Can the Aids crisis be solved?

Many South Africans perhaps are experiencing a sense of Aids fatigue, especially among those not (yet) generally affected by the effects of the pandemic. Chances are that some readers will have picked up this edition, and felt some disappointment that more than a quarter of the newspaper is dedicated to HIV/Aids issues.

It would be unfortunate if such readers were to ignore this portion of this week’s content, because Aids, and the Church’s role in addressing the crisis, is neither well nor widely understood. Even when they are grasped, much of the debate is clouded in misunderstandings about the causes of Aids, medically and socially. Worse yet, the response in terms of prevention and treatment in South Africa has largely been inadequate.

Matters are not helped when the president of this country has embraced ideas about Aids which are broadly discredited within the medical community, when the minister of health is advocating poorly expressed positions that are difficult to defend, and when government and civil society are pulling in different directions.

The absence of common purpose in addressing matters of prevention, treatment and social effects leaves the most vulnerable to the disease ever more exposed.

The Catholic Church, which is performing such splendid and essential work in treatment and care, itself is still struggling to harmonise its pastoral and doctrinal response to the question of prevention.

The Church’s line that abstinence from sexual activity outside marriage and scrupulous fidelity within represents the only safe way of avoiding the transmission of HIV is in principle the most logical counsel. It is an ideal which must be vigorously promoted.

However, this ideal requires not only a change of behaviour among individuals, but a revolution of social mores within the societies hit hardest by the pandemic. The truth is those most at risk of infection have little primacy over their sexuality. Many women cannot refuse sexual relations with an adulterous husband who might be infected (often, the man himself will not know whether he carries the HI-virus, because of a cultural resistance to Aids testing), or insist on abstinence in a relationship with a boyfriend. Rape, in its various manifestations, further places women at risk.

Poverty fuels the crisis, as desperate women and even girls resort to selling sexual favours to feed their families, or even to finance transport to school.

It is right to advise people that abstinence and fidelity are the only safe ways of preventing infection, but it is inadequate counsel to people who do not have the autonomy to actually make decisions about abstinence of marital fidelity.

The bishops of Southern Africa in 2001 left the question of condom-use within marriages where there is a possibility of infection to the conscience of such couples. The Vatican is still caught in the slow process of discerning a formal teaching on condom-use in Aids prevention (there is no such defined teaching at present).

Many Aids activists apportion some blame to the Church for rising numbers of infections on the basis of its supposed position on condoms. While some Church officials have made irresponsible statements about the safety of condoms (such as the untrue charge that condoms are more porous than they actually are) or even raised bizarre conspiracy theories, it is equally apparent that the promotion of condoms has not succeeded in reducing Aids rates.

It seems evident that within the cultural setting of the pandemic in Southern Africa, neither the Church’s message nor the advocacy of condoms is being accepted .

As many Catholic Aids activists have argued, the combination of poverty and a patriarchal culture in many African societies are the root cause of the pandemic. Changing these conditions, however, is a long process and perhaps an impossible task.

The urgent question is this: what strategies can succeed in the short-term, and how much collective will and pragmatism exists to identify and implement these.