As the proverb states, an ounce of prevention is worth a pound of cure. This writing concerns itself not with the very worthy apostolate of care for victims of the HIV/AIDS epidemic, but with halting its spread and eventually eliminating it from the human race.
To insist on the condom is pure illusion," writes Dr. Ntari Benoit from Brazzaville in the Congo (Dolentium Hominum, 1997, No.2,36-38). This approach sounds a false message "that it is thus unnecessary to modify one's sexual behavior, the primary cause of infection" (p.36).
"Can people modify their behavior to prevent HIV infection?" asked a skeptical medical doctor some ten years ago. "We have to find a cure and a vaccine," he said shaking his head. But ten years later medical interventions continue to elude us like a receding rainbow, whereas the epidemic marches with heavy beat around the globe. A modification of human behavior, even if once unthinkable, begins to look like the cure of necessity forced upon us. Dr. Benoit writes:
"To change behavior and transform mentalities is fundamental; the longer we wait to act, the greater the risk is that it will be too late...The true and only effective form of care remains education which helps human beings to grow towards emotional and sexual maturity" (Dr. Benoit, pp.38,37).
There are no vaccines, continues Dr. Benoit, and medicines to relieve the sufferings are not within the reach of the Congolese. The Archdiocese of Brazzaville organized sessions for AIDS education and information in all its parishes in March and April 1996. "All our pastors are called to be familiar with AIDS to combat it decisively and talk about it with precision and security without shame" (p. 37).
The same Archdiocese has instituted a comprehensive and all-embracing program to deal with the situation, both for care of the victims and for prevention. Education must begin with the young and the youngest, writes Dr. Benoit, "since for most of our secondary school students it may already be too late"[!](p.38). The Church throughout the world is now challenged with a most serious mission: to modify human behavior as the most efficient and perhaps only means to decelerate the spread of pandemic HIV/AIDS, and to eventually eliminate it.
The huge Kenyatta National Memorial Hospital in Nairobi had 30% of the beds occupied by AIDS patients when I visited there in August 1993. A resident doctor and professor cited grim statistics: 2 million of Kenya's 25 people million were already infected. Life expectancy for the infected is a short several years in Kenya.
Sister Birgitta Ursula, OSB of St. Benedict's Hospital in Ndanda, Tanzania, provides data on the steep rise of infection in her neighborhood: seropositive results of Elisa tests given to volunteer blood donors rise ominously:
Year 1988 1989 1990 1991 1992 1993 1994 1995 1996
HIV +: 0.5% 0.9% 2.1% 3.8% 6.8% 18.5% 6.55% 7.3% 9.4%
Doubtfully positive: 15.75% 14.9% 3.4%
The doubtfully positive are treated as positive (Annual Reports).
Life expectancy, from initial infection to termination in death, is 2-3 years there.
Other countries of Africa fare as badly: The World Health Organization recently reported HIV infection of populations as follows: Botswana 16.45%, Zimabwe 15.88%, Zambia 15.66%, Uganda 13.31%, and Malawi 12.28%. Fr. Matthew Habiger OSB of Human Life International on a lecture tour in Uganda reports that most of the infected in Uganda will die in five years (HLI Reports, 158, February 1998). Governments put their trust in condoms to tame the epidemic but Cardinal Emmanuel Wamala of Uganda told his countrymen: "The way to avoid the disease is by conduct, not by condoms."(The Wanderer, December 18. 1997). Some villages have 3-4 funerals per week, ghost towns exist, orphans are left to cope.
A dozen prostitutes can infect several hundred clients per night in some African situations. Sporadic figures indicate that "some Nairobi working-class area prostitutes average nearly 1,000 sexual contacts per year (see Caldwell et al., Population and Development Review, June 1989:222). Other studies suggest much lower frequencies, but it does not require a mathematical genius to foresee that brothels with HIV positive prostitutes can spread the disease among a client population with the speed and roar of a prairie fire. In a controlled real-life study done in Kenya, it was found that in a little more than a year at least one third of the prostitutes became infected (see Cameron, Family Research Report, July-August 1992, citing Science News, 7/25/92, p.54).
I asked my companion as we drove toward the airport in Dar Es Salaam, Tanzania, why a part of the town appeared to be blighted and deserted. Houses were unoccupied, apartments were in a state of disrepair, weeds grew in the abandoned lots. Apparently buyers and new renters were not moving into the devastated area quickly. My companion shrugged: "AIDS, I suppose." He had recently buried five parishioners in another part of the country.
A group of sociologists researching in Nigeria foresee that fear of AIDS will confront polygynists with a do or die choice: abandon polygyny or die. "If projections...prove correct, then that disease will dominate all other considerations in African social policy, and society and social relations are likely to be ridden by fear" (Caldwell and al. 1989: 226). Fear of AIDS, they suggest, will in future support an historic cultural shift from polygyny to monogamy: "In the long run Africa may be nudged toward a Eurasian pattern (of monogamy) not by missionaries but by fear" (ibid. p. 225).
The researchers noted that men of means with several wives typically had a somewhat stable relation with a handful of other women as well. And some of their wives and companions, in turn, tended to have to have several on-going extra-marital relations with other men. Young women especially, not greatly attached to an aging husband, sought younger company. They acquired additional income from quasi-contractual relations with a handful of men. Sexual encounters were therefore multiple but limited mostly to quasi-stable partners known face to face. In this situation AIDS does not spread rapidly in the initial phase, but once it starts, entire networking populations are endangered. Studies by I.O. Orubuloye, John C. Caldwell, and Pat Caldwell in Ondo State of rural Nigeria, via 488 interviews, indicate that "all respondents averaged more than seven different partners in their sexual lifetimes" (Pop. and Dev. 1992:346). That is, the mean age at first sexual contact of young men was 16 years, but the average age at first marriage was 27 years. Seventy-seven percent of the married men were in monogamous marriages and 23 percent were in polygynous ones, with 40 percent of all their wives being in polygynous marriages. Since the life cycle was not yet complete, the average of polygynous marriages would increase with time. Among their fathers, 60 percent had been polygynists. At the time of the study, all respondents currently averaged 2.3 sexual partners. Of all the married men in the study, more than 90 percent reported having current sexual activities outside their marriage (ibid.: 345-349).
Older men taking several wives sweep the young marriageable women off the market, leaving the younger men with greatly reduced chances of finding a young bride. The polygynist men are proportionately much older than their recently acquired wives. The second, third and fourth wives being younger than their husbands, and having lesser emotional ties with them, tend to be available for extra-marital affairs. Women and men went through an average of seven partners during a lifetime.
AIDS had not been reported in the area where the above study was made, but its inevitable arrival is foreseen. Young men migrate for seasonal labor to cities and coastal areas where brothels exist. They are likely to be infected, and carry the virus into the home sex networking circuitry. The authors suggest that pattern of limited sex networking, in which partners know each other face to face, in contrast to the one-night-stand more typical of brothels, will not spread AIDS in the explosive manner of the commercialized brothels.
The southern Nigerian model "affords a great deal of protection to the population during the early part of an HIV/AIDS epidemic, with a low rate of spread of the infection for perhaps the first 15 years. But once the infection reaches a certain level in the community, it spreads rapidly thereafter in the absence of changes in behavior, and in fewer than 30 years, according to Anderson's projection, it catches up with the infection rate in societies where prostitution plays a more significant role" (ibid.:350). Ultimately, the epidemic will reach much higher levels of infection in the all pervasive sex networking community where the vast majority will eventually be exposed, than in the brothel model where exposure is more limited to the section of the population which frequents the brothels.
Chastity and monogamy can protect Africans completely from the deadly virus. When polygamists convert to Catholicism, one of the tasks of the basic communities is to come to the help of the other women after the husband has decided upon his monogamist partner. The Catholic Church is growing at a rapid pace in many countries of Africa today. In the long run, the chaste and the monogamists will inherit the continent.
Sr. Anne John, RJM, President of the Catholic Nurses' Guild of India wrote that
"The number of HIV/AIDS cases have increased in India like wild fire. The Archdiocese of Bombay Board of Education is working with CNGI to educate the youth especially in the Colleges and Schools about the sacredness of sex and the preciousness of life, and to teach them to be the agents of change. Since last year we have already covered over 130 Catholic Schools as well as trained two teachers from each of these schools (private correspondence, 8 January 1998)."
A recent UN report estimated that 1% of the adult population in India is now infected with the HIV/AIDS epidemic. This translates to about 5,000,000 infected in India, and numbers keep growing. Far worse, currently, is sub-Saharan Africa with 12% of sexually active adults infected. A total of 2,300,000 worldwide was expected to die from the epidemic in 1997, 50% more than in 1996. The UN report indicated that 30,000,000 in the world had HIV or AIDS in 1997, again a 50% increase over the previous year. In 1997, 5,800,000 new cases were expected (see The Daily Yomiuri 30 November 1997). The Global AIDS Policy Coalition reported on November 11, 1996 that if current trends continue, between 60 and 70 million adults will have been infected with HIV by the year 2000. The reports indicate that the epidemic is already enormous on a global scale, that an immense amount of human suffering and of economic losses are caused thereby, and that the epidemic is growing in intensity.
In the USA, 548,102 cases of people with AIDS have been reported to the Centers for Disease Control and Prevention (CDC) as of June 1996. Of these, 343,000, more than 62%, have died by that date. AIDS is now the leading cause of death among people aged 25 to 44. A recent study estimated that 630,000 to 897,000 adults and adolescents were living with the HIV infection as of January 1993, among them 107,000 to 150,000 women. Among men diagnosed with AIDs in 1995, male-to-male sexual contact accounted for the largest proportion of cases (51%) followed by injection drug use (24%). From 1985 to 1995 the proportion of AIDS cases attributed to heterosexual transmission grew from 2.5% to 16.7% (HIV/AIDS Statistics,Internet).
Among the 305,843 who had died through 1995, 192,191 (63%) died before reaching the age of 40 (Statistical Abstract of the USA 1996, Table 134). Although we take some comfort in the fact that the majority of the infected lived in a quasi-ghetto where high risk life-styles are the fashion - practicing homosexuals and drug abusers - we know that the ghetto is not an isolated Alcatraz. Cruisers infect hapless inexperienced adventurers, and sodomite habituates aggressively solicit new juvenile partners. That the disease is creeping out of the ghetto's is indicated by the growing trend of heterosexual transmission.
In America as elsewhere, chastity before marriage and monogamy in marriage, plus freedom from drug addiction, renders families practically 100% proof against HIV/AIDS contamination. The epidemic affects almost exclusively notorious offenders against the Sixth Commandment (sodomites, the promiscuous, the serially divorced and re-married) as well as drug abusers. But the contraceptive lifestyle now rampant in America is apt to erode defenses even in the general hetero-sexual population.
With contraception and contraceptive sterilization we see a parallel rise in fornication, adultery, serial marriages, and promiscuity. Recent statistics indicate that in the USA, 10.7 million women are sterilized for contraception, 10.4 million use the birth control pill, 7.9 million use the male condom, and 4.2 million males are sterilized (National Center for Health Statistics, June 4, 1997, based on a survey conducted in 1995).
Fornication, multiple sex partners, and prostitution spawns venereal diseases causing lesions which allow easier entrance to the virus. In addition, the chemical action of birth control pills, as well as of Norplant and Depo-provera, directly suppresses the strength of immune defenses against infection by HIV. Furthermore, the "misery" side effect of these drugs on mothers makes them irritable, renders marriages unstable, and results in hyper-active children who need drug therapy. In turn, drug dependence of children to control hyper-activity - now 10% in the USA - brings them one step closer to later drug addiction. All these factors added together put the USA into a position resembling somewhat the vulnerability caused by polygynism, sex-networking, and prostitution in other parts of the world. We may not be as far from wild-fire AIDS in the USA as we like to think.
Advantages of the USA in this respect are better general health and vigor, and the increased use of anti-retroviral drugs which decelerate the progress of the infection but do not cure it. A macabre disadvantage of this improved medication is that infected persons have a longer life-span during which they may be spreading infection, whereas in the developing countries death puts an end to infectious action more quickly.
"If the bugle gives an indistinct sound, who will get ready for battle?" (1 Cor 14:8). The advocacy of condoms to combat HIV/AIDS is exactly like that: it fails to rally the troops into combat. The dream of containing AIDS with condoms only postpones the time of awakening to the stern realization that chastity is the one and only sure remedy we have against the virus today. Dr. Jacques Suaudeau, M.D. who made a comprehensive study of the medical literature, shows that condoms do not provide "safe sex":
"Statistics show that in 10 to 15% of sexual acts condoms do not prevent HIV transmission. This risk rises to 20-30% when the act is homosexual, when sexual promiscuity is high, and when there is an STD [sexually transmitted disease]. The risk can fall down below 10% in case of a faithful hetero-sexual couple, without STD. Therefore, true "safe sex" cannot be expected from the use of a condom. Rather, it requires chastity, sexual abstinence, or faithfulness in marriage" (Medicina e Morale, 1997, pp.689-726, Summary).
Government officials who nevertheless encourage the use of condoms to damp down the spread of AIDS seduce citizens into courting an untimely death. Many prostitutes and their clients in infected populations die will within a few years, whether they use condoms or not.
When a marriage partner is HIV positive, only complete abstinence gives certain protection to the spouse. Intercourse with a condom provides only doubtful protection. It resembles playing Russian Roulette with a deadly weapon. The command of the Lord "Thou shalt not kill" binds marital partners to abstain if one of them is seropositive.
The Church combats AIDS most effectively when she radiates the splendor of chastity through her members and arms the faithful with power through her Sacraments and Liturgy. The Gospels indicate that Christ inspired people to follow Him by His chaste and challenging lifestyle. The disciples were drawn to His side by the sheer attraction of His robust goodness:
"The two disciples heard him say this and they followed Jesus. Jesus turned, and saw them following, and said to them, "What do you seek?" And they said to him, "Rabbi (which means Teacher), "where are you staying?" He said to them, "Come and see." They came and saw where he was staying; and they stayed with him that day, for it was about the tenth hour" (Jn 1:37-39).
Chastity is a thing of beauty, noble to behold, filled with glory. The example of the chaste Christ worked with dramatic effect among the twelve apostles, who elected to become celibate as the Gospel implies. Peter, once married, says as much: "Lo, we have left our homes and followed you" (Lk 18:28). Christ approved this radical change of life:
"Truly, I say to you, there is no man who has left house or wife or brothers or parents or children for the sake of the kingdom of God, who will not receive manifold more in this time, and in the age to come eternal life" (Lk 18:29-30).
Highly motivated women also followed Christ and His disciples, preferring close companionship with Him, and a life of service for others, to family life.
During twenty centuries celibate priests, brothers and women virgins have pioneered chastity in numerous cultures, in every age and in all parts of the world. Struggling with determination to preserve their own virtue, they generate a surplus of dynamic powers to inspire chaste lives all around them. For professed celibates Christ is the supreme attraction: "Ipsi sum desponsata," sang the virgin Agnes as she waited for the axe to introduce her to Christ. Celibates are the happiest people on earth, bubbling with joy, singing psalms and hymns to the Lord, going about their tasks with devotion. Celibates witness weddings, instruct First Communion Classes, anoint the sick, bury the dead. They are heart and hands of Christ among His people. They are the hope of the world now puddling in a messy situation of sex and AIDS.
Culture in the Church cultivates chastity in the world. Gregorian chant, that soulful, sincere and unpretentious communion with the Lord, ennobles the characters of celibates in seminaries, of virgins in convents. Singing and organ music at Sunday Mass delights worshipers with a taste of heaven. Soaring church towers in every village and town point ceaselessly to heaven. The peal of church bells accompanies daily tasks of life. Ceremonies, ritual, and vestments mark the great passages of life: baptisms, graduations, weddings, funerals. The beauty of music and art and the splendor of holy lives drive out the ugliness of unchastity.
Young men devoted to live chaste lives fill seminaries in Africa; young women in even greater numbers fill convents. Latin America rejoices in new hope as vocations finally pick up the pace. Mexico with a flood of candidates for the priesthood leads the way. South Korea, the Philippines, and Indonesia are three powerful engines of the Church in Asia, where seminarians and sisters abound in numbers. Where devoted celibates set the pace with power, chaste monogamous marriages follow in sheltered step. Chastity in the Church is the vaccine against AIDS in the world. The Church, with its over 400,000 priests, over 800,000 sisters, and 1,000,000,000 Catholics, when mobilized full force to live chastely, is equal to the job to be done.
Christ radiated chastity as a special gift to humankind. He selected the Virgin of Virgins to be His mother, who modeled for Him and for us the sweetness and beauty of womanly chastity. He chose Joseph, celibate foster father, to image the strength and pride of chaste manhood. He Himself chose the celibate life, and fasted and prayed to firm up His strength. He appointed John the Baptist as His forerunner, a celibate who became a martyr by reason of his denunciation of unfaithfulness in marriage.
Christ knew what was in humans, for He it was who, with the Father and the Spirit, designed and crafted human nature. He knew that we can be chaste if we will, and He did not shrink from demanding chastity by divine authority:
You have heard that it was said, "You shall not commit adultery." But I say to you that every one who looks at a woman lustfully has already committed adultery with her in his heart. If your right eye causes you to sin, pluck it out and throw it away; it is better that you lose one of your members than that your whole body be thrown into hell (Mt 5:27-29).
Christ's virginal presence at the wedding feast in Cana brightened the life of the new family with grace and holiness, we reasonably assume. At the bidding of His mother He filled six huge jars with superior wine to add joy to the occasion. We can easily believe that the new family became Christian, that the couple remained faithful for life, that John perhaps visited them before he recorded the events in his Gospel.
Moses mediated the commandment to the Israelites: "Thou shalt not commit adultery." That is what the Church teaches today when in confrontation with pandemic HIV/AIDS. But she is aware that preaching and teaching chastity does not suffice. It is heresy to believe that we can keep God's laws without His help in the form of grace. Pelagius preached an impotent "do-it-yourself" asceticism sixteen hundred years ago, but it never worked without the help of God's grace. It is especially at Holy Mass, in Confession and Holy Communion, in prayer where two or three gather in His name, in invocation of the Blessed Mother, that strength from God is poured into our souls to live chastely.
"With God nothing will be impossible" (Lk 1:37) said Gabriel to Mary. "Be not afraid," says the Pope. He encourages all pastors: "It is our common duty, and even before that our common grace, as Pastors and Bishops of the Church, to teach the faithful the things that lead them to God, just as the Lord Jesus did..." (Veritatis Splendor, 114).
Each new generation shapes its own destiny. We pray that the generation which will shape itself in the next 30 years will not tolerate sex outside of marriage, will live monogamously and faithfully with fierce determination, and will terminally purge the earth of the Human Immunodeficiency Virus when they bury deep under the ground the last remaining victim of AIDS on the face of the earth.