Mail

A friend and reader writes (in response to this post):

No one is trying to claim that condom usage will stop the AIDS
epidemic, but it will slow its growth. Yes, in about 20% of condom
uses, HIV may pass through the barrier. However, these odds are still
better than if there were no condoms used at all. In my home visits in
India with medical students, we have come across at least 5 (of the
100 women I have spoke with) who knew that their husbands had AIDS
(contracted from prostitutes) and understood that they did not want to
get AIDS. These women have an annual family income of Rs ~300/- per
month (~$6). Their children are starving and they can't afford their
next meal, how are they supposed to afford or even think about using
condoms to save their own lives. [And, in the majority of these cases,
not having sex with their husbands is not a choice that they are
allowed to make.] While I respect the fact that the Catholic Church
does not condone or promote condom usage, it is an insensitive error
to suggested that the promotion of condom use by non-religious
organizations (including through distribution of free condoms) will
not save lives. True, it won't save them all, but has the potential to
save that 80%.

In response, I'll first link to this article.

It makes a great point, that actually follows from the problems you lay out in your e-mail: the AIDS problem is at its root a cultural problem. Think of the (married) man who contracted AIDS from a prostitute. Think of his wife, and how it's inconceivable for her to avoid sex with her husband and live chastely with him (ie, she's a piece of meat at his sexual disposal). The problem is not that AIDS is sexually transmittable. The chances are really good that if a husband and wife have one partner apiece in their entire lives (their respective spouses), then chances are really good that they're not going to contract AIDS.

Consider developments in Uganda, cited in the article:

Uganda's noted success in reducing the prevalence of AIDS was due a program that focused on delaying sexual activity among adolescents, promoting abstinence, encouraging faithfulness to a single partner, and condom use. Condom promotion was last in order of importance, notes the article.

Hearst and Chen explain that increased use of condoms was not responsible for the decline in AIDS among Ugandans. "The main cause of falling incidence in Uganda was a substantial drop in numbers of casual sex partners," they wrote. Their article also attributes falling HIV prevalence among pregnant women in parts of Zambia and Tanzania to reductions in numbers of sexual partners.

In another article, a group of experts on HIV stressed the need for greater emphasis in changing sexual behavior. "It seems obvious," said an article in the April 10 issue of the British Medical Journal, "but there would be no global AIDS pandemic were it not for multiple sexual partnerships." The article was entitled "Partner reduction is crucial for balanced 'ABC' approach to HIV prevention."

Distributing condoms may save a life or two, but it does nothing to address the culture that allows for the spread of AIDS in the first place. The men who are wearing condoms are still the sort to sleep with any woman they can get their hands on. Their basic outlook is still one guided by sexual appetite, and if you're starting from a position of unrestraint it's really easy to have unprotected sex anyway, whether or not condoms are available (ie, if sex is good and I can still have it anytime and a condom isn't available, oh well...). Condom distribution, if anything, distracts us from addressing the much messier real problem, one that can't be solved with a few bucks and a boatload of Trojans.