Harvard Researcher agrees with Pope on condoms in Africa

Mar 21, 2009 / 08:11 am

Pope Benedict’s recent brief remark against condoms has caused an uproar in the press, but several prominent scientists dedicated to preventing AIDS are defending the Pope, saying he was correct in his analysis. In an interview with CNA, Dr. Edward Green explained that although condoms should work, in theory, they may be “exacerbating the problem” in Africa.

Benedict XVI’s Tuesday comments on condoms were made as part of his explanation of the Church’s two prong approach to fighting AIDS. At one point in his response the Pontiff stressed that AIDS cannot be overcome by advertising slogans and distributing condoms and argued that they “worsen the problem.” The media responded with an avalanche of over 4,000 articles on the subject, calling Benedict a “threat to public health,” and saying that the Catholic Church should “enter the 21st century.”

Senior Harvard Research Scientist for AIDS Prevention, Dr. Edward Green, who is the author of five books, including “Rethinking AIDS Prevention: Learning from Successes in Developing Countries” discussed his support for Pope Benedict XVI’s comments with CNA. 

According to Dr. Green, science is finding that the media is actually on the wrong side of the issue.  In fact, Green says that not only do condoms not work, but that they may be “exacerbating the problem” in Africa.

“Theoretically, condoms ought to work,” he explained to CNA, “and theoretically, some condom use ought to be better than no condom use, but that’s theoretically.”

Condom proponents often cite the lack of condom education as the main culprit for higher AIDS rates in Africa but Green disagrees.

After spending 25 years promoting condoms for family planning purposes in Africa, he insists that he’s quite familiar with condom promotion. Yet, he claims that “anyone who worked in family planning knew that if you needed to prevent a pregnancy, say the woman will die, you don’t recommend a condom.”

Green recalls that when the AIDS epidemic hit Africa, the “Industry” began using AIDS as a “dual purpose” marketing strategy to get more funding for condom distribution. This, he claims, effectively took “something that was a 2nd or 3rd grade device for avoiding unwanted pregnancies” and turned it into the “best weapon we [had] against AIDS.”

The accepted wisdom in the scientific community, explained Green, is that condoms lower the HIV infection rate, but after numerous studies, researchers have found the opposite to be true. “We just cannot find an association between more condom use and lower HIV reduction rates” in Africa.

Dr. Green found that part of the elusive reason is a phenomenon known as risk compensation or behavioral disinhibition. 

“[Risk compensation] is the idea that if somebody is using a certain technology to reduce risk, a phenomenon actually occurs where people are willing to take on greater risk.” The idea can be related to someone that puts on sun block and is willing to stay out in the sun longer because they have added protection. In this case, however, the greater risk is sexual. Because people are willing take on more risk, they may “disproportionally erase” the benefits of condom use, Green said. 

Another factor that contributes to ineffective condom use in Africa, is the phenomenon where condoms may be effective on an “individual level,” but not on a “population level.” Green’s research found that “condoms have been effective” in HIV concentrated areas where high risk activities are already being conducted, such as brothels in countries like Thailand.

Claiming to be a liberal himself, Green asserts that promoting Western “liberal ideology” where, “most Africans are conservative when it comes to sexual behavior,” is quite offensive to them. Citing his new book, “Indigenous Theories and Contagious Disease,” Green described Africans as “very religious by global standards” who are offended by “trucks going around where people are dancing to ‘Rock ‘n’ Roll’, tossing out condoms to teenagers and the children of the village.”

Green also noted that there is an ideology called “harm reduction” that is being pushed by many organizations trying to prevent AIDS.  The ideology believes that “you can’t change the underlying behavior, that you can’t get people to be faithful, especially Africans,” the HIV specialist explained.

One country, Uganda, recognized these issues and said, “Listen, if you have multiple sex partners, you are going to get AIDS.” What worked in Uganda, a country that has seen a decline by as much as 2/3 in AIDS infections, was that officials realized that even aside from religious and cultural reasons, “no one likes condoms.” Instead of waiting for “American and European advisors to arrive,” Ugandan officials reacted and developed a program that fit their culture; their main message being “stick to one partner or love faithfully.”

However, in 2004, Uganda’s AIDS infection rates began to increase once again, due to an influx of condoms and Western “advice”, Green recalled.  Western donors also came to Uganda and said behavioral change doesn’t work and that, “most infections nowadays are among married people.” Green said these claims are “misleading,” pointing out that “married people always have lower HIV infection rates than single or divorced people of the same age group.”

Green’s new book, “AIDS and Ideology,” to be completed in the next few months, will describe the industry in Africa that is “drawing billions of dollars a year promoting condoms, testing, drugs, and treatment of AIDS” and is clearly resistant to the idea that behavioral change is the solution.

Yet the two countries that have the highest infection rate of AIDS in the world, Botswana and Swaziland, have recently launched campaigns to promote fidelity and monogamy, the Harvard researcher said. These countries “have learned the hard way” about the failure of condoms in preventing AIDS, he said, noting that “Botswana has probably had more condom promotion” than any other county on a per capita basis. Green said he had no problem “having condoms as a backup to fidelity-based programs.”

According to Green, the Catholic Church should continue to “do what it is already doing,” avoid “arguing about the diameter of viruses” and cite scientific evidence in connection with scripture and moral theology.