Partially evidenced in our assigned TEDx video about increased contraceptive distribution in Thailand to stall population growth and the spread of HIV/AIDS was the friction between religious doctrine and scientific consensus on the role of contraceptives in public health. In the TEDx video, the speaker presents a photograph of himself assisting a Buddhist monk in blessing birth-control pills. The photograph was distributed as a means of communicating that obtaining a prescription was an important and commendable step families could take to improve their health and maintain a more 'ideal' family size. The speakers noted that this communication strategy worked in Buddhist communities but would be ineffective in communities with a strong Catholic presence.
The Catholic Church has emphasized it's teaching that the use of contraceptives to prevent a human being to come into existence is intrinsically wrong since Pope Paul VI's encyclical letter on the subject of human life in 1968. This particular teaching of the Catholic Church has been in practice since the origins of the Church and its predecessor, Judaism. In opposition, many public health policies across the world support the use of condoms to control the size of families and prevent the spread of HIV/AIDS through sexual contact. Approximately two-thirds of people infected with HIV/AIDS across the globe live in sub-Saharan Africa, while the Catholic population in Africa, which accounts for 16% of the global Catholic population, grew nearly 21 percent between 2005 and 2010.
Since the rise of the HIV/AIDS epidemic in the 1980's both African public health groups and African bishops of the Catholic Church have argued for circumstantial acceptance of the use of condoms. The arguments center around a person's right to defend themselves for mortal danger, and that in a situation where one partner of a married couple has HIV it is morally defensible for the couple to utilize condoms. In 2010, Pope Benedict XVI wrote in Light of the World that condoms could present "a first step in the direction of a moralization, a first assumption of responsibility". The ambiguity of this statement did anything but satisfy the calls from HIV prevention groups and public health professionals. Although the current leader of the Catholic Church, Pope Francis, has been outspoken on the need for global changes to bring about social justice, there is still no strong indication of a change in the Church's stance on condoms as a means of preventing HIV transmission.
Currently, the Church only endorses two of the three measures of the ABC method for HIV prevention. Those two would be the A (abstinence) and B (being faithful to one's partner) but not the final measure, C (contraceptives), which non-Catholic healthcare workers would argue is the most important to the prevention of the spread of HIV. The odds are that the Catholic Church will never approve of the use of contraceptives or abortion for family planning purposes. Equally unlikely is that the Church will approve of condoms as a method for HIV control. In a region of the world where practice of Catholic doctrine is increasing simultaneously with HIV prevalence, what are global health professionals convinced of the need for condoms to do?
In a debate where the two sides in opposition are assured of their position based on separate principles, resolution and agreement is unlikely to occur. Arguments of policy that pit beliefs and values against scientific knowledge are difficult to reconcile. Issues of science and morality often intersect, but neither is fully capable of addressing the central concerns of the other. Programs like Thailand's free condom campaign of the 1990's can continue across the globe, it has certainly been replicated outside of Thai borders, however in the future the issue of HIV prevention in practicing Catholic communities will have to be settled. When the the time for compromise comes, will global health be willing to accept interventions designed around just an AB strategy?
This is something really interesting and troubling to think about because religious leaders often act as gatekeepers to communities. I tend to think about this a lot when discussing health issues, because I have a strong Christian belief system. Because of this, it bothers me a lot when religious leaders refuse to examine the facts about a situation as dangerous as HIV. If one member of a married couple has HIV, the C is the most important part of the ABCs because B isn't as relevant and expecting A is absurd. Hopefully a compromise can be made that results in a positive health outcome.
ReplyDeleteExcellent post Matt! And Helen, you are right, we cannot enter into many communities both physically and mentally unless our actions are sanctioned by the religious gatekeeper. This is why health is such a fascinating area to work in where here are so many layers. And my read is, rather than looking for a single resolution either on ABC or AB, its good for the dialogue and tension to continue where, as global health workers we keep on trying endlessly in the methods that we believe in. For me, the ultimate dialogue rests in human rights and social justice.
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