1. The mass media have circulated news that I granted an interview to the BBC, which was broadcasted last October 12, 2003, on the eve of Pope John Paul II's 25th Anniversary in his service as Bishop of Rome. On that occasion, I answered different questions for more than an hour, especially those dealing with the family. But, surprisingly, what was shown from the whole interview on the BBC Panorama's film, Sex & The Holy City, were merely three questions of less than half a minute each, the answers to which were certainly much more complete. The program apparently tried to deliberately and systematically criticize the Catholic Church for supposedly contributing to the death of people by not allowing the use of condoms to prevent the spread of HIV/AIDS.
The bishops of England and Wales have rightly complained to the BBC for that film, which, along with another program, was "biased against and hostile to the Catholic Church", and which has "given offence to many Catholics… For many decades the BBC has deserved [and] enjoyed a worldwide reputation for fairness and objectivity, especially in its News and Current Affairs. This reputation is increasingly tarnished."1 Many individuals and groups also manifested their disgust with the said BBC's Panorama program.2
In that interview I warned about "safe sex", stating that one cannot truly speak of objective and total protection by using the condom as a prophylactic,3 when it comes to the transmission not only of HIV/AIDS (Human Immunodeficiency Virus, which causes the Acquired Immune Deficiency Syndrome), but also of many other STD's (Sexually Transmitted Diseases). I emphasized that in order to control the pandemic, it is necessary to promote responsible sexual behaviour that is inculcated by means of authentic sexual education, that respects the dignity of man and woman, and that does not consider others as mere instruments of pleasure and thus objects "to be used". I also said that such responsible sexual behaviour takes place only in conjugal love, assuming the responsibilities of marriage as a reciprocal, exclusive and total self-giving of a man and a woman in a community of love and life.
Therefore, my position was absolutely clear against the so-called inordinate sex, against promiscuity that is fuelled today by certain permissive political measures and certain means of communication. That is why I reminded the audience that the Church teaches a moral position that is valid for all, both believers and non-believers. I also proposed that the Ministries for Health should require labels for condoms, as they do in the case of cigarettes, stating that the protection condoms provide is not total, and that the risks are indeed significant.4
In order to stress that the level of protection provided by the condom against HIV/AIDS and STD's is not sufficient, I also referred to a certain permeability suggested by the results of scientific investigations. Such concern also has to be given attention considering that the AIDS virus is 450 times smaller than the sperm cell -- in addition to other risks brought about by different factors in the condom's structure and in its actual usage.5
2. The Catholic Church has repeatedly criticized programs promoting condoms as a totally effective and sufficient means of AIDS prevention. The different Bishops' Conferences all over the world have expressed their concern regarding this problem. The Catholic Bishops of South Africa, Botswana and Swaziland categorically "regard the widespread and indiscriminate promotion of condoms as an immoral and misguided weapon in our battle against HIV/AIDS for the following reasons. * The use of condoms goes against human dignity. * Condoms change the beautiful act of love into a selfish search for pleasure -- while rejecting responsibility. * Condoms do not guarantee protection against HIV/AIDS. * Condoms may even be one of the main reasons for the spread of HIV/AIDS. Apart from the possibility of condoms being faulty or wrongly used they contribute to the breaking down of self-control and mutual respect."6
The Sub-commission for Family and Life of the Spanish Episcopal Conference said that the campaigns that promote the condom in Spain to supposedly stop HIV/AIDS are gravely irresponsible for three reasons: "because they tend to be deceitful, because they hide information, and because they do not contribute towards prevention, but rather to a greater spread of risky behaviour, since they imply that the health authorities are giving their approval to behaviour and lifestyles that are responsible for the epidemic".7
The Catholic Bishops' Conference of the Philippines maintained that while "an encounter with people infected with HIV-AIDS should be a moment of grace -- an opportunity for us to be Christ's compassionate presence to them as well as to experience His presence in them", nonetheless, [t]he moral dimension of the problem of HIV-AIDS urges us to take a sharply negative view of the condom-distribution approach to the problem". Besides, "[a]s in contraception, so also in preventing HIV-AIDS infection condom use is not a failsafe approach".8
Even earlier, the bishops of the United States of America affirmed in their 1987 statement: " … abstinence outside of marriage and fidelity within marriage as well as the avoidance of intravenous drug abuse are the only morally correct and medically sure ways to prevent the spread of AIDS. So-called safe sex practices are at best only partially effective … As the National Academy of Sciences has noted in its study of AIDS, ‘many have argued that it is more accurate to speak in terms of ‘safer' sex because the unknowns are still such that it would be irresponsible to certify any particular activity as absolutely safe'".9
3. I thought that the Church's position and the reasons behind it were already well-known. I am quite concerned because people, especially the young, are misled when total protection is seemingly offered to them, while in fact there is no such total protection. Aware of the immensity of the pandemic, while at the same time maintaining the different but complimentary levels of what is moral and what is merely hygienic, I wanted to speak out regarding the need not only to contain the continuous expansion of this pandemic, but also the need to prevent condom users from getting an infection that they previously thought was impossible to get, and which until now has had lethal consequences.
There are persons at risk of being contaminated, even though they think that their sexual relations, from the hygienic point of view, are totally safe. How many fall victim to this error? They would have taken a different attitude, at least to a certain extent, had they been given more valid and objective information. Indeed, a great number of sources giving the correct information on condom ineffectiveness are public, but, apparently many are not well publicized. The mere fact that this discussion has led persons to doubt to a certain extent the effectiveness of condoms in preventing infection is already, I think, a timely service. The reader is invited above all to reflect why, despite the invitation to promiscuity made by the "safe sex" campaign and the distribution of an enormous quantity of prophylactics where the pandemic is more widespread, the problem of infection has become even greater.10
These are precisely the points I wish to consider in this present reflection, with the aid of information gathered from different sources. I have no reason to doubt the expertise of persons and institutions with internationally renowned competence on these matters. The position of the Church is truly human and responsible: it is a call to fully respect the human person's freedom and dignity. The family suffers, above all in the poor countries. The fact that families and youth are oftentimes misinformed and given false security should not be tolerated any longer. It is clear that if I make this reflection, it is because of the close relationship between family and procreation, and also because matters regarding the family touching on condoms and other contraceptives pertain to our field of work. In describing the tasks of the Pontifical Council for the Family, the Apostolic Constitution Pastor Bonus states that it "strives to ensure that the rights of the family be acknowledged and defended even in the social and political realm. It also supports and coordinates initiatives to protect human life from the first moment of conception and to encourage responsible procreation."11
As a Father of the Church said, "We should not be ashamed of the things that God has created". Not only should we not be ashamed of things created by God, we should also defend them, for everything that he has created is good. Human sexuality, conjugal love, responsibility, freedom, bodily health: these are God's gifts to us that we have to treasure.
4. I mentioned earlier that I thought the position of the Church and the foundations of my assertions were already well-known. On the other hand, it might also be possible that this position is still unknown to many, as manifested in concrete campaigns where scientific aspects are mixed with certain economic interests on the part of condom producers, and with an "ideology" of the powerful against the poor in line with "population control".
A well-known and authoritative moralist, Dionigi Tettamanzi, who is now the Cardinal of Milan, tackled these matters in a voluminous book, Nuova bioetica cristiana, published in 2000. He clearly shows why the condom cannot guarantee the so-called "safe sex" when used as a prophylactic. "The Ministry of Health [in Italy], through the National Commission for the fight against AIDS, often supplies the following information to children, youth, and other interested parties: ‘The chances of contamination increase with more unprotected intercourse; thus, if you are not sure of your partner, always use a condom'12 But is the condom truly an effective means to stop contamination? Some critical reflections become necessary.
a) The first reflection is of a properly hygienic nature. It is said that the condom is to be used as a ‘defense' measure, as a ‘barrier' so as not to contaminate and be contaminated during sexual intercourse. Now, what is at stake, that is, caring for one's health (and life) and another's, calls for an accurate critical analysis of the real efficacy of this defensive means or barrier.
"There are two types of efficacy that could be considered in particular. First, ‘technical' efficacy: since when did the condom ‘prevent' the risk of contamination? In scientific circles, it is openly admitted that condoms are in fact not 100% safe. On an average, it is said that there is a 10-15% inefficacy, since the AIDS viruses are much more ‘filtrating' [able to pass through] than the sperm.13 Therefore, even at a ‘technical' level of efficacy, one should question the scientific seriousness and the consequent professional seriousness of the condom campaign. There is a great risk involved: to ‘deceive' persons by propagating ‘safe sex because one is protected', while in fact it is not safe, or is not safe in the way it might be thought to be. The illusion becomes much more dangerous and serious when there is an even greater duty for persons ‘at risk' or who indulge in promiscuous sexual relationships not to spread the infection (both to the partner and, eventually, to present or future children).'"14
5. Another Italian moralist, Elio Sgreccia, currently a bishop and Vice-President of the Pontifical Academy for Life, wrote that campaigns based only on the free distribution of condoms, "can become not only fallacious, but counterproductive and encourage… the abuse of sexuality; at any rate, they are devoid of truly human content and do not contribute to holistically responsible behaviour."15 Many other moralists and experts also tackled these questions, including Lino Ciccone and Jacques Suaudeau, some of whom will also be cited in this paper.
Cardinal Tettamanzi further notes along this line that it is totally unacceptable for the State to organize and promote "safe sex" campaign, because of the lack of efficiency of condoms as a "barrier" against infection, and especially because of the danger of an irresponsible use of sexuality. For instance, when a soldier receives a condom, he knows that he should avoid contamination; but at the same time he is being induced to believe that any form of sex is licit. To these considerations one must add the risks to an individual's freedom of choice: when the "safe sex" campaign is undertaken in such a way that it exerts undue pressure on youth and on the public in general, together with an illusion of the condom's efficiency, it becomes tantamount to an imposition.16 There is a paradox here in that the State (which claims to be neutral) is allowed to actively propagate and spread contraceptives, while it would be accused of being denominational if it undertook an educational campaign on the value (including hygienic) of marital fidelity!17
6. The concern that condoms do not provide total protection against AIDS and STD's is not at all new, nor limited to Church circles. Dr. Helen Singer-Kaplan, who founded the Human Sexuality Program at the New York Weill Cornell Medical Center, Cornell University, wrote in her book, The Real Truth about Women and AIDS: "Counting on condoms is flirting with death".18 A Dutch medical journal also stated that, "Practice shows that there is a great need for a method that prevents both HIV as well as pregnancy. Sad to say, the people still have not become aware that this method cannot be the condom".19 In the 1980's and the 1990's, questions on the real protection provided by condoms arose from electron microscopic studies on the latex material, a concern related to the fact that the AIDS virus is about 25 times smaller than the sperm cell's head, 450 times smaller than the sperm cell's length, and 60 times smaller than the syphilis bacterium.20
In 1987, the Los Angeles Times published an article entitled, Condom Industry Seeking Limits on U.S. Study.21 It stated that "[t]he condom industry has launched an intensive campaign to weaken, delay or possibly shut down a federally funded Los Angeles study of the effectiveness of condoms in preventing transmission of the AIDS virus… The research has taken on a new element of urgency in the wake of a series of questions raised about the ability of condoms to reliably prevent the spread of human immunodeficiency virus (HIV)".22 Two years later, the same reporter wrote in an article, 4 Popular Condoms Leak AIDS Virus in Clinical Tests, that "Four of the nation's most popular condom brands permitted the AIDS virus to escape in laboratory tests conducted for UCLA, prompting researchers to warn users they should not assume that all condoms work equally well in preventing spread of the disease… Overall, among the thousands of condoms tested, the study found that 0.66% of condoms -- more than one of every 200 -- failed, either allowing water or air to escape, breaking in tensile strength tests or leaking the AIDS virus."23
As a summary of these and other studies, Dr. John Wilks stated the following in his Letter to the Editor in the Nov 17, 2003, issue of The Australian: "In 1989, the Los Angeles Times reported that four of the nation's most popular condom brands permitted the AIDS virus to escape in laboratory tests conducted for UCLA, … Carey and associates (‘Sexually Transmitted Diseases', 1992) reported that HIV-sized particles leaked through 29 of 89 commercially purchased latex condoms in simulated intercourse… Voeller (‘AIDS Research and Human Retroviruses', 1994) reported that leakage of virus-sized particles occurred in different brands of condoms of different ages at a rate of 0.9 per cent to 22.8 per cent in the laboratory setting… Lytle and others (‘Sexually Transmitted Diseases', 1997) reported that under test conditions, 2.6 per cent of latex condoms allowed some virus penetration…". In still another test, only 30% of membrane samples from "Trojan" brand condoms were found to be absolutely without defects.24
On the other hand, a British newspaper reported that "the organisation [World Health Organisation] says ‘consistent and correct' condom use reduces the risk of HIV infection by 90%. There may be breakage or slippage of condoms…".25 The International Planned Parenthood Federation even gave a higher failure rate, stating that "use of condoms reduces by approximately 70% the total risk between unprotected sex and complete sexual abstinence. This estimate is consistent with findings from most epidemiological studies".26
It should be stated that the remaining 10-30% from these figures, which represent the failure range, is relatively high when one deals with a potentially mortal disease such as AIDS, especially if there is an alternative that provides absolute protection against the sexual transmission of the same: namely, abstinence before marriage, and fidelity to one's spouse.
Given that AIDS is a serious threat, any inadequate information based on false security offered by condoms used as prophylactics would be a grave irresponsibility. Hence, a continuous effort to present the correct information clearly and comprehensively, avoiding all ambiguities and confusion, is certainly called for -- not only for the benefit of the public in general, but also in order to help the sincere and countless efforts to prevent the pandemic of AIDS and the other sexually transmitted diseases.
7. The above cited medical literature and many others have opened several questions regarding condom effectiveness in preventing sexually transmitted diseases. In fact, on June 12-13, 2000, four US government agencies responsible for condom research, condom regulation, condom use recommendations, and HIV/AIDS and STD prevention programs co-sponsored a Workshop precisely "to evaluate the published evidence establishing the effectiveness of latex male condoms in preventing HIV/AIDS and other STDS". The four agencies were the US Agency for International Development (USAID), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH). The Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention was later prepared by the National Institute of Allergy and Infectious Diseases, the National Institutes of Health, and the Department of Health and Human Services, and was published on July 20, 2001.27
The Workshop's focus was on "the latex male condom for the prevention of HIV/AIDS and STDs during penile-vaginal intercourse". "Representatives of the sponsoring agencies and outside experts were asked to work as a panel", including experts on "STDs, genitourinary tract anatomy, contraception, condoms, behavioral science, epidemiology, medicine and public health". "The workshop examined only peer-reviewed literature [a total of 138 papers] because these studies have been subjected to independent scientific evaluation prior to publication." An additional 42 other papers are cited in the Workshop Summary.28
The said Workshop Summary explains that available scientific evidence indicated that the condom reduces the risk of AIDS/HIV by 85%.29 There is then a 15% risk that remains.
The Workshop also studied in particular the transmission of other genital infections, and the usual conclusion is that studies demonstrated either no or some protection through condom use, or that there is insufficient data to confirm risk reduction. The diseases studied individually are the following: Gonorrhea (caused by Neisseria gonorrhoeae), Chlamydial infection (Chlamydia trachomatis), Trichomoniasis (Trichomonas vaginalis), Genital Herpes (Herpes Simplex Virus or HSV), Chancroid (Haemophilus ducreyi) and Syphilis (Treponema pallidum).30 The Human papillomavirus (HPV) is given some more attention, with the conclusion stating clearly that "[t]here was no evidence that condom use reduced the risk of HPV infection…"31. HPV is a very important STD associated with cervical cancer, which in the US kills many more women than the HIV.32
There is no such thing then as a 100% protection from HIV/AIDS or other STD's through condom use today. This data should not remain unnoticed, since many users, including youth, think that the condom provides total protection.
In connection with these findings presented in the Workshop Summary, the Catholic Family and Human Rights Institute made a report, "Physicians Groups Charge US Government with Condom Cover-up", stating that "[g]roups representing over 10,000 doctors have accused the US Government's Centers for Disease Control and Prevention (CDC) of covering up the government's own research that shows that condoms do not protect individuals from most sexually transmitted diseases". According to the report, these groups claim that, "…the CDC has systematically hidden and misrepresented vital medical information regarding the ineffectiveness of condoms to prevent the transmission of STDs. The CDC's refusal to acknowledge clinical research has contributed to the massive STD epidemic".33
8. In an article subsequent to the Workshop Summary,34 four of the Workshop panel members, along with other experts, further analyse points and issues stemming from this Workshop, such as the definition of terms,35 risk prevention (i.e., provides absolute or total protection) versus risk reduction (i.e., provides partial protection),36 cumulative risk, factors that influence condom effectiveness37 and public health implications.
In their article, Fitch et al emphasize that the cumulative risk factor is very significant. "For example, an intervention that is 99.8% effective for a single episode of intercourse can yield an 18% cumulative failure rate with 100 exposures."38 Likewise, based on an International Planned Parenthood Federation (IPPF) article, "the risk of contracting AIDS during so-called ‘protected sex' approaches 100 percent as the number of episodes of sexual intercourse increases".39 IPPF is an institution promoting all forms of "birth control".
What has to be considered therefore is not only the risk of each single condom use, but also of its continued use, a risk which dramatically increases in the long run. This means that the safe sex Russian Roulette becomes even more serious with repeated condom use.
9. Most probably related to the condom's efficiency in preventing the transmission HIV/AIDS and STD's is its efficiency in preventing pregnancy. The WHO explains that perfect use of the condom does not prevent pregnancy all the time. "Estimated pregnancy rates during perfect use of condoms, that is for those who report using the method exactly as it should be used (correctly) and at every act of intercourse (consistently), is 3 percent at 12 months"40. Needless to say, the condom's typical use, which includes perfect and imperfect use (i.e. not used at every act of intercourse, or used incorrectly) is much less effective in preventing pregnancy. "The pregnancy rate during typical use can be much higher (10-14%) than for perfect use, but this is due primarily to inconsistent and incorrect use, not to condom failure".41
Indeed, pregnancy in spite of condom use is well documented, with the Pearl index placed at around 15 failures per 100 women years within the first year of use.42 If pregnancy may occur in spite of condom use, wouldn't it be only logical to conclude that the condom also allows transmission of HIV and STD's, given that the disease-causing organisms may be present with the sperm cells, in the seminal fluid, and even elsewhere, such as on skin surfaces not covered by the condom? Moreover, one must consider that a woman can become pregnant only during her fertile days (approximately 5-8 days in a cycle, taking into account the sperm's lifespan inside her body), while the HIV and STD's may be transmitted on any day.