Who’s the real expert?

Did any journalists ask an epidemiologist whether the Pope might be right about the ineffectiveness of condoms in fighting the African AIDS epidemic? We did. 
Jokin de Irala | Mar 21 2009 | comment  



Pope Benedict XVI ignited a firestorm of controversy earlier this week. On a flight to Cameroon where he later greeted rapturous crowds, he held a press conference. A French journalist asked him about the African AIDS epidemic. What he said was only half a sentence, but the repercussions in the Western media were explosive: “the scourge cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem.”

Instead of jumping on the bandwagon and huffing and puffing about the Pope’s ignorance, MercatorNet implemented its strategy of evidence-based ethics. We interviewed genuine experts on AIDS prevention strategies. Here is the response of Dr Jokin de Irala, a Spanish epidemiologist.

* * * * *

MercatorNet: The Pope said "the scourge cannot be resolved by distributing condoms". Is there any truth to this? Is the Pope far removed from the reality on the ground?

Jokin de Irala: This is completely true and any public health specialist who is aware of the epidemiological data knows that no major HIV epidemic in the world has been curtailed with programs centered on the the promotion and distribution of condoms. The only successful stories associated with declines in the transmission of HIV are associated with the implementation of “Abstinence” and “Be Faithful” in the triad of Abstinence, Be faithful and use Condoms. In other words, only programs that have seriously recommended the delay of sexual debut in youth and mutual monogamy (what Christians call faithfulness) have been successful.

MercatorNet: The Pope went on to say that "we risk worsening the problem" if AIDS prevention programs rely upon condoms. Is there any truth in this?

Jokin de Irala: This is state of the art public health and epidemiology. Programs that rely upon condoms are conveying wrong messages to the general population and especially to youth. They convey the message that whatever you do in sex is completely safe, risk-free, as long as you use condoms. This is absolutely wrong. Risk compensation is one of the results of messages relying upon condoms. If people feel 100% safe as long as they use condoms then they tend to take higher risks.

For example young people who have not engaged in sex start doing so, or those having sex may start having more partners – exactly what HIV needs to fuel the epidemic. Risk compensation has been clearly described in the scientific literature. Condoms reduce risk but never eliminate it altogether and this is the right message. We have studied representative samples of youth in the Philippines and El Salvador and now in Spain. In each of these settings young people who believe condoms are 100% effective tend to have sex earlier. So risk compensation is, I am afraid, a fact.

MercatorNet: It has been argued that the single most important factor in fighting AIDS in Africa is "partner reduction". What is meant by this -- monogamy? Is monogamy too hard for Africans? Are there higher levels of promiscuity in Africa than in the USA?

Jokin de Irala: Monogamy is what we Christians call faithfulness. Any human being is capable of faithfulness because this is intrinsic to true love and all humans have been created out of love and to love. Africans have clearly shown the West not only that they understand and cherish faithfulness but that they have been able to apply these recommendations to the general public and curtail the HIV epidemic in many settings. The West has in fact lots to learn from Africa on this respect. We will be releasing a book soon in the US which explains this: Avoiding AIDS, Affirming Love: What the West Can Learn From Africa.

MercatorNet: You have argued that fidelity and abstinence programs are essential. Over the past couple of years, has there been much scientific support for this? Have experts in the field expressed doubts about condom use?

Jokin de Irala: Epidemiological evidence is in fact increasing on this respect – so much so that UNAIDS now collects information about age at first sexual contact and number of lifetime sexual partners to evaluate whether prevention is being well implemented in different countries. As I said, no major epidemic has been curtailed without partner reduction. Many scientific experts have in fact said exactly the same as what the Pope is conveying. The Pope is being in fact more scientific than many of his critics.

MercatorNet: But in situations of poverty, turmoil and instability, aren't programs aimed at behaviour change and faithfulness doomed?

Jokin de Irala: They are not doomed. They already have proven to be successful in settings of poverty.

MercatorNet: Are the Catholic Church and other faith communities a help or a hindrance in fighting AIDS in southern Africa?

Jokin de Irala: The Catholic Church has been teaching abstinence before marriage and faithfulness for quite a few centuries. The Church is actually an expert on these matters. Since scientific evidence in favor of A and B is increasing, the Church should be helped to do this job better instead of being criticized for not recommending condoms. In fact. The Church is conveying this message of true love all over the world. Let’s not forget that the Church’s stand is based on a view of sexuality that involves true human love, fulfillment and happiness.

Dr Jokin de Irala is Deputy Director of the Department of Preventive Medicine and Public Health at the University of Navarre, Spain. He has a Master of Public Health and doctorates in Medicine and Biostatistics and Epidemiology.




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