martedì, marzo 24, 2009

The Pope and the condoms

THE POPE AND CONDOMS

March 23, 2009

On March 17, a reporter asked Pope Benedict XVI, while en route to Cameroon, to defend the Church’s promotion of monogamy and opposition to condoms in the fight against AIDS, especially since such positions are “frequently considered unrealistic and ineffective.” He responded in part by saying that “the scourge cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem.” This prompted a fresh, if predictable, round of scorn from the western press. France went so far as to say his statements represent a threat to public health. Yet it might surprise the casual observer to learn that empirical record supports the Pope’s assertions.

First, every instance in which HIV rates have fallen in Africa is most attributable to fundamental changes in sexual behavior, most importantly an increase in faithfulness. In contrast, HIV transmission rates have remained high and even grown in other African countries where widespread behavior change has not occurred, despite considerable increases in condom use. An influential article in Science last year lamented that international HIV prevention priorities had not yet shifted to reflect this epidemiological profile.

In recent years, researchers have paid greater attention to the specific issue Benedict raised: the possibility that condom promotion even risks “worsening the problem.” The theory that people may take greater risks in exposing themselves to harm because they feel a new technology grants them a measure of protection in doing so, goes by the names of “risk compensation” or “behavioral disinhibition” in public health circles. A series of recently published articles (including in the Lancet) have concluded that this phenomenon – that condom promotion can lead to greater risk taking - is quite real indeed.

Finally, the track record for condoms – by far the most emphasized approach over the years – has been rather poor in Africa. An exhaustive review of the impact of condom promotion on actual HIV transmission in the developing world concluded that condoms have not been responsible for turning around any of the severe African epidemics. This rigorous study was originally commissioned by UNAIDS, and conducted by researchers at the University of California at San Francisco. Instead of welcoming the findings, and adapting HIV prevention strategies accordingly, UNAIDS first tried to alter the findings, and ultimately refused to publish them. The findings were so threatening to UNAIDS that the researchers were finally forced to publish them on their own in another, peer-reviewed journal.

This episode provides a disturbing glimpse into the priorities of the lead United Nations’ AIDS agency. Though normally quick to insist on the right to “accurate information” about condoms, in this case they placed their own ideological convictions above the welfare of those they are charged with protecting. Still, the New York Times claims, mere hours after the Pope’s remarks, that he “deserves no credence when he distorts scientific findings about the value of condoms in slowing the spread of the AIDS virus.” The informed observer might well conclude that the outrage aimed at the Pope over the fight against AIDS is poorly directed.

Matthew Hanley

PS.
Per chi non capisce l'inglese, traduco il paragrafo piu' importante.

Negli anni recenti i ricercatori hanno prestato piu' attenzione alla questione specifica sollevata da Benedetto: la possibilita' che la promozione del condom rischia di "peggiorare il problema". La teoria secondo la quale le persone possono incorrere in rischi maggiori esponendosi al danno perche' hanno la sensazione che una nuova tecnologia assicuri loro una misura di protezione nel farlo viene chiamata nei circoli che si occupano di salute pubblica "compensazione del rischio" o "disibizione comportamentale". Una serie di articoli pubblicati recentemente (su The Lancet incluso) hanno concluso che questo fenomeno, ossia che il la promozione del condom puo' portare a rischiare maggiormente, e' certamente reale.