Green On Condoms and AIDS

Recently I discussed the hoopla over the Pope’s comments on condoms and AIDS. He said condom distribution does not reduce AIDS in Africa and may increase it. I said it’s a mistake to think that condom distribution is a key issue, but that the Pope’s general view on condom use is nevertheless wrong.

Frank Pastore has written a column in which he quotes a National Review Online interview with Edward C. Green, director of the AIDS Prevention Research Project at the Harvard Center for Population and Development Studies. Here’s what Green had to say:

We have found no consistent associations between condom use and lower HIV-infection rates, which, 25 years into the pandemic, we should be seeing if this intervention was working.

The pope is correct, or put it a better way, the best evidence we have supports the pope’s comments. He stresses that condoms have been proven to not be effective at the level of population. There is a consistent association shown by our best studies, including the US-funded Demographic Health Surveys, between greater availability and use of condoms and higher (not lower) HIV-infection rates. This may be due in part to a phenomenon known as risk compensation, meaning that when one uses a risk-reduction technology such as condoms, one often loses the benefit (reduction in risk) by compensating or taking greater chances than one would take without the risk-reduction technology.

I also noticed that the pope said monogamy was the best single answer to African AIDS, rather than abstinence. The best and latest empirical evidence indeed shows that reduction in multiple and concurrent sexual partners is the most important single behavior change associated with reduction in HIV-infection rates (the other major factor is male circumcision).

But Patore is not quite revealing the full picture. Just yesterday, the Washington Post published an article by Green in which he adds:

In a 2008 article in Science called “Reassessing HIV Prevention” 10 AIDS experts concluded that “consistent condom use has not reached a sufficiently high level, even after many years of widespread and often aggressive promotion, to produce a measurable slowing of new infections in the generalized epidemics of Sub-Saharan Africa.”

Let me quickly add that condom promotion has worked in countries such as Thailand and Cambodia, where most HIV is transmitted through commercial sex…

The problem, then, is not the distribution of condoms, but the failure to use them. The overwhelming problem, though, writes, Green, is that “in significant proportions of African populations, people have two or more regular sex partners who overlap in time.”

But of course the Pope’s position is not merely that condom distribution in Africa doesn’t work: his position is that condom use is inherently immoral. But Christians who cite Green for some religious purpose are going to have difficulty with Green’s general views: “‘Closed’ or faithful polygamy can work as well. … All people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship.”

By coincidence, I agree with the Christians that “faithful polygamy,” while it might reduce the spread of AIDS, is nevertheless inappropriate. I say “by coincidence” because, while Christians offer religious reasons against polygamy (though some argue the Bible endorses it), my case against polygamy rests on the inherent difficulties of maintaining a true romantic relationship with more than one other person at a time.

Green has even more to say in a BBC interview (as with the earlier link via Wikipedia).

Pastore is right that throwing condoms at the AIDS problem is not likely to solve it. But throwing religious dogma at the problem will produce no better results.