A few weeks back I posted on what I perceived to be an incorrect suggestion in a Washington Post editorial on the position of Pope Benedict with respect to condom use in Africa and his contention "You can't resolve [the AIDS epidemic] with the distribution of condoms. On the contrary, it increases the problem." At the time, I said that surely the Pope's claim was that condoms lead to an increased frequency of sex and that increased sex led to an increase in AIDs. So the claim was a hypothesis subject to testing: does the increased-sex effect of condom use outweigh the safety benefits of using condoms.
Michael Webb of Balliol College has now followed up and done an extensive set of interviews with experts in public health to test Pope Benedict's assertion and they are posted on a website called The Alligator.
Webb describes the controversy that the Pope's statement provoked:
Delivered to a continent where 22 million people live with HIV, and which accounted for 75% of all AIDS deaths in 2007, his words provoked strong reactions. Journalists, politicians and AIDS activists from around the world lined up to criticise the Pope's views: "The Pope deserves no credence" said the New York Times in an editorial; "Impeach the Pope" urged a guest writer in the Washington Post. The British medical journal the Lancet accused him of having "publicly distorted scientific evidence to promote Catholic doctrine", Former French Prime Minister Alain Juppe suggested that he was "living in a situation of total autism", while Rebecca Hodes of the Treatment Action Campaign in South Africa described his remarks as "alienating", "ignorant" and "pernicious".
The row goes beyond previous disagreements because the Pope appeared to stray from morals, on which he has some claim to authority, into science, on which he does not. His comment was a "testable proposition", noted The Times in its leader, with "immense implications for human health and welfare." The article concluded by arguing that "the Vatican must amend its position on Aids." The specific scientific claim aside, the problem is that it is apparently impossible for the Vatican to do this.
Webb reviews the literature and seems to conclude that based on what we know today the overall effect is inconclusive whether the Pope's claim is correct. Here's one comment that supports the Pope:
Mr Doerflinger explains the science behind their claims: "There's plenty of data. Condom distribution as a solution to generalised AIDS epidemics is often very disappointing in its results, and there's some data that it makes things worse. [There's] the whole concept of risk compensation, that people engage in more risky behaviour because they have a false sense of security from the condoms. So I thought his comments were perfectly sensible to anyone who knows the literature." Green and not heard
This literature to which he refers does exist, though it is not mainstream. Its principal proponent has been Dr Edward Green, Director of the AIDS Prevention Research Project at Harvard. "The best evidence we have", he says, "supports the Pope's comments. There is a consistent association shown by our best studies between greater availability and use of condoms and higher (not lower) HIV infection rates." He told me:
In epidemics that are population wide, where most HIV is found in the general population, for whatever reason we can't get people to use condoms consistently, and when they use them at all, that seems to have the effect of disinhibiting people's behaviours so they end up taking greater sexual risks and cancelling whatever risk reduction they have gotten from the technology they're using.
The article is really terrific for those wanting to know more about this.