It is undeniable that condoms help cut down on HIV infections. They do. Wear a condom during sex, and the chances of transmitting the virus are significantly lower. THERE IS NO DENYING THIS. And yet, Pope Benedict XVI made the unfortunate argument that condom use in Africa “increases the problem.” Yes, when condoms are used improperly, their effectiveness wanes. But the very technology behind a condom — trapping semen in an impermeable container to keep it from entering your sex partner — limits the spread of HIV. But there went the pope, who has the ear of tens of millions of people on this planet, saying good morals will do more to cut down on HIV transmissions than rubbers. But, um, how to say this … WHAT IF HE’S RIGHT?
He could be. But only on a technicality.
While condom use has shown to be effective in minimizing new HIV infections in countries like Thailand and Cambodia, the data coming out of Africa suggests popping on a Trojan does little to nothing to stem infection rates. A 2003 study for the United Nations’ AIDS program “found no evidence of condoms working as a primary HIV-prevention measure in Africa,” reports the Washington Post. “UNAIDS quietly disowned the study. … Since then, major articles in other peer-reviewed journals such as the Lancet, Science and BMJ have confirmed that condoms have not worked as a primary intervention in the population-wide epidemics of Africa. 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.’”
But pay attention there: The studies say condom use is not saturated enough to be effective. That is, a single weak link — just a few people here and there not using condoms — can destroy the entire safeguard. How come? Because of “risk compensation,” which has people actually having riskier sex because they use condoms sometimes, making them think they’re safe. Also, people who think they’re in monogamous relationships might choose not to use condoms, because forcing your partner to wear one signifies a lack “lack of trust.” So when one partner is sleeping around outside of his “monogamous” relationship, guess what he’s bringing home to the girlfriend?
However, it’s those ongoing relationships that drive Africa’s worst epidemics. In these, most HIV infections are found in general populations, not in high-risk groups such as sex workers, gay men or persons who inject drugs. And in significant proportions of African populations, people have two or more regular sex partners who overlap in time. In Botswana, which has one of the world’s highest HIV rates, 43 percent of men and 17 percent of women surveyed had two or more regular sex partners in the previous year.
These ongoing multiple concurrent sex partnerships resemble a giant, invisible web of relationships through which HIV/AIDS spreads. A study in Malawi showed that even though the average number of sexual partners was only slightly over two, fully two-thirds of this population was interconnected through such networks of overlapping, ongoing relationships.
Notes Edward C. Green, director of the AIDS Prevention Research Project at Harvard University: “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.”
But make no mistake: None of this data suggests condoms don’t work. They do. But only when most, if not all people are using them. It’s then we move beyond preventing one-on-one infection and toward preventing many-on-many transmissions.
The problem in Africa appears to be a passive or negligent attitude toward condom use, and that’s where inroads need to be made. Promoting wider-spread use — which has always been a core tenant of advocating condoms — is where the solution lies. And the pope, who said “the scourge cannot be resolved by distributing condoms,” did nothing to help that message.