AIDS and Condoms: an Ongoing Debate
John Kleinsman and Michael McCabe
Issue 18, April 2006
It has been estimated that the Catholic Church provides approximately 25% of the total care given to those infected with HIV-AIDS, making it a major partner in the fight against this disease. Catholic organisations have also been at the forefront of campaigns to ensure that the infected have access to essential drugs at an affordable price.
Many agencies involved in the campaign for prevention of HIV-AIDS actively advocate safe sex or safer sex through condom use as a primary means of reducing the risk of HIV transmission. Research data shows that this strategy has been effective in lowering the spread of HIV-AIDS when it has been part of a broader effort to influence behaviours.
Catholic agencies, however, have consistently refused to distribute condoms. Instead, they have promoted chastity in the form of abstinence and/or marital fidelity as the best way of preventing further spread of the AIDS pandemic. The practical wisdom of this approach has generated widespread criticism from outside of the Church, and both support and criticism from those inside the Church.
More recently a number of prominent Catholic voices, including bishops and theologians, have entered the debate in an attempt to either defend or to provide a more nuanced interpretation of the Church's stance. The question most often being asked is whether the Catholic Church should revisit its position on condoms.
In response to this question, it first needs to be noted that the Vatican does not have an official position on the use of condoms in AIDS prevention. Cardinal Javier Lozano Barragan, head of the Pontifical Council for Health Pastoral Care is one of many who have explicitly noted that there has been no definitive papal statement on the subject. Neither is the matter commented on in the Catechism of the Catholic Church. Some individuals have made remarks, but that is not the same as an official position," 
It is interesting to note that outside of Catholic circles it is becoming increasingly acknowledged that permissive and irresponsible behaviours must be addressed if any real impact is to be made on the spread of HIV infection. An article published in the Lancet (27 Nov 2004) by a group of medical experts notes that when campaigns target young people who have not yet initiated sexual activity, the first priority should be to encourage abstinence or delay of sexual onset, hence emphasising risk avoidance as the best way to prevent HIV and other sexually transmitted infections as well as unwanted pregnancy. While the article supports condom use, it also points out that for those already involved in sexual activity, returning to abstinence or being mutually faithful with an uninfected partner are the most effective ways of avoiding infection.
At the same time, it is a feature of the current Catholic debate over the use of condoms that an increasing number of senior Catholic leaders have publicly stated their belief that restricted condom use may be justifiable in faith based HIV prevention work. These leaders include Cardinal Barragan, Cardinal Danneels of Brussels, Cardinal Georges Cottier (theologian to the papal household), Cardinal Christian Tumi of Cameroon, Archbishop Boniface Lele of Kenya, Bishop Kevin Dowling of South Africa, Bishop Filipe Arizmendi of Mexico, Bishop Juan Antonio Martinez Camino of Spain and most recently Bishop Gilles Cote of Papua New Guinea.
The comments made by these leaders - and some moral theologians have generally focused on two moral questions: (i) whether or not married couples might legitimately use condoms when one partner is HIV positive and the other is not (statistics show that worldwide most HIV positive women have been infected by their monogamous, life-long partner) and (ii) whether condoms should be used by those engaging in extra-marital sex.
Responding to the first question, Cardinal Barragan has offered his personal view that the use of condoms may be justified as an act of self-defence. If an infected husband wants to have sex with his wife who isn't infected, then she must defend herself by whatever means necessary.  Other theologians have expressed the opinion that condom use is justified as a form of health protection. Describing the issue as a conscience one reserved to the couple themselves, the South African Bishops' Conference have written: They are the only ones who can choose the appropriate means, in order to defend themselves against the infection. Decisions of such an intimate nature should be made by both husband and wife as equal and loving partners.  In a similar vein, Bishop Kevin Dowling, drawing on Humanae Vitae, the 1968 encyclical that condemns artificial contraception but supports the use of oral contraceptives for the medical purpose of controlling menstrual bleeding, sees it as providing a moral precedent for married couples to use a condom. Dowling has been quoted as saying that when used to protect against AIDS, condoms are not being used as a contraceptive.
On the question of those engaging in extra-marital sex, there is unanimous agreement by Catholics that such activity is immoral. Nevertheless, while adamant that chastity is the best way to prevent AIDS and HIV infection, Danneels, and others, note that failure to use a condom by someone who is HIV positive merely adds the sin of the fifth commandment (thou shalt not kill) to the sin against the sixth commandment (thou shalt not commit adultery).
Some theologians justify the use of condoms in such situations in terms of the principle of the lesser evil. This principle is designed to cover cases where a person is clearly committed to performing an evil act. In such cases, knowing that they cannot persuade them from performing the act, any one who is in a position to influence that person may counsel them to do something less serious. Some have gone so far as to say that the use of condoms in such a situation is a moral obligation.
In the face of these responses by some senior church leaders, other leaders continue to reject the use of condoms in any situation, exhorting married couples that the only assured way to prevent passing on the HIV virus is for them to express their love in ways other than through sexual intercourse. For many, the concern is that the church, by changing its position, could be seen to be institutionalising promiscuity? Many argue that it also represents a departure from the Catholic Church's longstanding and principled opposition to contraception?
Redemptorist Father Brian Johnstone, a moral theologian at Rome's Alphonsian Academy, has stated his belief that the comments by Danneel's and others can be seen as totally consistent with traditionally accepted principles in Catholic moral theology. Those who think Danneels 'contradicted' church teaching don't understand the difference between two levels of moral discourse: one is a moral rule, the other the application of that rule in a complex situation. Considering how to apply a norm in a particular situation is not to undermine the norm. 
Catholic AIDS workers are another significant voice in the ongoing debate over condom use. Emphasising the fact that they are the ones working day in and day out with the victims of the HIV virus, many are advocating the need for a pastoral approach that better reflects the reality of people's lives. Without wanting - or needing - to challenge the wisdom of the Catholic emphasis on abstinence and fidelity, people like Ann Smith (CAFOD) argue that 'risk' needs to be understood in terms of a continuum, with high risk activity at one end and low or no risk at the other end. She points out that reducing risk is a process; a process that occurs within a complex cultural and social context that acts upon and often limits an individual's ability to choose a particular path.  The contextual factors referred to include such things as the economic deprivation of many families (and women in particular), cultural attitudes to women, pressures to conform to certain stereotypes, social and cultural attitudes towards sexuality and illness and exploitative employers, to name some of the more obvious ones. It is over simplistic, idealistic and pastorally naive, Smith argues, to frame the challenge to change one's sexual behaviours as a simple exercise of individual moral agency when people's choices are constrained by so many structural and institutional factors.
Looked at from this perspective, it is argued that reducing a person's level of risk taking through the use of condoms, in addition to implementing programmes that seek social transformation that will enable other personal changes to take place, can be regarded as a necessary step on their journey to grow more fully in their God-given identity.
The theological justification for this approach is part of the accepted Catholic moral tradition. In Familiaris Consortio (n.9) Pope John Paul II exhorts Catholics to set themselves in opposition to all injustices penetrating the structures of today's world through a conversion of mind and heart. However, fully acknowledging the injustice originating from sin - which has profoundly penetrated the structures of today's world - often hindering the family's full realization of itself and of its fundamental rights, he then says:
What is needed is a continuous, permanent conversion which, while requiring an interior detachment from every evil and an adherence to good in its fullness, is brought about concretely in steps which lead us ever forward. Thus a dynamic process develops, one which advances gradually with the progressive integration of the gifts of God and the demands of God's definitive and absolute love in the entire personal and social life of humankind. Therefore an educational growth process is necessary, in order that individual believers, families and peoples, even civilization itself may patiently be led forward, arriving at a richer understanding and a fuller integration of this mystery in their lives.
To adopt such an approach to moral action does not necessarily imply that the ideal has been abandoned or even undermined. Rather, it reflects the reality that an ideal is always reached in steps, and that the ideal must be nurtured.In the meantime the debate continues.
 Franciscan Father Maurizio Faggioni, moral theologian and a consultor to the Congregation for the Doctrine of the Faith, quoted by John Thavis in VATICAN LETTER, AIDS and Condoms: Issue far from settled at the Vatican, Dec-12-2003, Catholic News Service.
 Quoted by Stacy Meichtry, AIDS, condoms and grass-roots reality: Cardinal's words may indicate moral trickle-up from health workers, in National Catholic Reporter, Feb 25, 2005.
 South African Bishops' Conference, Message of Hope, 30 July 2001.
 Quoted by John L. Allen Jr. The Word from Rome: Cardinal Danneels on Condoms, in National Catholic Reporter, January 16, 2004.
 Smith, Ann. (2004). HIV Debate: No simple Solutions, in The Tablet, 25 September 2004.
John Kleinsman is a Researcher for The Nathaniel Centre.
Michael McCabe, PhD is Director of The Nathaniel Centre.