Friday, April 28, 2006

"Trojan" Horse in the Vatican?

As many people know by now, the use of condoms as a means of preventing the AIDS virus, as a morally acceptable alternative, is currently under review in Rome. According to sources in the Catholic press, a study is underway by the Pontifical Council for Health Pastoral Care. One possible outcome would be a document which gives "provisional" moral license to condom use, albeit within the context of marriage, and given the specific intention to protect the uninfected party. But such a document would still have to pass through the Congregation for the Doctrine of the Faith, and ultimately, by the desk of Pope Benedict himself.

It'll never fly, and here's why.

It would surprise many people to know that the Church has been dealing with the issue of artificial contraception from Her very beginning. In his epistle to the Galatians (5:19-26), St Paul warns against the use of "sorcery" (in ancient Greek, "pharmakeia," from which we get the term "pharmacuticals," or drugs). This would have referred to the mixing of potions for a variety of reasons; in this case, the prevention or termination of a pregnancy. Various post-Apostolic and Patristic writings also deal with the issue. Some years ago, the Washington Post reported on the discovery of fossilized remains of a plant that grew in Egypt, from which was created the active ingredient for a spermicide that was popular around the time of Christ. Did it work? Well, let's put it this way; the substance was worth its weight in silver, and the plant used to create it was harvested to the point of extinction. The cover story of the March/April 1994 issue of Archeology magazine goes into more detail.

So, John Allen of the National Catholic Reporter, writing in this week's installment of "The View From Rome," isn't quite on the mark when he says that "the church has never spoken officially on this specific question." She has. Still, the Allen column is worth reading, as it outlines both the Augustinian and Thomistic schools of moral thought that are brought to bear on the issue, as well as an explanation of the "double-effect" principle, and both sides of the fence on its application. Bear in mind, however, that an objectively sinful act is always just that. The subjective issues may or may not mitigate the guilt, particularly in the area of intention, but considering that the virus can easily pass through latex -- adjusted to scale, it has been compared to throwing a basketball through a doorway -- application of the so-called "double effect" is quite a stretch, if only because no good end can be achieved with any assuredness in the first place.

The matter has been under review, primarily due to the public statements of various Cardinals supporting it. Rome must now go to all this trouble, just to shut them all up -- especially Martini. Sandro Magister and others of L'espresso provide the lowdown. (Recommend printing out and reading over the weekend.)


Anonymous said...

If you think the church is absolutely unchangeable, how do you explain the changes in the church's teaching on slavery, the "guilt of the Jews", religious freedom, ecumenism, scriptural interpretation, sexual intimacy and pleasure, war and peace, evolution, married clergy, usury, and JPII's apology to Galileo and the Jews???

It is nonsensical to suggest that the church cannot change its teaching on sexuality. We have to be able to "read the signs of the times" as well as to consult our traditions in crafting moral positions on contemporary issues. The "no, no, never" stance is no longer morally tenable, because in heavily Catholic countries, and in matters of teaching and distribution of AIDS prevention information, the church has an enormous impact on availability and use of such life-saving measures.

Poor women in third-world countries often have no choice when it comes to having sex. The suggestion that it is moral for the church to actively discourage the use of condoms to prevent the spread of such a deadly disease, is to take the position that women and their children--who may or may not be Catholic--must die. That position is immoral.

The teaching on contraception is not an essential article of faith. One need not subscribe to it to be a Catholic.

Those who suggest otherwise are in error.

Anonymous said...

Oh, and one more thing. The suggestion that the HIV virus can pass through latex is demonstrably false. When condoms are used consistently and properly, they very effectively prevent the spread of HIV. That is a proven fact.

How dare you spread such terrible, and potentially death-dealing information?

David L Alexander said...

"Potentially death-dealing" is putting a human organ in a place where nature never intended it to be inserted. Shall I be more picturesque than that, or can you demonstrate that that alone would be false?

More to come...

Darwin said...

It is a well known rhetorical fact that it takes far less time to raise a false position that to put it to rest. Rea's first paragraph would take a veritable tome to answer fully, which I assume is the reason she has strung so many misunderstandings, misrepresentations and downright falsehoods together in a rapid-fire manner not unlike a telegraph with a stutter.

But since they are my particular hobby-horses, allow me to place special emphasis on pointing out that she is very much wrong that the Church ever dogmatically said evolution to be impossible, nor was the Galileo case a matter of doctrine, but rather one of discipline, and a rather more complex one than most of the intellectually unwashed give it credit for at that.

Really, though, the thing that has always confused me about the "Why doesn't the Church tell these poor women whose HIV+ husbands will force themselves on them no matter what that it's okay to use condoms" like of reasoning is that it's such a pathetic attempt to be 'progressive', unless it is rather a case of extreme racial and classist prejudice.

Is the Church to say that because a woman is poor and black that she should be trapped in a marriage with a man who treats her as a sexual object and cares so little for her well-being that he is unfaithful to her in getting himself infected with AIDS and then ignors the obvious danger to her caused by forcing his attentions on her regardless of his infection?

If we personally knew such a woman, we would tell her, "Get out of that relationship. Don't let him do that to you." But since the unfortunate woman is in the Third World, progressives seem eager to say, "Here you are, dear. Just ask the nice man to wear a condom and it will all be better."

Morality is the realm for absolute goods, not settling for the decidedly mixed blessing of reducing a 1 in 500 chance of receiving AIDS through heterosexual intercourse to the 1 in 5000 chance of receiving it in heterosexual intercourse through a condom.

David L Alexander said...

"[I]t takes far less time to raise a false position than to put it to rest."

It is easier still when a detractor completely ignores evidence already presented. (A case in point here would be that the origins of Church teaching on contraception were already presented, as well as the historical context that gave rise to such witness.) This could be dismissed as setting oneself up easily for defeat, but even this presumes the detractor has any interest at all in what is presented, as opposed merely nay-saying it out of hand. The result is not an exchange of ideas, let alone a mutual search for the truth, so much as a kind of moral bludgeoning with words.

To put it another way, if someone gave you the reason for the Catholic teaching for this or that, would you even care to know, or are you already prepared to dismiss it? If so, how can you defeat a position with any eloquence, if you don't even know what it is?

It raises a more fundamental issue than, well, the issues themselves.

For my own part, if I were to think so little of the beliefs that make me a Catholic (and we are Catholic on the basis of what we believe, as opposed to how many parish committees we join), why would I even want to BE a Catholic? This is a fair question, one that can be posed with kindness to any skeptic, if only to facilitate their peace of mind. I know of no one who is forced against their will to believe in anything. Such "hard sayings" (as they are called in John's Gospel, chapter six) are an inconvenience, after all, were they not to exist for some higher purpose. If I did not consider them necessary to save myself from eternal damnation, they would hardly be worth my attention, let alone getting up early on Sunday morning.

With all that, the gauntlet has been thrown, and I will attempt to explain at least some of the issues laid out here, one at a time. The "misunderstandings, misrepresentations and downright falsehoods" will be exposed for exactly what they are, whether anyone likes what they are told or not.

But it will likely take time, for the reason Darwin gave in his opening remark. Soooo... stay tuned, and stay in touch.

Anonymous said...

The idea that condoms are perfect foils for HIV is on shaky ground. The "pore size" of the latex condom seldom passes the virus. BUT in real-world, published case studies the incidence of either pregnancy or HIV conversion runs about 16-20% with "condom use." True, much of the problem seems to be failure to "use as directed." But the real world is the one we live in and with HIV in a marriage partner, that 16-20% possibility seems pretty stark.
In the old days, that would make a fine case for sexual abstinence. Though perhaps Rea Haworth would think such a notion was too awful to consider.

David L Alexander said...

You know, Anon, it's too bad you didn't include an internet address to refer us to a detailed study. Now we have no choice but to conclude, that a piece of rubber bought for a few dollars on the rack at a convenience store is our best sure defense against a horrible, debilatating virus.

Unless it breaks while we're using it. Ooops!

David L Alexander said...

I was asked by "Anon" to post the following, as he has experienced difficulty in doing so directly. As with any such reading material, parental discretion is advised.

+ + +

Perspect Sex Reprod Health. 2003 Mar-Apr;35(2):79-86.

Evaluation of the efficacy of a nonlatex condom: results from a
randomized, controlled clinical trial.

Walsh TL, Frezieres RG, Peacock K, Nelson AL, Clark VA, Bernstein L.
Research Division, California Family Health Council, Los Angeles, USA.

CONTEXT: To reduce unintended pregnancy and HIV infection, it is
critical to develop reliable male condoms that will attract consumers
who reject conventional latex condoms. METHODS: In a prospective
clinical trial conducted in 1998-2000, 830 monogamous couples were
randomized in equal numbers to use either a nonlatex condom or a
commercial natural latex condom for six months as their only method of
birth control. Couples completed detailed reports for the first five
condom uses and recorded intercourse and condom use in coital diaries.
Pregnancy rates associated with typical and consistent condom use were
calculated using life-table analysis. Rates of clinical failure (condom
breakage or slippage) were determined for the first five condom uses.
RESULTS: During the first five uses, the nonlatex condom had a higher
frequency of breakage or slippage during intercourse or withdrawal
(4.0%) than latex condoms (1.3%); the breakage rate for the nonlatex
condom was about eight times that of latex condoms. The six-cycle
typical-use pregnancy rate did not differ significantly between users of
nonlatex (10.8%) and latex condoms (6.4%). The six-cycle consistent-use
pregnancy rate was higher for nonlatex condom users than for latex
condom users (4.9% vs. 1.0%). CONCLUSIONS: The data present strong
indirect support for public health messages that promote the use of
latex condoms and, for individuals who cannot or are unwilling to use
latex condoms, the use of nonlatex condoms for prevention of pregnancy
and disease.

Cochrane Database Syst Rev. 2002;(1):CD003255.
Related Articles, Links

Update of:
• Cochrane Database Syst Rev. 2001;(3):CD003255.

Condom effectiveness in reducing heterosexual HIV transmission.

Weller S, Davis K.

Preventive Medicine, University of Texas Medical Branch, Galveston,
Texas 77555-1153, USA.

BACKGROUND: The amount of protection that condoms provide for HIV and
other sexually transmitted infections is unknown. Cohort studies of
sexually active HIV serodiscordant couples with follow-up of the
seronegative partner, provide a situation in which a seronegative
partner has known exposure to the disease and disease incidence can be
estimated. When some individuals use condoms and some do not, namely
some individuals use condoms 100% of the time and some never use (0%)
condoms, condom effectiveness can be estimated by comparing the two
incidence rates. Condom effectiveness is the proportionate reduction in
disease due to the use of condoms. OBJECTIVES: The objective of this
review is to estimate condom effectiveness in reducing heterosexual
transmission of HIV. SEARCH STRATEGY: Studies were located using
electronic databases (AIDSLINE, CINAHL, Embase, and MEDLINE) and
handsearched reference lists. SELECTION CRITERIA: For inclusion, studies
had to have: (1) data concerning sexually active HIV serodiscordant
heterosexual couples, (2) a longitudinal study design, (3) HIV status
determined by serology, and (4) contain condom usage information on a
cohort of always (100%) or never (0%) condom users. DATA COLLECTION AND
ANALYSIS: Studies identified through the above search strategy that met
the inclusion criteria were reviewed for inclusion in the analysis.
Sample sizes, number of seroconversions, and the person-years of
disease-free exposure time were recorded for each cohort. If available,
the direction of transmission in the cohort (male-to-female,
female-to-male), date of study enrollment, source of infection in the
index case, and the presence of other STDs was recorded. Duplicate
reports on the same cohort and studies with incomplete or nonsepecific
information were excluded. HIV incidence was estimated from the cohorts
of "always" users and for the cohorts of "never" users. Effectiveness
was estimated from these two incidence estimates. MAIN RESULTS: Of the
4709 references that were initially identified, 14 were included in the
final analysis. There were 13 cohorts of "always" users that yielded an
homogeneous HIV incidence estimate of 1.14 [95% C.I.:.56, 2.04] per 100
person-years. There were 10 cohorts of "never" users that appeared to be
heterogeneous. The studies with the longest follow-up time, consisting
mainly of studies of partners of hemophiliac and transfusion patients,
yielded an HIV incidence estimate of 5.75 [95% C.I.: 3.16, 9.66] per 100
person-years. Overall effectiveness, the proportionate reduction in HIV
seroconversion with condom use, is approximately 80%. REVIEWER'S
CONCLUSIONS: This review indicates that consistent use of condoms
results in 80% reduction in HIV incidence. Consistent use is defined as
using a condom for all acts of penetrative vaginal intercourse. Because
the studies used in this review did not report on the "correctness" of
use, namely whether condoms were used correctly and perfectly for each
and every act of intercourse, effectiveness and not efficacy is
estimated. Also, this estimate refers in general to the male condom and
not specifically to the latex condom, since studies also tended not to
specify the type of condom that was used. Thus, condom effectiveness is
similar to, although lower than, that for contraception.

J Assoc Nurses AIDS Care. 1998 Nov-Dec;9(6):88-9.

Updated estimates of condom effectiveness.

Pinkerton SD, Abramson PR, Turk ME.
Department of Psychiatry and Behavioral Medicine, Medical College of
Wisconsin, Milwaukee, USA.

PIP: This paper reports results of a study concerning the effectiveness
of condoms in preventing HIV transmission. The study expands on a 1993
meta-analysis that pooled the results of a number of studies of HIV
transmission in serodiscordant couples to arrive at an overall condom
effectiveness estimate of 69%. A meta-analysis of studies that compared
seroconversion rates among couples who regularly use condoms and those
who used them inconsistently was conducted to determine the use and/or
effectiveness of condoms in preventing HIV transmission. Results of the
analysis indicated that condoms are 90-95% effective when used
consistently. To illustrate the impact of differential assumptions
regarding the effectiveness of condoms in preventing the transmission of
HIV, a community of gay men is considered in which the prevalence rate
of HIV infection is 20%, supposing each man has sex once a week with a
monogamous partner from the same population. The expected annual
incidence of HIV infection in this community is 13% if condoms are never
used, while consistent use of 95% effective condoms would reduce the
incidence to about 1%. In this example, the probability of transmission
for 52 acts of condom-protected intercourse is less than for a single
act of unprotected intercourse. Moreover, inconsistent condom use also
offers some protection against HIV in which the reduction achieved by
using condoms 50% of the time is equal to almost half the reduction
associated with consistent use.