A few years ago, in the town of Pemba on Mozambique's soggy east coast, I met the director of the state Aids prevention office for the district of Cabo Delgado and asked him how many condoms he had to distribute. The answer was 200,000, said Candido Matias, but only every three months, sent from the capital, Maputo. But the supply wasn't always regular, and the quantities varied.
But let's assume it was a regular supply, I said, before we looked at the statistics. The province has a population of 1.2m, 60% of whom were under 24, of whom 11% were sexually active (according to the government's own figures). That's about two condoms per sexually active person every three months. Or maybe it's four, if you take only males. But you get the point.
And that's the pope's point. Aids cannot be solved by condoms, because condoms are only effective in reducing the spread of Aids if they are used in certain ways, as recommended by Dr Catherine Hankins, the chief scientific adviser for UNAids. She says 60% of "risky sex acts" – which she defines as sex with a casual partner or with a married partner who has other partners – would need to be covered by condom use. Currently, the coverage in sub-Saharan Africa is about 18%, which works out at 4.6 condoms per man per year. In short, you can only defeat Aids by massively increasing the quantity available.
Yet if the problem is one of supply, why does the pope say that Aids "cannot be overcome through the distribution of condoms, which ... even risks aggravating the problem"??
One reason that the pope's claims have been scorned is that a Vatican official, Cardinal Alfonso Lopez Trujillo, tried to prove (with a scientific paper with 87 footnotes) in 2004 that condoms were porous. They had a 15-30% failure rate, claimed the cardinal, and should therefore carry a health warning. A BBC Panorama programme decided to test the assertions, and found them risible. Studies in San Francisco show that if 100 uninfected people have sex using condoms with infected partners for a year, only one of them will get the virus. This hardly makes condoms foolproof – as the unlucky one-in-a-100 Californian would tell you – but it does prove that, used properly and regularly, they are highly effective against Aids, and the good cardinal badly undermined the church's case by his spurious claims.
Yet the church's case – however badly it can be represented by popes and more-Catholic-than-the-pope Catholics – stands. The unavoidable fact is that, in Africa, Aids transmission rates have increased alongside the promotion of condoms. In Africa condoms cannot be used in the way that gay people use them in San Francisco, because the context is quite different. Condoms are not easily available, on a regular basis. They cannot readily be afforded, when not supplied. And even when they are available, the motivation is often lacking. What drives promiscuity is not hedonism, but desperation and despair. Aids rates explode around the mineral mines, the shanty towns, the lands ravaged by war, and child soldiers and drugs.
Then there is the evidence gathered by Dr John Richens, who lectures in the Centre for Sexual Health and HIV Research at the Royal Free and University College, who some years ago published a Lancet article that questioned the theory of Aids prevention being used by the international agencies. Prophylactics, he says, are a "unique weapon" in the battle against the virus; but at the same time, they undermine that battle, because they encourage risky behaviour. In the west, the removal of the fear of unwanted pregnancies through contraception has led to the age of young people's first sexual encounter coming down year on year. In Africa, the switch has been dramatic: Africans arriving in the cities have abandoned their traditional authority and morality structures and moved towards western-style attitudes to sex – but without the lifestyles to support the regular and proper use of contraception which those attitudes take for granted.
The Catholic case is, essentially, that a "technical" approach to Aids – one that relies on education and contraception – is doomed in Africa to fail, and indeed has failed. The only really effective method is one that aims to change behaviour – as the case of Uganda, where Aids transmission rates, almost uniquely in Africa, have gone down. Fidelity and abstinence were promoted by major religious organisations with backing from President Museveni, who called for a return to "time-tested cultural practices that emphasise fidelity and condemn extramarital and premarital sex". The government programmes do not exclude condoms, but the level of use among Ugandan males is lower than in neighbouring countries. The Ugandan model suggests there should be less fatalism among the international agencies about changing the behaviour of young people. And there should be less fatalism in the world about acting to save Africa from poverty and war – which is the main burden of Pope Benedict's message from that continent.
The church's case would be helped if it did not attempt to bolster its arguments with bad science. And it is certainly time for the pope to announce the almost universal consensus among moral theologians that the use of a condom to prevent the transmission of death is on a quite different moral plane from using them to prevent the transmission of life. (He doesn't, because it mixes the message). But however badly the case is made – and however resistant people are to it – the fact is that, when it comes to condoms as a weapon to fight Aids in Africa, the pope is right.
