Pope Benedict XVI just wrapped up his second trip to Africa as pontiff. The last time he made such a journey, you may recall, it became a public-relations nightmare, as most media coverage focused on a single exchange — naturally, about AIDS and condom use — on the airplane ride from Rome. To discuss why the pope actually has a point to be heeded by the public-health and AIDS-aid communities, Matthew Hanley, co-author of the award-winning Affirming Love, Avoiding AIDS: What Africa Can Teach The West, as well as author of The Catholic Church and the Global AIDS Crisis, discussed some of these issues with National Review Online.
KATHRYN JEAN LOPEZ: How is the Church’s approach to the AIDS crisis “sensible and constructive”?
MATTHEW HANLEY: She places confidence in the capacities of people to live in ways which enable them to avoid infection altogether; each of Africa’s declines in AIDS rates is most attributable to these types of changes in behavior — that is, greater fidelity and reductions in casual sex. The Church treats the person as a whole. No one else provides more care and support to those with AIDS around the world.
LOPEZ: Do we shy away from talking about behavior change — really getting to the root of the AIDS problem in Africa — because it might make us look at our own culture and behavior?
HANLEY: That’s a great insight. Our country’s approach to STDs is not something we merely export — something we dump abroad but shun here. Risk reduction is currently what we do here. The result? Constant, or rising, rates of infection. One quarter of teenage girls in our country has an STD. That’s a crisis. But it’s one we attempt to normalize. Chicken pox at eight. Syphilis at 18. It’s just the new normal. There are medicines for that.
There are financial incentives, of course, and professional pride, that also keep robust discussions of behavior — along with the failure of our technical approaches — at bay. And we cherish our ideas — our supposed freedoms, and our non-judgmentalism, which is itself a judgment. These may be the hardest to relinquish, even once we begin to suspect that they may be deficient, that they have led us astray. As Plato said, we prefer ourselves to the truth.
LOPEZ: Do you worry that you take for granted the ideological assumptions of many well-intentioned people at global-health bodies.
HANLEY: We couldn’t possibly speak to the motives of everyone involved. But we do go out of our way to say that many people are well-intentioned. The professionalism, intelligence, and fair-mindedness of so many people are unmistakable. Nonetheless, we felt it would be helpful to put some names to the broad underlying strains of thought which hold sway today.
Why? People know the Church’s teaching, or at least that the Church has a specific teaching — even if only from media soundbites. But they may not know the criterion by which they make their own judgments. I think it is fair to say, as we do in the book, that utilitarianism, relativism, and individualism are the tenants which occupy many minds in the West today. These are the true drivers of our AIDS-prevention policy, and they are inherently destructive, so it should not be altogether surprising that they have failed when it comes to an epidemic such as AIDS. We argue that this policy of risk reduction is a philosophy (rather than a science) which deserves much greater critical scrutiny. #more#
LOPEZ: When John Paul II died, The New Statesman explained, “The Pope probably contributed more to the continental spread of the disease than the trucking industry and prostitution combined.” Is there some truth to that? If not, why such exaggeration?
HANLEY: Nothing could be farther from the truth. The fact that statements of such profound inconsistency and condescension are so commonly recycled points to a certain egotism and emotivism which leads to great poverty of thought. Are we really to suppose that great numbers of people do not use condoms because they heard somewhere — from the pope in Rome! –that that’s not allowed, but nonetheless engage in prostitution or other kinds of sexual activity proscribed by the Church? Furthermore, these types of statements typically imply that people in Africa have no alternative but to engage in inherently risky situations — that they are incapable of change, of reasoning, of choosing what is good. This is not only to condescend, but to view them as not fully human. But the statement is designed to appear magnanimous and non-judgmental.
We probably see such wild exaggeration because figures such as the pope represent a threat to some people’s worldview, and to their own wants. We’ve seen forms of this not only in the New York Times, but also in once-reliable medical journals. Even France officially said the pope’s remarks represent a threat to public health. And yet, when authorities such as UNAIDS suppress inconvenient findings of a condom study that they themselves commissioned and resist sensible behavior-change measures, it escapes these critics’ disapprobation.
This is what it looks like when we become unhinged from both reason and faith, and become wedded to ideology.
LOPEZ: What is a “discordant couple” and isn’t that an awful way to describe two people with some painful decisions to make?
HANLEY: It’s a term taken from the medical literature. And I agree, it’s not the most felicitous of terms, but it is simply meant to refer to the fact that one member of the couple has HIV while the other does not (i.e. they are “sero-discordant”).
The term was initially used to refer mainly to married couples in which one spouse had HIV — a particular situation which has attracted rigorous debate among theologians and ethicists. But the term has since been used so broadly that it raises another question: What constitutes a “couple” these days anyway? All new infections result, by definition, from two persons with different HIV status. The vast majority of infections do not occur within married couples. The marriage rates in southern Africa — the AIDS epicenter — are quite low, by the way.
LOPEZ: Why do you begin the Affirming Love, Avoiding AIDS book with a photo of a father in Kenya?
HANLEY: The father in that photo is going to visit someone with full-blown AIDS who was living alone in a humble hut without any food or provisions — and lying in his own waste, as it turns out. This father was a volunteer caregiver who had taken time away from his work to check up on a neighbor in need. Few people would do that at the time.
This was the late 1990s — a time of great fear, as about a quarter of the local population had HIV/AIDS, but very few had any health care whatsoever. It was the first time I ever went to Africa, and the reason I went in the first place was to work on a home-based-care program. The Church was essentially the only entity attempting to provide such care at the time; the international donors and NGOs were strictly focused on condoms and such.
I wanted to convey that the imperative to care for the sick is not in conflict, as some suggest, but complements the imperative to respect others and self in the arena of human sexuality. It is all of a piece.
For more from Hanley, see here.