Saturday, April 11, 2009

The Pope on AIDS and condoms

My attention has been drawn to a very interesting article on Alligator online by Michael Webb, which goes into some detail about the research on the effectiveness of condoms. The Pope's claim that condoms 'make things worse' with the AIDS epidemic in Africa has overwhelming plausibility to those who have watched the failure of contraception to reduce so-called 'unwanted pregnancies', and, for that matter, ordinary sexually-transmitted diseases, in the West. If fire-hosing condoms at people doesn't reduce pregancies, it is not going to work with AIDS either. In fact we actually see an increase of pregnancies, and abortions, where contraceptives have been pushed at people; a similarly tragic consequence, one may infer, is likely to happen with AIDS. The fact that the advocates of condoms refuse to accept that this is happening, and insist the situation would be even worse without the condoms, just shows the blind attachment to ideology when you face ostracism and redundancy for dissent.

Why condoms might be counterproductive as preventers of pregnancies and AIDS is, intuitively, that promoting contraception promotes a culture of promiscuity, and the culture of promiscuity is actually not very friendly to putting those rubber things on just at the moment life is getting interesting. Webb, however, uncovers some very interesting research which not only supports the casual empiricism against condoms but gives a slightly different (though not conflicting) explanation, that of 'risk compensation'. When you make an activity safer, people performing the activity will take more risks with it: see 'The Pope was right' on the Cornell Society.

Everything we do is based on an assessment of benefit and risk. We have a certain appetite for risk (as they say in finance), and if something becomes safer, we'll tend to go for the extra benefits associated with taking on another slice of risk. This is really not controversial; the only question, in making things safer in any given situation, is whether the risk compensation will end up making the situation worse over all. It will depend on how much safer people are made to feel, and what the opportunities for greater risk-taking might be.

People in countries afflicted by AIDS are still willing to engage in promiscuous sex: hence AIDS continues to spread. Whatever the (perceived) risk they are running is, that is a level of risk they are happy to live with. If you give them condoms and they wear them 50% of the time, thinking that makes them 50% safer, they would rationally double their number of partners to get back up to the old level of risk. The reward of doing this, of course, is fantastic: twice as many partners! There may, of course, be other factors.

So much for the principle. But this is exactly what many researchers have found. Over to Michael Webb:

Dr Edward Green, Director of the AIDS Prevention Research Project at Harvard. “The best evidence we have”, he says, “supports the Pope’s comments. There is a consistent association shown by our best studies between greater availability and use of condoms and higher (not lower) HIV infection rates.” He told me:

In epidemics that are population wide, where most HIV is found in the general population, for whatever reason we can't get people to use condoms consistently, and when they use them at all, that seems to have the effect of disinhibiting people's behaviours so they end up taking greater sexual risks and cancelling whatever risk reduction they have gotten from the technology they're using.

Webb points out that the studies making this point are fairly limited in number: no surprise there, since this is not a conclusion the AIDS industry wants to hear. He also points out that there is agreement accross the debate that IF condoms were used 'consistently and correctly', and IF behaviour didn't change, then condoms would help with AIDS: true, but irrelevant.

More interstingly, Webb makes the odd conclusion that 'the Pope should not make claims that can be interpreted as being scientific.' This is odd because he adds that the Pope's remarks were interpreted as making a claim not supported by the evidence. But the body of Webb's article has shown that it is perfectly scientifically respectable to hold that view; it may not be the view of the WHO but there is plenty of evidence for it, and the WHO is not infallible.

A deeper reason for Webb's criticism of the Pope, however, is that the Pope's position is, or ought to be, really a matter of moral teaching: against promiscuity, and against contraception. Webb seems to think that if this was made clearer, criticism of the Pope would have less traction.

It is true that the Pope's position is driven by moral concerns, and the moral teaching of the Church. But it is because voicing this moral teaching has been condemned as tantamount to mass murder - as Jon Snow gently put it, the Pope is responsible for 'millions of deaths' - that it become necessary to look into the claims being made about the effectiveness of condoms.

Catholic reseachers and all people of good will can and must refute the lies which are used to justify crimes. The Nazi genocide was unjustifiable, but people were persuaded to go along with it on the basis of grotesque lies about the Jews. The Church has had to contend with 'black legends' in every age; the work of the Bollandists on Church history is an example of her response. It is true that even if they were successful, condoms would not be justified, but the Pope in concerned to influence opinion and policy, and the lies must be opposed.

The idea that Catholics should leave the 'facts' in the hands of their opponents to distort at will only has to be stated to be rejected.

1 comment:

Daniel Hill said...

`the blind attachment to ideology when you face ostracism and redundancy for dissent'

Yes, and who will fund Dr Green, now that Harvard's funding for his project has run out?