peripheries

Condom War: Another Catholicus Ignoramus: Cardinal Pell from down under

The head of the Catholic Church in Australia has open his mouth to add primate bunk to previous pontifical nonsense.

Unsurprisingly, the Cardinal Pell from down under endorsed the papal comment made in Africa that condoms “can even increase the problem” of HIV, adding that, “The idea that you can solve a great spiritual and health crisis like AIDS with a few mechanical contraptions like condoms is ridiculous”.

HIV and AIDS have been jumbled with quite a lot of nonsense but to relate it with a great spiritual crisis is a rather interesting novelty. With the Church in charge of the spiritual (alongside our sex-life), one wonders is the Cardinal is advertising for his own business on the back of HIV infected people.

Reporting a conversation with “a non-Catholic health worker”, the Cardinal added that “people in remote areas are too poor to afford condoms and the ones that are available are often of very poor quality and weren’t used effectively.” For crying out loud, isn’t that saying that what is needed are good quality condom provided as an affordable price? What about fre condoms?

But of course not, because and without a shred of evidence Cardinal Pell added that “Condoms are encouraging promiscuity. They are encouraging irresponsibility.” How could condoms encourage promiscuity? And if they were, would it matter as long as people are using them whilst being promiscuous? There is no evidence that people who started anti HIV treatment or men who were circumcised became more promiscuous. So why the idea of using a condom or their availability would be any different? There is little hope that the Cardinal could understand what is sacerdotal vestments forbid him to know.

Adding misinformation to ignorance the prelate could not refrain harking back the old red herring of Thailand vs. the Philippines: “If you look at the Philippines you’ll see the incidence of AIDS is much lower than it is in Thailand which is awash with condoms.”

The myth was debunked here on peripheries, but it might be wise looking at more recent data from UNAIDS. For example at the estimated number of people living with HIV in 2001 vs. 2007 in the Philippines, <1000 vs. 8300 and Thailand, 660,000 vs. 610,000. Of course the number of people living with HIV is much higher in Thailand (see previous posting for an understanding of why) but it has also decreased between 2001 and 2007 whilst the figure has increased in The Philippines and is set to increase even more in the coming years if nothing is done now to ensure that the virus does not find a fertile Christian soil to multiply, like it did in Africa.

The catholic’s answer to HIV? As always, abstinence and faithfulness. But as pointed out by Don Baxter in The Australian, the pontiff’s comments about condoms could easily be misunderstood in Africa, where it is common for men and women to have several concurrent sexual partners but still see themselves as being faithful. “Calls for not using condoms and being faithful are heard by Africans to mean if they have regular partners, they don’t need to wear condoms,” said Baxter.

Abstinence is one method of preventing the transmission of HIV, condom is another one. To discourage the use of one or the other is plain stupid and irresponsible. Is it even stupider if it is done on spiritual background, because the HIV virus can be killed with a sign of the cross over someone and a few drop of holy water.

Cardinal Pell is not alien to controversy, in October 2007 he challenged the cause of climate change: “I am certainly skeptical about extravagant claims of impending man-made climatic catastrophes, because the evidence is insufficient. Climate change has always occurred. Scientific debate is not decided by any changing consensus, even if it is endorsed by public opinion.”

It is definitively a hard time for enlightenment, especially within the Catholic Church.

All you have to do is put on a condom

Prof Montagnier who co-discovered the HIV virus that causes AIDS (always worth repeating) warmed in Calgary that HIV prevention should not be forgotten. Montagnier also criticised people’s complacency towards HIV and AIDS:

“It seems that the young generation has forgotten about prevention, because they think there are cures for HIV, that it’s no big deal”

Montagnier’s comments come at a time when treatment as prevention is one of the hottest topics at the 16th Conference on Retrovirus and Opportunistic Infections where two studies have demonstrated that there is a lower risk of HIV infection in serodicordant couples when the HIV positive partner is on treatment and that pre-exposure prophylaxis study in Macaques have shown that ART could prevent some HIV infections.

Montagnier’s message is that “[AIDS] is still a very important disease, and it’s not a chronic disease.” Amanda Chapman, communications analyst for AIDS Calgary, commented that people should control their own actions because they can’t count on scientists making a breakthrough:

“So it’s really risky to say, ‘well, we think science is going to be able to find the answer for us’, when, really, all you have to do is put on a condom.”

Conventional HIV prevention has become a challenge particularly in the developed world where very few will ever know what AIDS is and many have already forgotten what it was. With treatment down to a few pills a day even when on second or third line therapy, AIDS may not be a chronic disease but it looks very much like one.

There is a compelling reason to put prevention back onstage: we know a very good prevention method which is effective in nearly 100% of the case when use consistently and properly: condoms. Regreatbly, condom use is still not a the norm for various cultural and social reasons. The real question is, have we achieved the best we can do when it comes to prevention? If not, how to reframe, rethink and rephrase it?

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Condom failure or media failure?

In a lengthy but rather well constructed and documented article published online in The East African, Curtis Abraham steers the charge against UNAIDS “for perpetuating the myth of condom effectiveness in Africa in the face of all evidence.”

Abraham rightly identifies that in a country like Uganda, the reduction in HIV incidence was not the result of condom-only prevention interventions (thanks to Helen Epstein for casting some light on the subject in her book “The Invisible Cure”) but was owning to behaviour changes and in particular partner-reduction campaigns such as that of “zero-grazing” promoted by President Museweni.

Referring to various studies, published or not, Abraham challenges UNAIDS (who commissioned some of these studies) for castigating the evidences that “condoms were seen as ineffective in preventing the spread of HIV/AIDS in generalized epidemics like those taking place in eastern and southern Africa. […] For years various UNAIDS reports maintained that condoms, not partner reduction had been the major reason for Uganda’s success against AIDS.”

Abraham marvels “Why would UNAIDS, a renowned global organization dedicated to educating governments around the world about the greatest plague of our times, behave in such a manner unbecoming of a world institution?”

The answer is simple: at UNAIDS “ideology [is] taking precedence over epidemiological facts.” I know some who would probably agree with that and I might well be one of them. Now things may not be that simplistic and to recognise that behaviour change is as important as condom use in the fight against HIV (if not more) but to ignore that this same behaviour is influenced by ideologies and beliefs generated and disseminated by media acting too often as the mouthpiece of some dubious organisations is not really sign of discernment.

There is a profound and fundamental difference between saying that condoms are ineffective and that condom use is ineffective. When used consistently and properly condoms are the best protection available against HIV infection. Now as noted by Abraham, condoms are seldom used in long term relationships, even concurrent ones, which are believed to fuel the HIV epidemic in some African countries. In these circumstances, no surprise that they do not work!

In a climate where condoms are already challenged on various grounds most notably religious with for example huge billboards being set up in Tanzania by Christian fundamentalist organisations to discourage people to use them, what will people remember of Abraham’s article? That condoms in Africa are ineffective to fight HIV. Those not already using them will feel vindicated in their choice, those who used them irregularly will probably use them less often and those who hesitated might join those who did not use them at all.

Maybe UNAIDS is politically driven, ideologically constrained but one should remember that UNAIDS is swimming if not drowning in a sea populated by life-threatening ideologic sharks. Two wrongs do not make a right but with HIV prevention trapped in a conundrum of beliefs that can’t rarely be fought by reason or by facts, the means might justify the end.

Back to Uganda or any other country dramatically affected by HIV, what should be done? Throw away condoms and promote monogamy, abstinence until marriage and faithfulness? Oh but wait, hasn’t this been tried and found wanting?

HIV prevention can’t be monolithic and must include a variety of approaches. To write bluntly that condoms are ineffective is pointless and dangerous. Condoms are an essential tools in the fight against HIV, and they work, when they are used – properly and consistently.

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Size matters – How big is your condom?

In a study published in STI online, Michael Reece and Colleagues empirically assessed the relationship between men’s penis size and their perception of condom feel and fit. Such perception is particularly important for the promotion of correct and consistent use of condom by men, and consequently their efficacy to prevent sexually transmitted diseases.

1,661 men self-reported penile dimensions ranging from 4 to 26 cm in length and 3 to 19 cm in circumference and were consequently grouped in 3 different dimension groups, “shorter,” medium and “longer” (not short, medium and long!).

Unsurprisingly, men in the longer group reported condoms being to short whilst men in the shorter group reported “unrolled” latex at the based of the penis. Those with larger penis circomference complained of condom’s tightness, while those with smaller penis circumference reported loose condoms.

“Longer penile length and larger penile circumference were both significantly associated with men’s reports that condoms are too short and too tight, longer length and larger circumference both associated with perceived tightness along the penile shaft, and perceived tightness on the glans and base associated only with larger circumference. Men with shorter penile lengths described having some unrolled condom left at the base of the penis after application. However, while some may find this to be an undesirable  characteristic of condoms, some have suggested that this unrolled latex may offer protection against condom slippage.”

There were several limitations in this study, self reporting not the least, but it is clear that having latex hanging about, or feeling squeezed like haggis in sheep’s stomach is not encouraging to use condoms. What is also striking is that men do not seems to be aware that condoms come in different sizes or shapes. Could it be that men are too embarrassed when buying condom to check the packaging for the size (whilst they check the size of their package) or that it is women, often mislead by men when it comes to size, who buy condoms?

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INTERMEZZO: Understandind HIV/AIDS Surveillance Data in the US

Blogging has slowed down due to an increased work overload. Today,  this intermezzo is provided courtesy of Kaiser Network

In this narrated slide tutorial, Jen Kates, M.A., M.P.A., vice president and director of HIV policy at the Kaiser Family Foundation, defines basic surveillance terms and explains the federal and states’ role in surveillance of the U.S. epidemic. The tutorial also features a guide to reading a surveillance report from the Centers for Disease Control and Prevention and explains the various data contained in the report.

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