africa’s modern history.’
What is so particularly irrational and different, that sets humans who inhabit Africa apart from other humans? Are you trying to say that Africa’s modern history is defined by AFrican irrationality?
A few points of clarification… condom programming to prevent AIDS is the quintessential example of what happens often in development– a strategy that has potential as part of the solution to a problem gets too much credit as people keep looking for a magic bullet. Then when everyone realizes it isn’t a magic bullet (which should have been obvious from the beginning) then the pendulum swings the other way and people forget about the effective part of the strategy and say simply “it doesn’t work.” Condom promotion and health education have made a huge different in limiting the spread of AIDS. They were not THE solution. Easterly is right that the insights of Halperin and Epstein show that concurrent partnering was and is key driver of the epidemic in east and southern africa. He is not right to imply that this is a different strategy. People are only now trying to figure out how to use those insights around concurrent partnering to reduce HIV infection. By the way, many of them involve condom use. Unfortunately, as has always been the case, convincing people to use condoms with “trusted” (read concurrent) partners has always been difficult to do.
My takeaway? Don’t look for or claim magic bullets and don’t jettison old strategies that have had limited success. This is true if you are the Pope or if you are funding HIV control programs.
One of our readers sent us a link to the following article:
Michael Cook | Saturday, 21 March 2009
African AIDS: the facts that demolish the myths
The mystery of why AIDS has been so devastating in Africa has been solved. And it’s not lack of condoms.
Benedict XVI’s recent comment on the African AIDS crisis — “the scourge cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem” – provoked an international sensation all out of proportion to its half-sentence length.
Continue reading here .
Religion should have nothing to do with AIDS prevention. The pope should care about something else, I believe more qualified people are working to help.
It is really frustrating as an african to hear (or read) people talking about something they have not seen or only thought of in a hypothetically way.
There is Poverty in Africa, but Condoms are extremely cheap.
People who cannot afford them, can have them for free.
I’m a christian, and I used to be catholic, but I don’t know what people were expecting from the Pope. The Vatican is not a liberal institution, it is highly conservative. matter of facts, it easy to say, that condoms won’t solve the AIDS issue in Africa, but what will then??? please propose a viable solution and much more complex and logical than just talking about abstinence.
It is and has always been a conservative thing to say that throwing money at something won’t solve anything. but who says this is wasted money??? My father has worked 20 years as a MD against HIV/AIDS, and for family health and prevention. and I can tell that In my country there has been progress, but there is still a lot of work…
who says condom are not working in africa is wrong. in every enterprise there are difficulties, and the main difficulties are education related.
what people need in Africa, is education. by educating the people, by creating schools, by promoting sexual education in schools (which is offered and obligatory in my country) this is how we will help these countries.
and something to protect themselves against STDs such as AIDS. and Condoms are the answers
talking about marriage, talking about abstinence is totally pointless since not everybody is Muslim or christian, I believe people know that Africans weren’t neither christian or Muslim to begin with… the pope should think about that, but I don’t even want to listen to anything a religious has to say about it.
This is in response to the article cited by Laura Freschi. The argument in the article is misleading. To say that condoms are not THE answer to HIV in Africa is not to say that they are not part of the answer. Yes, partner reduction is important and probably did not get the attention it deserved ten years ago. But you can’t promote partner reduction to sex workers who depend on sex partners for their living. That is where condom promotion is key and where that strategy has been very successful in mitigating the epidemic. There are other strategies that should be mentioned as well–male circumcision, STI treatment and ART treatment itself since lowering the virus levels also makes people less infectious.
By the way, no one has come up with any evidence for the disinhibition argument against condoms. There is evidence around ART leading to riskier behavior, but no one is arguing that we give up on that strategy.
“From the standpoint of the individual, this is obvious nonsense, you are much less likely to get AIDS if you use a condom.”
Based on this reasoning, individuals tend to take greater risks when they use condoms, and thus in the end may not be any likely to be infected. Dr. Edward Green, the Director of the AIDS Prevention Research Project at the Harvard School of Public Health and Center for Population and Development Studies, agrees with the pope that in Africa, when condoms are more used, there tend to be greater rates of infection, and he sees this as partly a result of “risk compensation”–people feel safer with condoms, and so they take more risks.
Dr. Edward Green is a medical anthropologist with 30 years of experience in developing countries and in the fight against AIDS.
The following is from an interview with him: [Source]
The Pope’s statement about AIDS and condoms is at the centre of a sharp debate and many – from Mr. Kouchner to Mr. Zapatero, including the EU Commission – have claimed his position to be abstract and eventually dangerous. What is your opinion ?
I am a liberal on social issues and it’s difficult to admit, but the Pope is indeed right. The best evidence we have shows that condoms do not work as an intervention intended to reduce HIV infection rates, in Africa. (They have worked in e.g. Thailand and Cambodia, which have very different epidemics)
In a recent interview to NRO you said that there is no consistent association between condom use and lower HIV-infection rates. Could you deepen this point?
What we see in fact is an association between greater condom use and higher infection rates. We don’t know all the reasons for this but part of it is due to what we call risk compensation. This means that a man using condoms believes that they are more effective than they really are, and so he ends up taking greater sexual risks. Another fact which is widely overlooked is that condoms are used when people are engaging in casual or commercial sex. People don’t use condoms with spouses or regular partners. So if condom rates go up, it may be that we are seeing an increase of casual sex.
So, even if it is surprising, it is proven that a higher use of condoms is associated with higher infection rates.
People began noticing years ago that the countries in Africa with the highest condom availability and highest condom user rates, also had the highest HIV infection rates. This does not prove a causal relation, but it should have made us look critically at our condom programs years ago.
Good post.
cas
I had a great time with this article as I read the topic extensively. Thank you for sharing your thoughts. I’ll definitely be subscribing to your posts.
Best,
Small Business Loans
I’m afraid to come late, but still I want to kindly refutate your last paragraph.
Condoms may aggravate the problem…show studies in Harvard.
http://article.nationalreview.com/?q=MTNlNDc1MmMwNDM0OTEzMjQ4NDc0ZGUyOWYxNmEzN2E#
But yeah, barely anyone listens to this…
Anyway, liked your post! (and your comment, christian)
Take care.
C.