Chicago Tribune - November 4, 2005
Laurie Goering, lgoering@tribune.com

The camp, close by the region's platinum mines and mine hostels, has no electricity, no water and few jobs, apart from prostitution. What it has in abundance are poverty and sex and AIDS and death.

Bishop Kevin Dowling will never forget ducking into the hut of a skeletal young mother with AIDS on one of his first visits to the settlement.

"She looked in my eyes and said, 'There is no hope for me, father. I have no hope,' and tears started running down," recalls the lanky, 61-year-old priest. "I looked around the house, and there wasn't a stitch of food."

The Catholic Church bans the use of condoms but Dowling believes the prophylactics--at least in his diocese--are a key to saving lives.

Abstinence and faithfulness in marriage, the church's answer to the AIDS epidemic, "are the only way to be sure you won't get infected. I have no problem with that," the controversial South African bishop acknowledges. But in his diocese, full of desperately poor women with few options beyond prostitution to feed their children, using condoms seems to him "a pro-life option in the widest sense."

"For me, the issue is simply this: How do you preserve and protect life?" he said last week at his offices in Phokeng, a poor township on the outskirts of Rustenburg, west of Pretoria. In a diocese like his, he said, "the only solution we have at the moment is condoms."

Bishop Kevin, as everyone calls him, is in some ways an unlikely campaigner. The slim, soft-spoken man with gentle brown eyes and gold-rimmed aviator glasses was raised in Pretoria, the conservative Afrikaner heart of South Africa, and spent time in Rome, working in the international leadership of the Redemptorists, a religious order.

But since 2001, when he first made public his views on condoms at a United Nations meeting on AIDS, the bishop of Rustenburg has become the church's most persuasive voice in favor of using condoms to stem the spread of AIDS.

"If there's an AIDS bishop in the church today, it's Kevin Dowling," said Rev. James Keenan, a theology professor at Boston College and a Jesuit priest who has written extensively on ethical issues surrounding AIDS. "To have someone of his magnitude saying it so clearly and, more importantly, with so much experience sets him apart from everyone else. There's no one else like him in the church today."

Dowling first began advocating for Rustenburg's poor when he became bishop 15 years ago, near the end of South Africa's apartheid era. In 1992, the church moved nearly 700 farmworkers--who Dowling said had been terrorized on white farms--onto mission land until they could be given permanent resettlement property. To serve them, and thousands of other people who had begun moving to the mining region, the diocese opened its first health clinic.

The AIDS rampage

Doctors and nurses there quickly saw that AIDS was burning through the community. Thousands of platinum miners, living in hostels far from their families, were regularly buying sex from poor women who flocked to camps like Freedom Park looking for work around the mines. With no jobs to be had, most of the women had little choice but to sell their bodies to feed themselves and their children. Soon, men, women and children sick with tuberculosis, oral thrush and other AIDS-related illnesses were flocking to the clinics.

The diocese responded by setting up teams of home-care nurses to visit and assist the sick and starting its own anti-retroviral treatment centers. Today the diocese has 10 teams of home-care nurses, its own 30-bed hospice so poor people with AIDS "can die in dignity and peace" and eight anti-retroviral treatment sites, with 400 people--including children--on AIDS treatment drugs.

By giving pregnant women the best available triple-therapy anti-retrovirals, the diocese has been able to halt mother-to-child transmission of the disease, with a 100 percent success rate in its 30 cases so far, and allow HIV-positive mothers to breastfeed their babies without passing on the disease, crucial help in an area where "people are too poor to buy [baby] formula," Dowling said.

Health workers attribute most of the successes to Dowling's tireless work.

He's "incredible," says Hilda De Bees, the administrator at the diocese's new AIDS hospice. "He's hardworking, he's compassionate, he's very, very supportive. Without him, we wouldn't be here."

But despite the church's campaign to ease the suffering from AIDS, many continue to die. At the hospice, a short walk down a red-dust road from the bishop's house, a skeletal 7-year-old boy in a frayed pink robe sits curled on his mother's lap, waiting for the end.

"He won't survive no matter what we do now," the bishop laments softly.

Church clinics also are seeing babies born with full-blown AIDS, he said, the product of mothers constantly reinfected with the virus through unprotected prostitution. In Freedom Park, 47 percent of pregnant women tested for HIV this year have turned up positive, Dowling said.

Condoms, he believes are one answer. Under longstanding church doctrine, condoms and other birth-control methods can be used in some specific cases--by an HIV-positive husband whose wife is postmenopausal, for instance, or in other cases where contraception isn't the primary effect.

Dowling believes that in his diocese--and in much of AIDS-afflicted Africa--the primary effect of using condoms would not be contraception but "to stop transmission of a death-dealing virus." Under church doctrine, that is "not only allowable, it's a moral imperative," he said. "The principle is to protect life. I'm fighting for the principle here."

Few church leaders agree with him. Pope Benedict XVI has made clear he supports a continuing ban on the use of condoms, and the Southern African Bishops Conference calls efforts to promote condom use an "immoral and misguided weapon against the disease," saying condom availability leads to moral decay and broader transmission of AIDS. Most African church leaders agree.

A few European cardinals and archbishops--in Brussels, London and Paris--back Dowling's view. But most church officials "have already made their decision and they just say no," Keenan said.

Call for a new ethic

Dowling believes the church's continuing rejection of condoms reflects a lack of firsthand experience with the AIDS epidemic and an inherent conservatism that makes questioning old doctrine unsettling.

"There's a sense of security from black and white," he said. "You can't do this. You can do that. But most of life is gray.

"I often think unless you've gone through what I've gone through personally, you can have a very ivory-tower approach to this."

What he would like to see from Rome, he says, is a "humble attitude" and a recognition that "we have to develop a theology for the HIV-AIDS pandemic that [recognizes] the poor and the suffering and the marginalized and the vulnerable" and is based on an ethic of "human dignity and justice and human rights instead of just on an ethic of sexuality."

The bishop has little doubt how unpopular his views are in Rome. The Vatican's official representative in South Africa has indicated Dowling's outspoken ideas are "unacceptable." Though no action has been taken against him, the bishop is also confident he can expect no promotions.

His parishioners keep him going, he says.

At Freedom Park, he stops to pat Selinah Mokholela on the arm and tell the 40-year-old AIDS counselor she looks beautiful.

Mokholela, who nearly died of AIDS last year before beginning anti-retroviral treatment, now has begun making public speeches to miners and camp residents, telling the men "they mustn't use us like a football" and urging the women to use condoms, be tested for the virus and start treatment if they turn up positive.

"Oh, help us to be strong and to love one another," she sings in a thin voice, trying out her latest gospel song. "We will find a way. There is an answer."

Dowling has no illusions that his condom push will halt the spread of AIDS around Rustenburg. In Protestant-dominated South Africa, Catholics remain a minority, so many churchgoers already have the freedom to use condoms and simply aren't doing so. In Freedom Park, plenty of miners buying sex still prefer women who don't demand a condom, and few women have the economic clout to refuse.

Dowling said he hopes an insertable microbicidal gel that would allow women to effectively kill the virus without their partners knowing the gel was there will eventually come on the market and begin stemming the epidemic.

But for now, AIDS remains "the defining issue of the whole sociocultural fabric," he says. In Rustenburg, with its sick and orphaned and jobless, "there's no doubt HIV-AIDS is going to dominate this society for years to come."

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