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More on Pope Benedict and Condoms:

A few weeks back I posted on what I perceived to be an incorrect suggestion in a Washington Post editorial on the position of Pope Benedict with respect to condom use in Africa and his contention "You can't resolve [the AIDS epidemic] with the distribution of condoms. On the contrary, it increases the problem." At the time, I said that surely the Pope's claim was that condoms lead to an increased frequency of sex and that increased sex led to an increase in AIDs. So the claim was a hypothesis subject to testing: does the increased-sex effect of condom use outweigh the safety benefits of using condoms.

Michael Webb of Balliol College has now followed up and done an extensive set of interviews with experts in public health to test Pope Benedict's assertion and they are posted on a website called The Alligator.

Webb describes the controversy that the Pope's statement provoked:

Delivered to a continent where 22 million people live with HIV, and which accounted for 75% of all AIDS deaths in 2007, his words provoked strong reactions. Journalists, politicians and AIDS activists from around the world lined up to criticise the Pope's views: "The Pope deserves no credence" said the New York Times in an editorial; "Impeach the Pope" urged a guest writer in the Washington Post. The British medical journal the Lancet accused him of having "publicly distorted scientific evidence to promote Catholic doctrine", Former French Prime Minister Alain Juppe suggested that he was "living in a situation of total autism", while Rebecca Hodes of the Treatment Action Campaign in South Africa described his remarks as "alienating", "ignorant" and "pernicious".

The row goes beyond previous disagreements because the Pope appeared to stray from morals, on which he has some claim to authority, into science, on which he does not. His comment was a "testable proposition", noted The Times in its leader, with "immense implications for human health and welfare." The article concluded by arguing that "the Vatican must amend its position on Aids." The specific scientific claim aside, the problem is that it is apparently impossible for the Vatican to do this.

Webb reviews the literature and seems to conclude that based on what we know today the overall effect is inconclusive whether the Pope's claim is correct. Here's one comment that supports the Pope:

Mr Doerflinger explains the science behind their claims: "There's plenty of data. Condom distribution as a solution to generalised AIDS epidemics is often very disappointing in its results, and there's some data that it makes things worse. [There's] the whole concept of risk compensation, that people engage in more risky behaviour because they have a false sense of security from the condoms. So I thought his comments were perfectly sensible to anyone who knows the literature." Green and not heard

This literature to which he refers does exist, though it is not mainstream. Its principal proponent has been Dr Edward Green, Director of the AIDS Prevention Research Project at Harvard. "The best evidence we have", he says, "supports the Pope's comments. There is a consistent association shown by our best studies between greater availability and use of condoms and higher (not lower) HIV infection rates." He told me:

In epidemics that are population wide, where most HIV is found in the general population, for whatever reason we can't get people to use condoms consistently, and when they use them at all, that seems to have the effect of disinhibiting people's behaviours so they end up taking greater sexual risks and cancelling whatever risk reduction they have gotten from the technology they're using.

Others disagree.

The article is really terrific for those wanting to know more about this.

Kazinski:
But it really doesn't matter if the Pope's statement has some scientific backing, does it? What matters is that he takes a position counter to the guardians of moral authority and conventional wisdom, that's his real sin.
4.11.2009 3:56pm
Thoughtful (mail):
Forgive my ignorance, Kazinski, but I thought the Pope WAS one of the "guardians of moral authority," albeit not of "conventional wisdom"...
4.11.2009 4:07pm
Jen:
I find the views of people who have taken a vow of celibacy to be absolutely dispositive when it comes to issues concerning sexual behavior. /snark
4.11.2009 4:20pm
einhverfr (mail) (www):
Like all real problems there is no simple solution. You can't just throw condoms at the problem (in the sense of providing them) and expect the HIV epidemic to go away. At the same time, I don't think you can approach the problem without making condoms a part of a control strategy.

There have been successful test programs using condoms and public awareness to reduce HIV rates in some countries (most notably Denmark in the early 1990's) but these tend to be extremely resource intensive, and place more emphasis on public awareness and emphasis on using condoms rather than simple distribution.

As in all things, you can look at failures and point to the ideas that this doesn't work. However unless you look at successes as well, you can't draw many conclusions.....
4.11.2009 4:41pm
Cornellian (mail):
But it really doesn't matter if the Pope's statement has some scientific backing, does it?

No it really doesn't matter, because even if distributing condoms were proven
beyond doubt to be the most effective way of preventing HIV by far,
the Pope would still oppose distributing them. He opposes them
because he thinks using a condom is immoral, even for a married
couple. If you buy that position, it doesn't matter if they're
effective.
4.11.2009 4:48pm
Cornellian (mail):
I find the views of people who have taken a vow of celibacy to be absolutely dispositive when it comes to issues concerning sexual behavior.

Yeah, we can see how well that "abstinence only" approach has worked in the priesthood.
4.11.2009 4:49pm
byomtov (mail):
Here's one comment that supports the Pope:

I think it might be appropriate to identify the source of the comment a bit more fully. It does not come from some objective observer, but from

Richard Doerflinger, Adjunct Fellow in Bioethics and Public Policy at the National Catholic Bioethics Center in Boston and recipient of the Gerard Health Foundation's inaugural $100,000 Life Prize.

He supports the Pope!! What a surprise.
4.11.2009 4:55pm
Daryl Herbert (www):
No it really doesn't matter, because even if distributing condoms were proven beyond doubt to be the most effective way of preventing HIV by far, the Pope would still oppose distributing them. He opposes them because he thinks using a condom is immoral, even for a married couple. If you buy that position, it doesn't matter if they're effective.

Let me get this straight: because it wouldn't affect the Pope's stance, therefore it "really doesn't matter," even though it could affect whether whether thousands of people get AIDS?

I'm glad you have your priorities in order.
4.11.2009 4:58pm
TruePath (mail) (www):

There is a consistent association shown by our best studies between greater availability and use of condoms and higher (not lower) HIV infection rates.


Well that's a great argument. There is probably also a consistent association between neighborhood crime rates and number of police patrols. I guess we should give up on police too.

Maybe it's just a simple misstatement or I'm taking it out of context but merely seeing someone present this kind of faulty logic as evidence make me very suspicious.
4.11.2009 5:01pm
Malvolio:
I find the views of people who have taken a vow of celibacy to be absolutely dispositive when it comes to issues concerning sexual behavior. /snark
It's not just snarky, it's wrong. Is your mortician dead? Is your historian long dead? Is your veterinarian a cat? A person can be an expert in a field without being a participant.
No it really doesn't matter, because even if distributing condoms were proven beyond doubt to be the most effective way of preventing HIV by far, the Pope would still oppose distributing them.
Obviously : the Pope opposed birth-control before AIDS was discovered.
He opposes them because he thinks using a condom is immoral, even for a married couple. If you buy that position, it doesn't matter if they're effective.
Let's try this in some other areas:

Since you think the Drug War is immoral, it doesn't matter that it doesn't significantly reduce drug use.

Since you don't believe in abstinence, it doesn't matter whether abstinence education reduces teen pregnancy.

Since you oppose gun control on political grounds, it doesn't matter if gun ownership reduces crime.

Mmmmm, no. Better, I think, to point out all the reasons that your position is the right one, even the ones that aren't so important to you personally.
4.11.2009 5:04pm
einhverfr (mail) (www):
Daryl:

Let me get this straight: because it wouldn't affect the Pope's stance, therefore it "really doesn't matter," even though it could affect whether whether thousands of people get AIDS?

Hmmm.... I thought that post was about whether the Pope's views had scientific basis, not whether the Pope's views were irrelevant to the debate.

The basic thing is that the Pope doesn't care if something outside of Catholic teaching has scientific backing regarding whether it is socially effective because the Pope sees this as a moral rather than a medical crisis at its root. His arguments are going to continue to be the same: Ignore Catholic morality and the medical crisis will be unresolved, and these arguments won't change regardless of scientific basis.

This is one area where any conflict will not be resolved by NOMA.
4.11.2009 5:05pm
TruePath (mail) (www):
Also I would point out that the most compelling points in that article all talked about generalized condom distribution. I don't know but it wouldn't surprise me if condoms weren't particularly helpful when used this way.

However, my (limited) understanding was that targeted condom distribution programs could be very effective, particularly when distributed to sex workers. Admittedly this makes condoms much better suited to combating AIDS in places like Thailand rather than in Africa where it is often spread through the general population.

Now when the pope says "it increases the problem" he pretty obviously doesn't mean that some types of condom distribution worsen the problem but the right kind of distribution can be a very effective method. The pope means we should give up entirely on condom distribution to fight the AIDS epidemic.

In short the pope's argument is fundamentally flawed (if not outright misleading) since any substantial cost effective role for condoms in combating the AIDS epidemic undermines the point he wants to make.
4.11.2009 5:11pm
A. Zarkov (mail):
I don't see how the Pope can be anywhere near correct. The probability of (uninfected) partner A getting an HIV infection from a carrier partner B is between 1/500 and 1/1000 per contact under normal male-female unprotected sex. With condom protection the chances of infection drop to less than 1 in a million assuming the condom is used correctly. Thus condoms buy you something more than factor of 1,000 in protection. Of course if condom distribution increases the frequency of unprotected sex, then the Pope is right.

BTW the chances of infection with unprotected normal sex was hard to come by in the 1990s. I had to get from graphs appearing in a JASA issue circa 1992. Back in the 1990s, the gay Mafia was promoting the idea that AIDS would jump into the heterosexual community in an obvious effort to scare the public to increase AIDS funding. As we know the jump never happened.
4.11.2009 5:23pm
Rod Blaine (mail):
How many advocates of the "torture doesn't work, it won't get you reliable intelligence" position also believe that torture would always be - what's that word - intrinsically evil, even if it did work? Does that mean their arguments about the efficiency of torture should therefore be ignored?
4.11.2009 5:29pm
ChrisTS (mail):
Back in the 1990s, the gay Mafia was promoting the idea that AIDS would jump into the heterosexual community in an obvious effort to scare the public to increase AIDS funding. As we know the jump never happened.

Umm, yes, it did.
4.11.2009 5:40pm
Cornellian (mail):
No it really doesn't matter, because even if distributing condoms were proven beyond doubt to be the most effective way of preventing HIV by far, the Pope would still oppose distributing them. He opposes them because he thinks using a condom is immoral, even for a married couple. If you buy that position, it doesn't matter if they're effective.

Let me get this straight: because it wouldn't affect the Pope's stance, therefore it "really doesn't matter," even though it could affect whether whether thousands of people get AIDS?


You don't have it straight. Read my comment again, it doesn't say
what you seem to think it says. Hint, I don't buy the Pope's position.
4.11.2009 5:45pm
Michael Alexander:
I've heard "the pope is against condoms" so often that I begin to think it is true. But is it? Where is the authority or quote saying that the pope is against condoms? (If it exists, as I assume it does, please say "I told you so.")
4.11.2009 5:53pm
Doc Merlin:
Actually, look at the countries in Africa with the lowest AIDS prevalence (Somalia for example) and you find that there is very little promiscuity and almost no homosexual sex their culture.

I think the pope is correct, condoms won't help, for any large scale shift in HIV prevalence you need a fairly substantial shift in a culture's attitude towards sex, and that condoms simply won't cut it.
4.11.2009 6:04pm
Garth:
condom use helps prevent aids. if people are truly using them haphazardly and engaging in risky behaviour, that simply highlights a need for more sex education not less.

the pope's position simply helps perptuate the aids crisis. he hasn't said that condom distribution and sex ed is ineffectual... he simply doesn't want it.

it's ludicrous to say it compounds the problem. arguement by anecdote doesn't work. if he wants to wade into this controversy he better be able to show that condom use has exacerbated the aids problem. i don't buy it.
4.11.2009 6:04pm
Mark F. (mail):
Umm, yes, it did.

Yes, of course there is heterosexual AIDS. But it is only a very minor problem in the United States. It has never become a big epidemic with heterosexuals as some people were predicting. In fact the number of 100% heterosexual men who have contracted AIDS without blood transfusions or using drugs in the United States is virtually zero (Magic Johnson is the rare exception, if he isn't lying). Women are much more at risk, but still the numbers are fairly small.

I wonder what the pope's position on using condoms for anal intercourse would be? Obviously he is against anal intercourse, but I can't see why using a condom would make it even more sinful than it is already.
4.11.2009 6:15pm
Thoughtful (mail):
I can see the provocative commercials now: The Pope, in his finest robes, partially reclining on a sofa, surrounded by several noviatiates.

Voice over: Condoms? I never use them...

Tag line: Trojans follow the word from Rome. Ultra-thins: it's like not using a condom at all...
4.11.2009 6:16pm
AndrewK (mail):
Assuming that the Pope knows nothing about the epidemiology of the matter, I find his style of argument interesting.

We proceed from a blanket opposition to condoms on principle to the assumption that condoms must necessarily have a bad effect as a result. And if the epidemiology here backs up the claim by showing that condoms and subsequent increased sexual activity actually increase the incidence of AIDS / other diseases, what then? Do we start taking other religious intuitions more seriously as evidence of deep-seated understandings of otherwise stochastic phenomena?
4.11.2009 6:23pm
Laura(southernxyl) (mail) (www):
"...when they use them at all, that seems to have the effect of disinhibiting people's behaviours so they end up taking greater sexual risks and cancelling whatever risk reduction they have gotten from the technology they're using."

Having been an informal observer of human nature, I totally get this.
4.11.2009 6:34pm
Cornellian (mail):
Where is the authority or quote saying that the pope is against condoms?

It's pretty commonly known that the Vatican opposes ALL forms of
"artificial" birth control, even between a married couple.

That includes not only condoms, but pretty much anything other than
abstinence or pulling out before ejaculating.

The Vatican doesn't keep this position a secret. I just went to their
web page, put "birth control" in their search engine and found an
article saying things like:

Similarly excluded [in addition to abortion] is any action which either before, at the moment of, or after sexual intercourse, is specifically intended to prevent procreation—whether as an end or as a means.
4.11.2009 6:36pm
A. Zarkov (mail):
ChrisTS:

"Umm, yes, it did."

By "jump into" I of course meant-- appear with the same prevalence as in the heterosexual community. That should be obvious, but I guess not. In the early 1980s, the blood supply became contaminated with the AIDS virus causing some limited transmission to the heterosexual world. Ditto for IV drug abuse. But it never really spread beyond certain limited high risk groups. The scare predictions from the gay Mafia never materialized. I remember a lot of heterosexual women wanted you to show them a negative HIV test, so these scare stories had some effect.
4.11.2009 6:37pm
Lior:
A. Zarkov: The scientific argument against condoms is precisely the one you give: all other things being equal, a condom would be better than no condom — but in practice having condoms changes people sexual habits. In particular, people may not use the condom correctly or consistently (thus gaining a smaller benefit from the condom use than you anticipate), but increase their sexual activity as if they were reaping the full benefit. It is not a-priori obvious that this will not happen. There has been research documenting such an effect for car safety features.

The pope mentioned this argument (for which he was roundly castigated). His core argument, though, is on a different plane. The Church's position has consistently been that if people completely avoided extramarital sex (which is anyway a sin), the spread of AIDS would be greatly reduced. If those who know themselves to be infected avoided sex altogether, a further reduction will take place. These are obviuosly correct statements.

From the policy point of view, the Church's position is completely useless. The men in Africa know that having extramarital sex is risky. They choose to take the risk anyway (and force women to take it too). If we wish to help, we can't simply follow the Catholic Church and tell them about risk-reducing strategies they will never adopt.

Clearly many African men consider neither the risk of AIDS nor the risk of eternal damnation large enough to merit a change of behaviour. They also assign a negative benefit to the use of condoms (admittedly, condoms only mitigate one of the risks). Trying to convince these men that they should change their behaviour is pointless. They have weighed the risks and made their choice.

What actually needs to change is the array of options and risks. Perhaps ensuring that women can safely say "no" to unprotected sex (and adulterous husbands) will reduce men's options and increase their risks to the point where they will change their behaviour.
4.11.2009 6:41pm
einhverfr (mail) (www):
Mark F:

In fact the number of 100% heterosexual men who have contracted AIDS without blood transfusions or using drugs in the United States is virtually zero (Magic Johnson is the rare exception, if he isn't lying). Women are much more at risk, but still the numbers are fairly small.


Not quite. I agree that heterosexual transmission in the US is overhyped, but you are missing a number of important things:

1) We can usually develop a pretty good idea of how someone contracted HIV. You have to look at how it was transmitted, not just who contacted it.

2) While it is true that a CDC study from 1999 through 2002 concluded that in the 23 states mentioned, the rates of heterosexual transmissions via sexual contact in those states accounted for only 1/7th of so of the male cases, that is still significant. Heterosexual transmission via sexual contact accounted for about 2/3 of the female cases. These were diagnoses in 23 states over 3 years and show something about transmission tendencies, rather than actual numbers living with HIV.

The 2007 estimate was that 1.2 million people in the US were living with HIV. If we assume (which is dangerous) that the numbers of transmissions to infect these people followed the data in the 23-state study, we would see a breakdown of: 10% male, got from heterosexual contact, 20% femail, got from heterosexual contact, 6% female, got from other source, and 44% male, got from other source.

This means that your definition of "near zero" and mine are not even in the same ballbark.
4.11.2009 6:49pm
einhverfr (mail) (www):
Lior:

What actually needs to change is the array of options and risks. Perhaps ensuring that women can safely say "no" to unprotected sex (and adulterous husbands) will reduce men's options and increase their risks to the point where they will change their behaviour.


My guess is that this is a complicated mess which can only be solved through a combination of economic development, education, etc. These elements seem to be major elements in reducing the spread of HIV. It is interesting that one can see rough correlations in spread of HIV to literacy and per capita GDP numbers.

Some on the left want to assume that HIV caused lower per capita GDP numbers, hampered education, etc, but I suspect that puts the cart before the horse.

I do think that condoms (and even other birth control methods, contrary to what common sense might suggest) have a place in reducing HIV transmission, but the key thing as you point out is to change the culture of sexuality and this requires IMO changing the economic realities on the ground.
4.11.2009 6:58pm
Cornellian (mail):
In fact the number of 100% heterosexual men who have contracted AIDS without blood transfusions or using drugs in the United States is virtually zero

Not much consolation if you're a 100% heterosexual woman.
4.11.2009 7:00pm
A. Zarkov (mail):
Webb writes:

"Delivered to a continent where 22 million people live with HIV, and which accounted for 75% of all AIDS deaths in 2007, his words provoked strong reactions."


Where does Webb get "22 million from?" From UNAIDS. Where does UNAIDS get the number from? Do they report verified cases? No. I have posted on this before, see this. High prevalence of AIDS in Africa seems to have achieved the status of an unquestioned axiom. At this point fighting African AIDS is a large and highly profitable industry akin to Global Warming. An industry operating at the expense of sub Saharan African health if other diseases have been mis-identified as AIDS. Let me tell you, the Bulletin of the World Health Organization 2001 79 (7) was a real eye opener for me as it (perhaps inadvertently) revealed the weaknesses in the UNAIDS methodology in the AIDS prevalence statistics data. Perhaps things have improved since that article, and I need to revisit this issue. But in the meantime color me skeptical.
4.11.2009 7:00pm
Lior:
Cornellian: regarding "pulling out before ejaculating" see Genesis 38, verses 9-10. The only birth-control method sanctioned by the church is the "rhythm" method. It acceptable (in some circumstances) to change the probability of procreation by choosing the timing of sex, but in no circumstances by changing the mechanics or the biology.
4.11.2009 7:06pm
A. Zarkov (mail):
Lior:

Old joke.

What do you call people who use the rhythm method for contraception?-- "parents."
4.11.2009 7:11pm
Thoughtful (mail):
"...when they use them at all, that seems to have the effect of disinhibiting people's behaviours so they end up taking greater sexual risks and cancelling whatever risk reduction they have gotten from the technology they're using."

This is actually just an example of the well known economic principle, moral hazard. Another example would be studies that have shown people drive (marginally) more hazardously in cars equipped with air bags.
4.11.2009 7:14pm
Cornellian (mail):
"rhythm" method

Reminds of a TV series I saw years ago. It was about doctors working in a hospital and one day one of the doctors says to a female patient using the "rhythm" method "do you know the term doctors use for women who use the rhythm method? We call them 'mothers'."
4.11.2009 7:20pm
ChrisTS (mail):
Cornellian: Thanks for making me laugh.

Mark F and Zarkov: Are we speaking only of the United States? I thought we were speaking more globally. In Africa, in particular, heterosexual AIDS is a terrible scourge. I appreciate einhverfr's setting us straight on the U.S. numbers, of course.
4.11.2009 7:20pm
einhverfr (mail) (www):
A Zarkov:

At the same time, the CIA World Factbook reports that there are more people in Botswana living with HIV than in the US. If you don't have better numbers, would you go with the ones which are generally accepted by our government?
4.11.2009 7:20pm
Cornellian (mail):
Darn, Zark beat me to the punchline.
4.11.2009 7:20pm
Bob from Ohio (mail):

This literature to which he refers does exist, though it is not mainstream. Its principal proponent has been Dr Edward Green, Director of the AIDS Prevention Research Project at Harvard.


Is Harvard really "not mainstream".

Can the AIDS director at the leading US college be considered a fringe figure?

Or by "not mainstream" does the writer mean "minority view"?

It goes without saying that minority views can often be right.

I think that if the Pope really was relying on the views of
a senior figure from Harvard, calling the Pope names (total autism, ignorant, fart-ass) does not exactly resolve the matter.

In fact, resort to name calling tends to show that the name caller's argument is flawed.
4.11.2009 7:25pm
NRWO:
Zark comments:
With condom protection the chances of infection drop to less than 1 in a million assuming the condom is used correctly. Thus condoms buy you something more than factor of 1,000 in protection [Where did this estimate come from, and what are its assumptions? It is probably based on the assumption that condoms are properly used, which may not at all be valid for groups with little or no prior experience using condoms.] Of course if condom distribution increases the frequency of unprotected sex, then the Pope is right.

Not so fast, Zark:

Proposition 1: Risk of condom failure is not insignificant, particularly for new and high-risk condom users. See, e.g.,

Mechanical failure of the latex condom in a cohort of women at high STD risk. M MACALUSO, J KELAGHAN, L ARTZ, H AUSTIN, M … - Sexually Transmitted Diseases, 1999 - stdjournal.com

Estimated condom failure and frequency of condom use among gay men JL Thompson - American Journal of Public Health, 1993 - Am Public Health Assoc

Proposition 2: Condom use increases rates of sexual intercourse among high-risk African males. See, e.g.,
Increasing condom use without reducing HIV risk: results of a controlled community trial in Uganda. P Kajubi, MR Kamya, S Kamya, S Chen, W McFarland, … - JAIDS Journal of Acquired Immune Deficiency Syndromes, 2005 - jaids.org [Abstract: Men in the intervention group increased their number of sex partners by 0.31 compared with a decrease of 0.17 partners in the control group (P = 0.004). Other measures did not support a net reduction in sexual risk in the intervention community compared with the control community and, in fact, showed trends in the opposite direction.]

Conclusion: It is possible -- perhaps even plausible -- that interventions that aim to increase condom use in African people may, paradoxically, also increase STD rates in those people (or perhaps have no effect at all), especially if condoms are not properly used.
4.11.2009 7:34pm
einhverfr (mail) (www):
BTW, South Africa is the country to watch. The government of that country estimates that almost 30% of pregnant women were living with HIV, and this ranges province to province from about 15% to nearly 40%. The estimated adult prevalence nationally is about 10%.

If these rates continue, I think we will see pervasive pockets of long-term carriers of HIV develop first in the female population and then we will start to see it seen as basically a disease that men die of within these communities. Remember that the illness strikes the lower classes primarily in these parts and these folks do not have free access to HIV tests or antiretroviral drugs.
4.11.2009 7:43pm
My Middle Name Is Ralph:

At the time, I said that surely the Pope's claim was that condoms lead to an increased frequency of sex and that increased sex led to an increase in AIDs. So the claim was a hypothesis subject to testing: does the increased-sex effect of condom use outweigh the safety benefits of using condoms.


I really don't see how this is plausible. It's undisputed that condom use greatly reduces the chance of getting HIV. Let's assume as a conservative WAG that it cuts your risk by 90% vs. unprotected sex (if anyone has the actual numbers, I'd be happy to amend). To compensate for this reduction, you would need the population to increase sexual intercourse by a factor of 10. The notion that the condom using population is increasing their sexual activity by a factor of 10 just does not sound plausible to me.
4.11.2009 7:45pm
einhverfr (mail) (www):
NRWO:

But those both go back to what I was saying:

1) Condoms by themselves probably don't have a big impact.

2) Condoms still need to be part of a comprehensive plan.

The objection that you can't just throw condoms at the problem is valid. However, it is not a valid corollary that condoms have no place in a comprehensive strategy against the HIV epidemic.
4.11.2009 7:47pm
Richard Aubrey (mail):
Risk compensation exists. Traffic engineers have to deal with it.
The question is whether the increase in risky activity times the protection provided by the condom (if used and if used correctly) is a net increase or decrease.
4.11.2009 7:50pm
LN (mail):

What matters is that he takes a position counter to the guardians of moral authority and conventional wisdom, that's his real sin.


The Pope is best understood as a rebellious upstart held down by tradition-bound authoritarians. Wow.
4.11.2009 7:53pm
Oren:

Risk compensation exists. Traffic engineers have to deal with it.
The question is whether the increase in risky activity times the protection provided by the condom (if used and if used correctly) is a net increase or decrease.

Moreover, at least to me, is that the presence of condoms allows the individual to decide whether he wants abstinence, protected sex or unprotected sex according to his own preferences. That is, he can chose the level of risk that best suits him. Without the option of condom, perhaps he would chose abstinence, but only as a second-best option -- e.g., he would be taking less risk than was optimal for him.

Of course, the Pope never seemed particularly interested in the notion that people can have a diversity of preferences and utility-weightings on different things and might, as a result, chose different ways to maximize their own personal utility. The notion that one size doesn't fit all is anathema to the concept of Catholicism anyway.
4.11.2009 8:44pm
Putting Two and Two...:
Bob from Ohio:

Is Harvard really "not mainstream".

Can the AIDS director at the leading US college be considered a fringe figure?


Woah, Nellie!

Let's take a look at Edward C. Green's group.

From their "about" webpage:

The AIDS Prevention Research Project at the Harvard University Center for Population and Development Studies was established to support evidence-based research on the role of behavioral approaches in reducing the transmission of the HIV virus worldwide. The Project investigates documented HIV prevention successes, as well as other promising behavior-based approaches, to help guide the development of evidence-based models of behavior change for both generalized and concentrated epidemics.

The pivotal role of partner reduction in reducing HIV prevalence in generalized epidemics will be investigated, as well as other prevention strategies that have been shown successful, such as the ABC approach (Abstain, Be faithful, or use Condoms) used in Uganda and elsewhere. This Project also seeks to promote a deeper understanding of the influence that spirituality, beliefs and values, such as respect and responsibility, can have on human behavior and health, especially with regard to the AIDS pandemic.

The APRP is supported by the John Templeton Foundation.


And the John Templeton Foundation is a private philanthropic group which supports science research but includes Intelligent Design and other ideas which seek to meld science and religious belief. John Templeton, Jr. also bears the "honor" of being the second largest contributor to Prop 8 ($900,000), a personal donation not intended to reflect on the organization.

Back in my religion classes, Sister Clement would have, perhaps, discussed the tricky questions of truth in advertising...
4.11.2009 9:00pm
Dave T (mail):
Ralph:

Let's assume as a conservative WAG that it cuts your risk by 90% vs. unprotected sex (if anyone has the actual numbers, I'd be happy to amend). To compensate for this reduction, you would need the population to increase sexual intercourse by a factor of 10. The notion that the condom using population is increasing their sexual activity by a factor of 10 just does not sound plausible to me.

Not really. The probability is multiplicative, rather than additive. If condoms cuts the risk by 90%, then a person having sex twice would have the risk reduced by 81%. Three times, 72.9%. When you get up to 7 times, the risk reduction is 47.8%, effectively, chances are that this person will get AIDS (or, at least HIV) even with consistent proper condom use. So, all that is really happening is that one delaying becoming infected by using condoms.

All this assumes that one has sex only with infected partners, but, since it is entirely possible for someone to have several instances of intercourse with one person over a period of time, that is not an impossible assumption.
4.11.2009 9:04pm
Thoughtful (mail):
"The notion that one size doesn't fit all is anathema to the concept of Catholicism anyway."

And yet it is a very common notion among condom manufacturers...
4.11.2009 9:11pm
Thoughtful (mail):
VERY basic model:

Before condoms: Community of 1 million individuals. Sex 1/yr. HIV risk/sex 1:10,000. Therefore Prevalence of HIV: 100.

After condoms: % condom use 80%. Sex 2/yr. HIV risk WITH condom/sex 1:100,000. Therefore prevalence of HIV =56
200,000 x 2 x 1/10000 = 40 PLUS
800,000 x 2 x 1/100000 = 16

In addition to limiting HIV, overall social utility is increased by doubling sexual encounters.

Therefore it seems that even if condom utilization falls well short of 100% AND sexual encounters increase with the availability of condoms whether used or not, it can still overall be the case that HIV prevalence drops with the availability of condoms.
4.11.2009 9:23pm
Bob from Ohio (mail):
Sure, Putting Two and Two, Harvard is well known as a nest of right wing religious nutjobs.
4.11.2009 9:41pm
themighthypuck (mail):
It would take quite the lawyer to show how Genesis 38 9-10 defines a general rule regarding pulling out. I think the obvious reading is that if God specifically tells you not to pull out, don't pull out.
4.11.2009 9:47pm
Bama 1L:
Natural Family Planning is not exactly the rhythm method. The rhythm method relied solely on observation of past menstrual cycles to calculate when fertility would occur in future cycles. NFP adds to this a daily thermometer reading and observation of cervical position and mucus. Of course, it eventually comes down to a choice to abstain. Supposedly NFP is effective if done properly but there's substantial user error.

pulling out before ejaculating

No. The Church teaches that there are substantial penalties for early withdrawal.
4.11.2009 9:52pm
Richard A. (mail):
Mark F: I generally agree with your comments but disagree that the Magic Johnson case has any bearing on the debate over heterosexual AIDS. He hs dodged the question of whom he had sex with and in any case no statement of his would prove anything. The on thing we seem to know is he didn't get it from his wife, but whatever partner he got it from is lost to history - ours if not his.
4.11.2009 10:16pm
Dave hardy (mail) (www):
"It's not just snarky, it's wrong. Is your mortician dead? Is your historian long dead? Is your veterinarian a cat? A person can be an expert in a field without being a participant."

Yes, but while none are participants, each has spent years in study. If the Pope has spent years studying sex and condoms, I'd be rather startled, and suggest that the College of Cardinals needs to introduce vetting procedures.
4.11.2009 10:17pm
A. Zarkov (mail):
einhverfr:

"At the same time, the CIA World Factbook reports that there are more people in Botswana living with HIV than in the US. If you don't have better numbers, would you go with the ones which are generally accepted by our government?"


The CIA Factbook reports an HIV/AIDS prevalence for Botswana of 300,000 (note the round number; this is an estimate). I interpret "HIV/AID" to mean either HIV positive or full blown AIDS. Being HIV positive does not mean you have AIDS.

CDC reports
1,106,400 HIV positive for the US in 2006 and 37,041 AIDS cases in 2007 with a cumulative total AIDS of 1,051,875. I'm not sure if the 37,041 refers to new cases diagnosed in 2007, or the prevalence as of 2007. The cumulative total would include people who died of the disease or are in remission from treatment. They really should break this down in a table with definitions.

In any case, US HIV/AIDS is way bigger than Botswana HIV/AIDS.

I'm sure the CIA uses UNAIDS data for Botswana, and I'm skeptical of those numbers for the reasons stated above. I once spent a year working in one of the Washington statistics mills and I don't trust their numbers for a variety of reasons, some technical and some political. They sometimes make basic methodological errors. These were once competent staffs, but no longer. Remember Clinton did away with the Civil Service Exam because of a disparate impact on minorities.

Finally I think no numbers are better than inaccurate numbers,
4.11.2009 10:26pm
Dave hardy (mail) (www):
"I've heard "the pope is against condoms" so often that I begin to think it is true. But is it? Where is the authority or quote saying that the pope is against condoms? (If it exists, as I assume it does, please say "I told you so.")"

It isn't quite that the Pope is personally, and ideosyncratically, against condoms. Standard Roman Catholic dogma (and in this field that is not a bad word) has been, for quite some time, that contraception in any form is unnatural and immoral. (The rhythm method is acceptable because it takes advantage of natural cycles).

To be fair, figure how many people today pop the pill or get tubes tied or vasectomies done and wouldn't dream of drinking anything but bottled water or eating meat from critters that were given antibiotics, or reject vaccines as unnatural.

DTH, a little of an expert, being a thoroughly nondevout Roman Catholic who was married to a very devout one, may she rest in peace.
4.11.2009 10:35pm
A. Zarkov (mail):
NWRO:

I think we are in agreement. I assume the condom is used properly. My number refers a material failure of the condom that the user has no control over. Condoms made in the US are (were?) of very high quality. It's not easy to make a very thin membrane with a uniform thickness. Condoms are so good we once used one as a part in a weapons system!

Looking at a package of "TROJAN SUPRA" it says "distributed by Church and Dwight Co. Inc. Princeton NJ 08543" I don't like that "distributed by" which suggests they are not made in the US. Do you trust Chinese condoms?
4.11.2009 10:36pm
Oren:

... or eating meat from critters that were given antibiotics ...

Totally offtopic, but the reason not to give animals antibiotics is to prevent selection for ever more drug resistance in bacteria. Horizontal gene propagation is a wicked survival mechanism.
4.11.2009 11:45pm
Oren:
As I realize it may be unclear (especially given the thread topic), I'm from New England and therefore 'wicked' in my above post does not have the usual meaning.
4.11.2009 11:47pm
Desiderius:
What an interesting world where the Pope plays the role of Luther speaking uncomfortable truth to a (much) larger power.
4.11.2009 11:47pm
einhverfr (mail) (www):
A Zarkov:

First, untreated HIV leads to AIDS in around 90% of cases. Treated HIV infection is a different matter, naturally.

What do you think of the recent epidemiological work in South Africa which asserts:

about 11% of the population is HIV positive, and this includes about 29% of pregnant women?
4.12.2009 12:33am
einhverfr (mail) (www):
(note these were South African Ministry of Health studies, not UN ones)
4.12.2009 12:34am
Grover Gardner (mail):

Sure, Putting Two and Two, Harvard is well known as a nest of right wing religious nutjobs.


The AIDS Prevention Research Project is a conservative advocacy group focusing on abstinence solutions to HIV, housed at Harvard but funded by religious conservatives. Really. It is NOT a left-wing organization by any stretch of the imagination.
4.12.2009 12:36am
Abdul Abulbul Amir (mail):

...does the increased-sex effect of condom use outweigh the safety benefits of using condoms.


Lets be clear. Having sex with an HIV carrier even when properly using a condom is dangerous. Period. Use of a comdom may reduce the danger to some degree, but it remains dangerous. The word "safety" has absolutely no business being used in any way to describe any form of sex with an HIV carrier.
4.12.2009 1:04am
ChrisTS (mail):
The AIDS Prevention Research Project is a conservative advocacy group focusing on abstinence solutions to HIV, housed at Harvard but funded by religious conservatives.

Sure, we takes the money whence we gets it.
4.12.2009 1:19am
John Moore (www):

The AIDS Prevention Research Project is a conservative advocacy group focusing on abstinence solutions to HIV, housed at Harvard but funded by religious conservatives. Really.


Therefore don't believe a word they say, but take Brookings Institute studies and those done by gay activists at face value.
4.12.2009 1:33am
John Moore (www):


Back in the 1990s, the gay Mafia was promoting the idea that AIDS would jump into the heterosexual community in an obvious effort to scare the public to increase AIDS funding. As we know the jump never happened.



Umm, yes, it did.


No, it really didn't. Not in any way close to the scare tactics of the gay mafia and their enablers. For years, they scared the crap out of people with predictions not backed up by any sceince, but very convenient to their ideological goal of confincing everyone that "AIDS is not a gay disease, anyone can get it."

In fact, with the exception of pattern II countries and their expats, HIV infection is a disease of biologically aberrant behavior - anal sex and IV drug use.

One thing I guess the gay mafia can be proud of: reducing the incidence of hemophilia genetics in the American population. Good work, guys (of the '80s).

It is truly ironic that if gays of the late '70s and '80s had followed religious doctrine and abstained from gay sex (which is asking a whole lot), the AIDS epidemic in the US would still be miniscule. More critically, if they had even engaged in the level of promiscuity of heterosexuals, the AIDS epidemic would have had a much slower start, allowing lives to be saved by blood screening and modern HIV therapy. Then there's the blackmail of the blood donor centers, as reported by Shilts.
4.12.2009 1:40am
Nick056:
As others have pointed out, the work coming from Green's Harvard-based institute is definitely funded by groups with conservative, pro-life presuppositions, and the program itself has a mission statement that privileges faith and spirituality as a primary means for combating AIDS. This group focuses on "behavioral" prevention of AIDS, and -- I'll note without comment -- prioritizes in its very mission statement partner reduction behaviors while leaving contraceptive use behaviors entirely off the radar. That, by the way, is not necessarily a conclusion wrought from study; it's in the group's mission statement.

I'm not saying that alone renders their perspective worthless or their methods questionable. But they are, as a matter of fact, researchers funded by pro-life conservative money and they hold to a particular pre-conceived conservative bent. I think at the very least that's relevant context, and Todd's failure to even mention it is really shoddy work. We all know that money and interest are significant when it comes to establishing or considering credibility, and these people are not funded by parties neutral to the issue at hand, namely, the Pope's statement. Most important in reviewing their defense of the Pope, their institute shares Pope's own moral holdings regarding abortion: the solution is in spirituality, beliefs, and values. Further, they concentrate specifically on "behavior-based" solutions which seem to exclude condom use.

Again, people can draw their own conclusions. But the relevance speaks for itself, and Todd's omission -- as well as John More's apparent view that it's entirely beside the point who funds them or what their goals are -- are simply strange.

Do we want to have a conversation about this, or not? Even the AIDS prevention group website provides its spiritually-oriented charter and conservative funding. Why does everyone else leave that out?
4.12.2009 2:02am
Grover Gardner (mail):

Therefore don't believe a word they say, but take Brookings Institute studies and those done by gay activists at face value.


I didn't say that, but they are an advocacy group with a very specific agenda--to promote abstinence over other forms of prevention--and as the article points out there isn't that much to back up their claims.
4.12.2009 2:04am
Putting Two and Two...:

Sure, Putting Two and Two, Harvard is well known as a nest of right wing religious nutjobs.


A diversity hire, perhaps?
4.12.2009 2:12am
John Moore (www):
Modern academia does not consider Conservatives important for academic diversity.
4.12.2009 2:17am
Nick056:
John, saying that with the exception of the area of the world where AIDS ravages the highest rates of the population, it's a homosexual disease, is a little silly.

Even in America, the CDC estimates that in 2006 47% of all AIDS transmission cases did not "occur in gay and bisexual men." So nearly half of all new cases were occuring in heterosexuals. Yes, this is wildly disproportionate, but are you comfortable implying that AIDS has not "jumped" into the heterosexual population?

Am I member of the mafia for bringing those figures to your attention? Or should I obtain funding from conservative groups to place my credibility beyond question in your eyes? I find it typical that in a thread that began as a discussion of AIDS in Africa, you shift the conversation to AIDS and homosexuality in America, and in the process short-shrift the severity of the problem in Africa, presumably to score a few points in your war against the gay mafia.
4.12.2009 2:22am
A. Zarkov (mail):
einhverfr:

"What do you think of the recent epidemiological work in South Africa which asserts:"

I don't know that work. It all depends their methodology. Do those numbers come from reported cases backed up by laboratory work? I highly recommend you read that Bulletin-- Modelling HIV/AIDS epidemics in sub-Saharan Africa using seroprevalence data from antenatal clinics, I linked to and you will see how soft the UNAIDS' numbers are.

The UNAIDS prevalence estimates are primarily model based; they don't come from population-based epidemiological data. They use something called epimodel-- a really crude deterministic model built on a mountain of assumptions.

Of course the article is 7 years old, and there might have been advancements since then. It's hard to tell from the UNAIDS website-- the last time I looked details were scant on the methodology behind their numbers.
4.12.2009 2:25am
Putting Two and Two...:

Modern academia does not consider Conservatives important for academic diversity.


I was just indulging in some gay-mafia humor.
4.12.2009 2:31am
A. Zarkov (mail):
Nick056:

Look at this article, Heterosexual transmission of human immunodeficiency virus. From the abstract
Studies of HIV transmission from women to men have been small so that it is difficult to assess the relative risks of transmission from women to men and from men to women. Infectivity of the index case cannot yet be measured. It appears that infectivity varies both between individuals and within individuals over time. Treatment to reduce infectivity may be important in controlling the epidemic.
In other words, it hasn't been studied much.

In looking through the summary statistics at various websites I see that they dance around and avoid telling us what fraction of the AIDS cases consist of white men, who practice standard sex, and who don't engage in other high risk behavior. This group does not appear on any of the charts I've looked at. I suspect it's very small. AIDS has simply not proven to be a problem outside the high risk groups in the US.
4.12.2009 2:44am
Nick056:
I apologize to John More. It appears that A. Zarkov said that remarkable thing about the reality that AIDS never "jumped into" the heterosexual community. Then again, he also said -- without further discussion -- that the the methodology and practice of statistics in civil service deterioriated because Clinton did away with the civil service exam, as it prevented the advancement of minorities. I know nothing of this -- and Zarkov didn't bless me with context -- but doesn't this rather pointedly suggest that when such standards were abandoned, two things happened: the minorities were no longer kept back, and the work product went to hell at the same time the minorities enjoyed greater prospects.

I mean, I'm not saying Zarkov posits a specific connection between the two events. That'd be just plain racist. He's merely apparently suggesting that the two events happened roughly over the same period of time in the same government departments. A correlation, not a causation. But still, hasty words, from the fella who talks about gay mafias. (To sum up, gay activists are a mafia, and government statistics went to hell coincident to the abandonedment of standards as a way to benefit minority advancement. Anybody seriously doubt where this guy's coming from?)
4.12.2009 3:06am
Nick056:
Oh, hey, there's Zarkov! Cool!

I see you don't dispute or engage my core -- my only -- claim. That in 2006 47% percent of all transmissions involved heterosexuals, according to the CDC. This doesn't constitute a jump? That has been studied enough to tabulate some data. Yes, straight white men who practice standard sex and don't engage in other 'high risk behavior' (does that imply near monogamy and condom use) may be at low risk of transmission. But that's not what you said when you talked about heterosexuals as a whole -- regardless of race, standard sexual practice, or aversion to other high risk behavior.

As for statistics dancing around truth to serve some interest, we can both play that. I direct you to the CDC classification of high risk heterosexual contact, which describes sex with people "who are known to have, or be at risk for" AIDS. Maybe there's an excellent reason for this category; my present knowledge isn't deep enough to judge. But I can say that evidently causes a division between transmission through non high risk contact, and high risk contact. No such category exists for homosexuals. That is interesting. You could say that's a method of making it difficult to express in a single accurate number the total cases of heterosexual transmission, since straight transmission is deivided by risk level, and gay transmission isn't. Of course, I don't know for sure what's going on there, but it does complicate the notion that statistics are never to be trusted because they're sliced and diced to exaggerate the threat of AIDS among heterosexuals.
4.12.2009 3:23am
A. Zarkov (mail):
Nick056:

I clarified what I meant by "jumped into." I wrote

By "jump into" I of course meant-- appear with the same prevalence as in the homosexual [original had a typo here, I wrote "heterosexual" instead of "homosexual"] community.
That still stands.

As for my comment on methodology and civil service-- that had two parts. One was referred to UNAIDS, and I have been specific about their shortcomings. The other was a general comment on state of US government statistics since the civil service exam was done away with, based on my personal experience. Do you think doing away with the exam improved the quality of the staff? Why do you think Clinton did away with the exam? BTW virtually everyone in the office where I worked was white. You want me to get specific about the skill areas I saw in decline?
4.12.2009 4:21am
A. Zarkov (mail):
Nick056:

"I see you don't dispute or engage my core -- my only -- claim. That in 2006 47% percent of all transmissions involved heterosexuals, according to the CDC."

I don't dispute that. But how many of the remaining 53% were IV drug abusers or prostitutes? Let's also remember that male homosexuals did change their behavior, and the epidemic peaked for them. The non-drug using male heterosexual community never showed the same prevalence.
4.12.2009 4:32am
Seamus (mail):

Yes, but while none are participants, each has spent years in study. If the Pope has spent years studying sex and condoms, I'd be rather startled, and suggest that the College of Cardinals needs to introduce vetting procedures.



You don't think the pope has spend years studying moral philosophy and theology?

I would think that celibates opining about the morality of various sexual practices would be advantaged by having no personal stake in the outcome. You know, the way we wouldn't want a lawyer who had bet on the outcome of a legal dispute serving as arbitrator in that dispute.

In any event, I guess Jen needs to amend her original post to "I find the views of people who have taken a vow of celibacy and who have not spent years of study on the subject to be absolutely dispositive when it comes to issues concerning sexual behavior. /snark" Kinda loses some of its punch that was, though, don't it?
4.12.2009 10:06am
Seamus (mail):
Uh, that should be "loses some of its punch that way"
4.12.2009 10:08am
mattski:

I would think that celibates opining about the morality of various sexual practices would be advantaged by having no personal stake in the outcome.

Who says they have no stake? If anything wouldn't they be suspect of dog-in-the-manger?

The Pope has a credibility problem here. The problem is he is on the record opposing condoms on moral grounds, not public health grounds. When he purports to question the efficacy of condoms vis-a-vis AIDS, but criticizes them in isolation rather than as part of a comprehensive strategy including sex education, then the world is justified in viewing his comments with skepticism.
4.12.2009 10:30am
Malvolio:
The problem is he is on the record opposing condoms on moral grounds, not public health grounds. When he purports to question the efficacy of condoms vis-a-vis AIDS, but criticizes them in isolation rather than as part of a comprehensive strategy including sex education, then the world is justified in viewing his comments with skepticism.
To continue someone else's apt analogy, would either of the the following actions be appropriate for someone morally opposed to torture?

1. Refrain from questioning the efficacy of torture, on the grounds that it can be useful as part of a comprehensive strategy including isolation and threats against family members; or

2. Make helpful suggestions about how torture might be better integrated into the whole interrogation program.

I think the Pope's remarks about condoms are intellectually consistent and (somewhat) factually supported.

(And but me not buts about the difference between condoms and properly used condoms, or about condoms in isolation versus condoms as part of a comprehensive program -- let's stick to discussing the real world.)
4.12.2009 12:12pm
mattski:

or about condoms in isolation versus condoms as part of a comprehensive program -- let's stick to discussing the real world.

That's a non-sequitur. In the real world condoms and sex-education co-exist.

If you find the Pope compelling on the morality of condoms then I think you're a member of a rather small minority of the human race.
4.12.2009 1:26pm
Malvolio:
or about condoms in isolation versus condoms as part of a comprehensive program -- let's stick to discussing the real world.
That's a non-sequitur. In the real world condoms and sex-education co-exist.
The real world is exactly what I wanted to talk about. Defenses of condoms here and elsewhere often use qualifiers like "properly used" and "integrated into a comprehensive program".

The Pope's claim was that the reduction of AIDS transmission by condoms, as actually distributed and actually used, was less than the increase in AIDS transmission caused indirectly by the social normalization of fornication (allegedly) resulting from the distribution and directly by the failures of condoms.

It's a bold claim, and personally, I don't believe it, but it's neither false on its face nor irresponsible.
If you find the Pope compelling on the morality of condoms then I think you're a member of a rather small minority of the human race.
Well, sanity is not statistical. The Pope and I agree on very little, but I found it amusing that Ratzinger made a subtle (if self-serving) point about the empirical value of condom distribution and the liberal world reacted like a bunch of religious nuts having their dogma threatened -- which I guess is what they are.
4.12.2009 1:46pm
byomtov (mail):
Dave T.,

Your math is not correct. I think the right way to do the calculation is this.

Let

Pu be the probability of being infected after an unprotected encounter
Pc be the probability of being infected after a protected encounter

where Pc = .1Pu (The 90% reduction we are assuming)

We want to know how many protected encounters lead to the same probability of infection as one unprotected encounter.

That means we are looking for n where

(1-Pc)^n = 1- Pu. (The chances of remaining uninfected are equal).

The left side is the probability of being uninfected after n protected encounters, the right side the same probability for a single unprotected one.

So (1-.1Pu)^n = 1-Pu

and n= ln(1-Pu)/ln(1-.1Pu)

For values of Pu from very small up to about .6 this breakeven number is 10-15. Of course that depends on the assumption of a 90% risk reduction. I don't know the actual figure.

If my solution is wrong I'm sure Zarkov will provide a correction.
4.12.2009 2:02pm
mattski:

and the liberal world reacted like a bunch of religious nuts having their dogma threatened -- which I guess is what they are.

The lack of citations combined with the sweeping generalization is powerful evidence that you are waving at the shadows in your imagination.
4.12.2009 2:17pm
TruePath (mail) (www):
Dave T:

You are right that it will be multiplicitive but you are multiplying the wrong numbers. I mean your model would give that even if condom use caused everyone to go from sex with one random person a year to 100,000 they would still see some risk reduction as a result of condom usage which is obviously silly.

The right numbers to multiply are the chances of not getting HIV. So suppose the risk of getting HIV on a given sexual encounter is R and that condom usage reduces transmission risk by 69% (meta-analysis). Now further suppose your number of partners when condoms aren't present is NCP and with condoms is CP. Then (against a fixed background population) your risk of contracting HIV without condoms would be.

1-(1-R)^(NCP)

Your risk of contracting with condoms would then become:

1-(1-.31*R)^CP

Since we assume that R is quite small (only 6% infected and then multiply by chance of transmission) the binomial theorem gives us that the risk without condoms is approximately.

NCP*R

and the risk with condoms is approximately

.31*R*CP

So yes, it does turn out to be about linear in the safety factor.

----

Still, I think the correct worry is not the moral hazard problem but that condom distribution actually increases the social acceptability of casual sex even without condoms. However, as I pointed out earlier the fact that widespread distribution to population as a whole might not be very effective really doesn't help the pope's argument out very much. When it comes to targeted distribution like to sex workers I think the case is pretty clear and the pope's conclusion would have us stop that as well.
4.12.2009 2:22pm
TruePath (mail) (www):
byomtov:

Got there before me but yes that's right.

To a first approximation if condoms make sex 100*x % safer then you need to have 1/(1-x) times more sexual encounters to have the same risk of infection. Of course this is presupposing you are just randomly picking partners each time.
4.12.2009 2:25pm
Dilan Esper (mail) (www):
I continue to think that the Pope is full of it. His position is at its absolute worst when we are talking about married African couples where the husband has run off and contracted the HIV virus. The Pope gives that couple no good options to avoid transmitting the virus from husband to wife. And that's how lots of faithful, married African women contract HIV.

That said, I have to admit that Ross Douthat advanced the ball a little bit on this issue. This is a pretty good post on what conservatives (including the Pope) COULD do on this issue other than advocating condom usage.
4.13.2009 12:42am
Ricardo (mail):
The scare predictions from the gay Mafia never materialized. I remember a lot of heterosexual women wanted you to show them a negative HIV test, so these scare stories had some effect.

So if "these scare stories had some effect", where do you get off attributing them to the "gay mafia" and suggesting, as you did earlier, that they were cooked up mainly to increase funding for HIV prevention? How would you react if someone said the post-9/11 fears of terrorism were obviously "scare stories" being perpetuated by "war mongers" or Halliburton cronies? Or concerns about crime in the 1980s and 1990s were scare stories since crime rates eventually fell. "Scare stories" can effect people's behavior and the kinds of policies they support which can change real-world outcomes. Implicitly assuming otherwise makes for a terrible argument.
4.13.2009 3:28am
Ricardo (mail):
In fact the number of 100% heterosexual men who have contracted AIDS without blood transfusions or using drugs in the United States is virtually zero (Magic Johnson is the rare exception, if he isn't lying).

"In the United States" is the all-important qualifier. I don't have the numbers handy but randomized control trials in Uganda and Kenya among young, HIV-negative uncircumcised men show a 50% lower HIV infection rate post-follow-up among those who were circumcised. Obviously, you can't lower a 0% risk by 50%. So maybe the reason why the number of straight, non-IV drug using men in the U.S. is so small is because HIV infection rates among women in the U.S. are relatively low. And maybe, just maybe, those rates are low because American women take the risk of HIV-infection to heart.
4.13.2009 4:09am
A. Zarkov (mail):
Ricardo:

The scare stories did have an effect-- they scared people. Do you deny that? A lot of people became afraid that AIDS would become as common in the general population as among male homosexuals. As we know, in the US, it didn't.

Where did some of the scare stories come from? Answer: from organizations such as ACT UP (AIDS Coalition to Unleash Power). Do you deny ACT UP put out scare stores about AIDS?

From the above linked Wikipedia.
When he [author of an article] refused, in the words of Maria Maggenti, they decided that they "had to shut down Cosmo [Cosmopolitan (magazine)]."
Isn't this how the Mafia operates? Do what we want or we will shut you down. Of course using a term like "gay Mafia" is hyperbole, but in this context, for a dramatic effect, I think the use is appropriate.

As to funding. I can't give a document that says "scare the people so we get more funding for AIDS research"-- signed Gay Mafia. But that's exactly what ACT UP and other similar organizations and pressure groups wanted. And they got it-- the funding for AIDS research is way out of proportion to the number of people infected.

As to 911 scare stories. Yes the US government certainly did scare the public about terrorism. That's how governments increase their power. The government is doing it about the economy. Didn't Ron Emanuel say "You never want a serious crisis to go to waste?"

Finally scare stories about crime. Yes the police can certainly increase their budgets, and get federal funding for high tech equipment if they get the public scared about crime. Of course they have some help from the criminals. In certain places like East Oakland you really should worry about crime.
4.13.2009 8:17am
Just a thought:

Yes, but while none are participants, each has spent years in study. If the Pope has spent years studying sex and condoms, I'd be rather startled, and suggest that the College of Cardinals needs to introduce vetting procedures.


Actually, though I don't know about Benedict XVI, his predecssor John Paul II did spend years studying, thinking, and writing about sex - in fact, John Paul II's study of sex is arguably the most significant and revolutionary teaching of his papacy. If you'd like to learn more, I'd recommend the book John Paul II wrote when he was a cardinal, Love and Responsibility, and then the series of teachings John Paul II made during his papacy collectively known as "The Theology of the Body."
4.13.2009 8:41am
Dilan Esper (mail) (www):
Just a thought:

All those years thinking about sex, and he turned out to know almost nothing about the subject.

Sex is a subject where you learn a lot more from experience than you do from a book. Ending priestly celibacy is essential to creating any catholic doctrines on sex and gender that have any relationship to reality.
4.13.2009 10:26am
Dilan Esper (mail) (www):
Also, a pope who understood something about sex would never have placed the retention of priests as a more important goal than protecting children entrusted to the church from sex abuse. JP2 got the single biggest issue relating to sex and his church completely wrong, and intentionally destroyed the lives of thousands of children in order to avoid bad publicity and losing priests.
4.13.2009 10:34am
Randy R. (mail):
Zarkov: "The scare stories did have an effect-- they scared people. Do you deny that?"

they sure did! Any perhaps they scared the heteros so well,that the hetero women started asking men about HIV status, and as a result, the straight people 'came to Jesus' and slowed the spread of HIV.

So the scare tactics worked, didn't they? I would think that you would be thanking the gay mafia for making your world a little safer.

You're welcome.
4.14.2009 12:48am
Randy R. (mail):
Just a thought: :"Actually, though I don't know about Benedict XVI, his predecssor John Paul II did spend years studying, thinking, and writing about sex "

Reminds me of that story that you can always tell a virgin because he thinks of sex as some spiritual virtue that must be savored only with those whom one has a spiritual connection.
4.14.2009 12:51am
Randy R. (mail):
Actually, it's pretty darn arrogant that after thousands of years, and hundreds of poets and songwriters, a celebate guy thinks that he has something to say about sex that hasn't been said before. Sure, you can go ahead and do it -- it's a free world.

By 'studying' sex, do mean to say that JP2 actually interviewed people who've had sex? Or did he just pour over books written by other celebate men who spend lots of time 'thinking and writing' about sex?

I mean, I guess I shouldn't pick on the poor guy, but really -- most people would prefer to go to a sex therapist for their issues with sex than talk to their priest, and for good reason. The priest talks about how sex between two people should be, and the therapist shows them how it can be.
4.14.2009 12:56am
Randy R. (mail):
Since no one else bothered, here is the article in the Washington Post written by Edward Green regarding condoms and Africa:

When Pope Benedict XVI commented this month that condom distribution isn't helping, and may be worsening, the spread of HIV/AIDS in Africa, he set off a firestorm of protest. Most non-Catholic commentary has been highly critical of the pope. A cartoon in the Philadelphia Inquirer, reprinted in The Post, showed the pope somewhat ghoulishly praising a throng of sick and dying Africans: "Blessed are the sick, for they have not used condoms."

Yet, in truth, current empirical evidence supports him.

We liberals who work in the fields of global HIV/AIDS and family planning take terrible professional risks if we side with the pope on a divisive topic such as this. The condom has become a symbol of freedom and -- along with contraception -- female emancipation, so those who question condom orthodoxy are accused of being against these causes. My comments are only about the question of condoms working to stem the spread of AIDS in Africa's generalized epidemics -- nowhere else.

In 2003, Norman Hearst and Sanny Chen of the University of California conducted a condom effectiveness study for the United Nations' AIDS program and found no evidence of condoms working as a primary HIV-prevention measure in Africa. UNAIDS quietly disowned the study. (The authors eventually managed to publish their findings in the quarterly Studies in Family Planning.) Since then, major articles in other peer-reviewed journals such as the Lancet, Science and BMJ have confirmed that condoms have not worked as a primary intervention in the population-wide epidemics of Africa. In a 2008 article in Science called "Reassessing HIV Prevention" 10 AIDS experts concluded that "consistent condom use has not reached a sufficiently high level, even after many years of widespread and often aggressive promotion, to produce a measurable slowing of new infections in the generalized epidemics of Sub-Saharan Africa."

Let me quickly add that condom promotion has worked in countries such as Thailand and Cambodia, where most HIV is transmitted through commercial sex and where it has been possible to enforce a 100 percent condom use policy in brothels (but not outside of them). In theory, condom promotions ought to work everywhere. And intuitively, some condom use ought to be better than no use. But that's not what the research in Africa shows.

Why not?

One reason is "risk compensation." That is, when people think they're made safe by using condoms at least some of the time, they actually engage in riskier sex.

Another factor is that people seldom use condoms in steady relationships because doing so would imply a lack of trust. (And if condom use rates go up, it's possible we are seeing an increase of casual or commercial sex.) However, it's those ongoing relationships that drive Africa's worst epidemics. In these, most HIV infections are found in general populations, not in high-risk groups such as sex workers, gay men or persons who inject drugs. And in significant proportions of African populations, people have two or more regular sex partners who overlap in time. In Botswana, which has one of the world's highest HIV rates, 43 percent of men and 17 percent of women surveyed had two or more regular sex partners in the previous year.

These ongoing multiple concurrent sex partnerships resemble a giant, invisible web of relationships through which HIV/AIDS spreads. A study in Malawi showed that even though the average number of sexual partners was only slightly over two, fully two-thirds of this population was interconnected through such networks of overlapping, ongoing relationships.

So what has worked in Africa? Strategies that break up these multiple and concurrent sexual networks -- or, in plain language, faithful mutual monogamy or at least reduction in numbers of partners, especially concurrent ones. "Closed" or faithful polygamy can work as well.

In Uganda's early, largely home-grown AIDS program, which began in 1986, the focus was on "Sticking to One Partner" or "Zero Grazing" (which meant remaining faithful within a polygamous marriage) and "Loving Faithfully." These simple messages worked. More recently, the two countries with the highest HIV infection rates, Swaziland and Botswana, have both launched campaigns that discourage people from having multiple and concurrent sexual partners.

Don't misunderstand me; I am not anti-condom. All people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship. This was a key point in a 2004 "consensus statement" published and endorsed by some 150 global AIDS experts, including representatives the United Nations, World Health Organization and World Bank. These experts also affirmed that for sexually active adults, the first priority should be to promote mutual fidelity. Moreover, liberals and conservatives agree that condoms cannot address challenges that remain critical in Africa such as cross-generational sex, gender inequality and an end to domestic violence, rape and sexual coercion.

Surely it's time to start providing more evidence-based AIDS prevention in Africa.
4.14.2009 1:06am
A. Zarkov (mail):
Randy R.

It was scared homosexuals that reduced the spread of AIDS because they are the primary vector for the disease, not heterosexuals. AIDS propagates mostly by anal sex. It does not propagate very well by normal sex, and that's why even unprotected normal sex has only a .001 to .002 probability of per contact of transferring the virus. AIDS is mainly a disease of the gay lifestyle, and of course IV drug use.

Yes the scare campaign, which was based on a lie, did make heterosexuals less likely to contract AIDS, but this came at a cost. A tremendous diversion of medical research funds away from more common diseases to AIDS research. To repeat-- the lie was that AIDS would jump into the heterosexual world and become as prevalent as in the homosexual world. Africa of course is a different story. But our data there (as I pointed out previously) might be faulty.
4.14.2009 4:39am
Randy R. (mail):
Although there are a great deal of funds used to support AIDS research, the benefits have been greatly disproportionate. We haven't learned how to cure it, or even get a vaccine. However, it has vastly helped our understanding of many other disease, such as cancer. There are new discoveries being made all the time that would not have come without the huge expenditure for AIDS.

Unfortunatley, I get from your tone that too much money is going to AIDS and not to other forms of research like cancer. However, the payback is much greater.
4.14.2009 1:15pm
Randy R. (mail):
Zarkov: "AIDS is mainly a disease of the gay lifestyle, and of course IV drug use."

if that's the case, then why are there so many heterosexuals who have the disease worldwide? It may be true in the US and Europe, but it certainly is not true in Africa and Asia. Unless you conclude that all those heteros got AIDS through just IV drug use.
4.14.2009 1:17pm
Dilan Esper (mail) (www):
It was scared homosexuals that reduced the spread of AIDS because they are the primary vector for the disease, not heterosexuals. AIDS propagates mostly by anal sex. It does not propagate very well by normal sex, and that's why even unprotected normal sex has only a .001 to .002 probability of per contact of transferring the virus. AIDS is mainly a disease of the gay lifestyle, and of course IV drug use.

You know, the epidemiologists who actually work on HIV/AIDS think this is total garbage. And I have to be thankful for the internet-- it's thanks to the internet that I learned that people still believed this.

But I guess it hits a lot of sweet spots for conservatives-- they get to condemn hippie drug users, lump gays in with drug users, and broad-brush Africans (i.e., blacks) as a bunch of sodomites. A certain type of person can't resist this.
4.14.2009 1:53pm
A. Zarkov (mail):
Dilan Esper:

"You know, the epidemiologists who actually work on HIV/AIDS think this is total garbage."

Kindly provide a link or a reference to a qualified epidemiologist to back up what you assert. Then tell us what item the word "this" refers to. Do you assert that the probability of HIV infection for normal sex is other than the numbers I gave. If you know better then tell me what is the probability that an uninfected man will become HIV positive from normal unprotected intercourse with a women infected with HIV. Is the probability a function of the stage of the disease in the woman?

All you have done is provide a broad brush insult. You give no specifics for anything. Words like "garbage" tell us nothing other than you like to hurl insults unsupported by facts or references.

If I'm wrong about something, fine. Tell me specifically.
4.14.2009 2:44pm
Dilan Esper (mail) (www):
4.14.2009 2:49pm
A. Zarkov (mail):
Dilan Esper:

The first reference supports my assertion.
This report summarizes the results of that analysis, which indicated that heterosexually acquired HIV infections represented 35% of all new HIV cases;
If we can assume that the other 65% of new HIV cases were caused by homosexual acts, then the HIV/AIDS prevalence in the hetreosexual community is not the same as the homosexual community as 65% > 35%.

But let's note. These were new cases, not the cumulative total since the epidemic began. What's going to count is the peak prevelance, because most epidemics peak and then die out as the disease either kills its host population or gets treated. For example tuberculosis actually waned before the drugs to treat it came along. Then we don't know if the heterosexual transmission was caused by normal intercourse and not anal sex. Then some of the heterosexual cases might also be caused by IV drug abuse. These highly aggregated statistics do not necessarily paint an accurate picture.
4.14.2009 8:36pm

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