The title (and much of the substance) of Sunday's op-ed by Harvard researcher Edward C. Green in the Washington Post is that the Pope's recent statement on AIDS and condoms is correct. http://www.washingtonpost.com/...
I'm not an HIV/AIDS researcher and I don't have at hand all the studies that might either support or refute this op-ed, but I am a public health researcher with 30 years experience as a guide on how to conduct and interpret health-related research. And I'm very disturbed by the conclusions Green draws and by the way his statements are being used by religious extremists.
Like many scientific statements that are misused, Green's point of view is far more nuanced than you get from his title (or worse, the title listed on the WaPo op-ed page which was "The Pope Was Right") or the right wing media. However, I give him very little credit because he took very little care to make sure people knew how limited his statement really is.
For example he says about the Pope's statements in Africa regarding condom use and the spread of AIDS:
in truth, current empirical evidence supports him.
By scientific standards, that is a very strong statement -- it is not modified by the words "some," or even "most". Even global warming, which is pretty much accepted by legitimate climate scientists, is often prefaced by "most" or "almost all."
According to Green, this conclusion is based on several studies, the last of which sounds like a review of the literature about which he says:
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."
He then goes on to speculate why it hasn't worked in Africa, after saying only in passing that
condom promotion has worked in countries such as Thailand and Cambodia, where most HIV is transmitted through commercial sex and where it has been possible to enforce a 100 percent condom use policy in brothels (but not outside of them).
As I said at the beginning, I can't speak to whether he is correctly summarizing the research (or whether he's leaving out studies that dispute his statements). But I can analyze his thinking from a general public health and research perspective.
- Part of the Pope's statement was that condoms make things worse:
"You can't resolve it with the distribution of condoms," the pope told reporters aboard the Alitalia plane heading to Yaounde. "On the contrary, it increases the problem."
http://www.huffingtonpost.com/...
Edwards actually agrees with this statement:
That is, when people think they're made safe by using condoms at least some of the time, they actually engage in riskier sex.
And yet the evidence he sites says nothing about condoms making things worse. A statement as radical and potentially harmful as saying that condoms may make the AIDS epidemic worse should not be made without strong evidence.
- He shortchanges the effectiveness of condoms in other parts of the world. While he briefly mentions Thailand and Cambodia as having been positively affected by condom campaigns (although he then undermines that by limiting the good effects to commercial sex), he leaves out the whole rest of the world! Maybe he's right that in certain parts of Africa (since when is Africa a single homogeneous entity?) a condom-use campaign is not as effective as some alternative program, but that doesn't make the Pope right in his general opposition to condoms in the world, or even in all of Africa.
- While he states that he is by no means anti-condom, he manages to leave out the importance of condoms for its original purpose (contraception). When he assumes that condoms aren't needed for strictly monogamous relationships, he ignores the risk to women of frequent pregnancies, and these pregnancies can be detrimental to women's health. (check out this link on pregnancy-related fistulas, for example http://ipsnews.net/...).
- He assumes an either/or situation -- either monogamy-oriented programs or condoms. But preventing HIV transmission is like having many exits when there is a fire in a movie theater. You don't want to block an exit because you think another one is better placed. Perhaps monogamy-based programs alone work for some communities, condom distribution for others, a combination of the two for yet other communities, and other creative solutions for still others. [Note: in one sentence he states that condoms should be available as a back-up strategy, but a few sentences later, belittles the notion of condoms doing any real good.]
- Finally, as a public health person, I, like Green, tend to focus more on the population than the individual. But the truth is that consistent condom use can protect an individual from contracting AIDS, and that is of value. I used to work across the hall from a nun, a radical/not-in-agreement-with-the-Pope nun, and she told me of an order of nuns she worked with in Africa who gave out condoms to women in defiance of the Pope's dictates. They did this to provide these women protection from unwanted pregnancies and from AIDS, and for any one of these women, availability of condoms could make the difference between life and death. And that is an action that is worth taking.