Who's the real expert?

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

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

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.

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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