Sunday Times (Johannesburg) - August 16, 2001

We, the Sisters for Justice of Johannesburg, wish to comment on the recent statement by Bishop Kevin Dowling after the United Nations Special Assembly on AIDS, held in June this year and the Southern African Catholic Bishops' Statement, A Message of Hope, issued in July. There has been a great deal of press coverage of these two statements in recent weeks and we wish to be part of this important debate, which is in fact not only around the use of condoms but includes much wider concerns such as the link between HIV/Aids and the moral fibre of the nation. Sexuality, the oppression of women and unjust socio-economic conditions are critical related issues.

We are given hope by the fact that the SACBC statement contains not only moral norms but also the emergence of the pastoral application of those norms in the case of married people when one or both of them are HIV positive. Such people are encouraged to "listen to their consciences" and make an appropriate decision. We would like to see conscience formation and personal responsibility explained and promoted more widely and in reference to other ethical decisions and situations, since it is consonant with human dignity.

We ask ourselves for whom the SACBC statement is in fact a message of hope? Upholding ethical and moral norms is one thing, but the pastoral application of such norms to people's lives is another. It is the contextualization, the pastoral application of the moral norms in the Message of Hope that concerns us. For many women, the SACBC message in its present form will not be one of hope.

The indiscriminate use of condoms is not at issue in this debate. Neither Bishop Dowling's statement nor the Message of Hope considers this morally acceptable. Abstention before and fidelity within marriage are the only real safeguards against HIV/Aids and upholding these moral norms builds the moral fibre of the nation. One would expect the bishops to uphold these norms, as they and we do. However, there are other Christian Church leaders who have pledged themselves to the moral renewal of the country as the Catholic bishops have done, and who are just as committed to building the moral fibre of the nation. Many of these promote the use of condoms to reduce the rate of infection and death and do not see this as undermining the coherence of their stance and message. Professor Jerry Coovadia, engaged in HIV/Aids research at Natal University, has said that "faith communities have done significant work in many African countries in helping to reduce the impact of the epidemic by combining religious principles with an understanding that not everyone subscribes to these values." (Sunday Times, 22 July 2001)

We support Bishop Dowling's pastoral application of the moral norms in the context of complex, ambiguous and often unjust socio-economic situations. We are deeply concerned about patriarchal attitudes which lead to severe discrimination against many women and girl children, the serious gender imbalance and inequality experienced by women in terms of sexual relationships and the fact that so many women have no say over their lives, much less over their bodies. We are also aware of the plight of women who are forced into desperate situations which might put them more at risk of infection.

Phrases such as "the beautiful act of love" and "equal and loving partners" seem to us to direct the Message of Hope to people who are in fairly healthy and stable marriage relationships, but not to people, usually women, in abusive, oppressive or desperate relationships or circumstances and who are very much at risk of being infected by the HIV.We share Bishop Dowling's and other bishops' compassion for these women. It is entirely within the context of the Aids pandemic in our country that the use of a condom to prevent infection of one's sexual partner could be seen to be permissible. The Message of Hope supports the principle that "everyone has the right to defend one's life against mortal danger". The reference is to married couples where one of the partners is living with HIV/Aids and in an indirect way, without using the word "condom", the statement opens the door to some form of self-protection.

On the principle that everyone has the right to defend their life against mortal danger, those who (often most unwillingly) are the sexual partners of people who have Aids would also be able to make a decision to use the appropriate means and course of action, even if they are not married. It is precisely this defence of one's life which is the central issue in Bishop Dowling's pastoral stance.

The use of a condom for the sake of defending life is morally defensible according to the principle of double effect. This principle is applied when a terminally ill patient is in great pain and is given high doses of morphine. The primary objective is the relief of pain, even though the other effect is the possible shortening of the person's life. Or a woman is permitted to take the "pill' to regulate dysfunctional menstruation even though she is rendered infertile while taking it. In the same way, it would surely be morally defensible to resort to the use of a condom to prevent infection by HIV, even though the possible prevention of conception is the other effect of condom use.

It is in the context of such desperate situations that we feel people should be educated to make responsible decisions and take appropriate action. This is the "grey area", not addressed in the SACBC statement, that we feel needs to be addressed. It seems unreasonable and unjust to insist that people in desperate straits should adhere absolutely to standards which describe the morally correct response of people living in fully human situations and conditions. This view is a very far cry from the "indiscriminate use of condoms."

James Keenan, S.J., professor of moral theology at Weston School of Theology, and others who have entered this debate, also invoke the principle of "the lesser evil." This applies, says Keenan, "to those sexual relations that occur outside the context of marriage. The Catholic Church has long held that any sexual activity outside of marriage is morally wrong because it violates the principle of chastity. In a time of Aids, such sexual activity could also cause the transmission of HIV and this would violate the principle of justice, because by unprotected sexual activity one could infect another with the deadly virus. The principle of the lesser evil means that the wrong-doing against chastity remains so, but, without condom use, the sexual action would also violate justice. The principle of the lesser evil does not diminish the agent's violation of chastity. Rather, the principle is concerned solely with another evil being added to the moral wrongfulness of the action, that is, the agent's violation of justice". (Keenan's paper on the SACBC statement). Unfortunately, a woman who is dominated by a man is hardly able to ask for the use of a condom. However, if either person is infected, the decision to use a condom shows some measure of responsibility, according to the principle of the lesser evil.

Dr Ingrid Skakal, a Catholic doctor in Johannesburg who has significant exposure to people with HIV/Aids, writes: "At the recent WONCA World Conference of Family Doctors it was disclosed that the greatest incidence of new HIV infections is in young women in the 14 to 19 year old category, primarily due to the high incidence of forced or reluctant sexual intercourse." It is imperative that girls and women be provided with the information and the means to protect themselves in abusive relationships. This point was well made at the UN Special Assembly on AIDS by the Prime Minister Pascoal Mocumbi of Mozambique on 25 June 2001. He said: "We need to develop protection methods like microbicides that women can use with or without a partner's knowledge or co-operation." One wonders whether female condoms would not be one of the more effective methods of protection for women who are at risk.

"Condoms do not guarantee protection against Aids". This is an uncontested fact. Poor quality or faulty use means that there is no guarantee of protection. However, we question the statement in the "Message of Hope" that condoms may be "one of the main reasons for the spread of HIV/Aids." Professor Louise Kuhn, an epidemiologist engaged in full-time AIDS research at Columbia University, states that "the efficacy of condoms to prevent transmission is well-established scientifically." (E-mail response to SACBC statement, 14 August 2001) Prof. James McIntyre of the perinatal HIV unit at Wits University and Professor Coovadia are quoted in The Tablet of 28 July and in the Sunday Times of 22 July as stating that many international and national scientific studies show that condoms, if properly and consistently used, "have played a significant part in preventing transmission of the virus from an infected partner to the uninfected partner."

The bishops in the SACBC statement cannot be denying any value in the use of condoms if they permit their use (as is suggested) in defending the uninfected partner in a marital relationship. If what they really mean is that education about condoms, or their availability, may lead to an increase in promiscuity, there is evidence to the contrary. Fuller and Keenan state: "It has now been well demonstrated that education which includes information about the appropriate use of condoms does not increase the rate of sexual intercourse, and in fact can lead to a delay in the age of first intercourse. Numerous studies (from Uganda, Senegal, Thailand, among others) have demonstrated that educational programmes which discuss condoms and which also encourage a delay in the age of first intercourse and a reduction in the number of sexual partners can make enormous strides in decreasing new HIV infections as well as other STDs." (Catholic Ethicists on HIV / AIDS Prevention, Continuum 2000, p 35.),

It seems clear, from the preceding discussion and from what many people who have entered the debate are saying, that the condom issue is only a surface issue. What is on the table now is about much more than condoms. It is about the kind of Church we would like to be as we reach out in compassion, as disciples of Jesus, to those who are in mortal danger and have no other means of protecting themselves. It is about the way we feel for people in complex socio-cultural-economic situations; people who do not live in regular, equal and loving relationships. It is about educating people so that their consciences are formed in making responsible moral choices. It is about our accompaniment of young people, and particularly of young women, at this crucial time in their lives, as they face choices that are about life and death. It is about how we search humbly and sincerely for truth, justice and compassion without seeing everything in "black and white" terms as though there are no grey areas in between. And finally, it is about gender imbalance in society and Church, about the ongoing injustice, violence and discrimination against women. The HIV/Aids pandemic, with all its ramifications, calls us urgently to address the issues of social, economic, racial and gender injustice which make our country so vulnerable to the spread of the virus.

As Ingrid Skakal points out: "To reserve the ethical debate to those who are privileged enough to have stable, caring relationships is to exclude large numbers of the population and will continue to ignore the need for women to develop a voice in their destiny."

We must continue to address these issues. Teresa Malcolm (NCR, August 10, 2001) citing Fuller, declares: "The statement from the Southern African Bishops' certainly does not end the conversation. It should further stimulate dialogue on this question. What are our priorities here - defending an ethic of sexuality, or protecting lives?"

SISTERS FOR JUSTICE: PATRICIA FRESEN OP, SHELAGH MARY WASPE HF, JOAN MUMAW IHM, MARIE BERGIN HF, BRIDGET ROSE TIERNAN SND, RAYMUNDA BRENNAN OP, NATALIE KUHN OP, SHEILA CALLANAN FMM, LUCY BOWE FMM, LOEK GOEMANS, MARGO VERSPEEK OP, ANN MAUREEN YAZBEK OP , MARY JANE LUBINSKY OP, THERESA PAUL HF.

OTHERS WHO SUPPORT THIS STATEMENT ARE: ALISON MUNRO OP, COLLEEN MOORE HF, ANN WIGLEY OP, MARK POTTERTON, SR VERONICA CHAPMAN SND, GERALDINE DEVINE OP, ALOYSIA ZELLMANN OP, AGNES MURPHY OP, MAUREEN YENSON OP, ROSELLA LANGER OP, HANNA REMKE OP, JUDITH COYLE IHM, EVELYN JUNG OP, RUTH K NG OP, MEGAN CRAIG OP, B. VON FELTEN, SR JACQUELINE OP, PAULA HORN, SR CHRISTA BUCHER OP, SR MARGARET SCHAEFFLER OP, B.F. HARINGTON OP, FR JOHN CONVERSET, SR DIETHARDE STEFFAN OP, ROSEMARY ANNE LYONS, TERESE MARIE OP, THERESE SACCO, RITA BULL, ANDREW BULL, JEAN VERMAERKE, MARGIE BAKER, ZODWA MABASO, FIONA McFARLAN, ANNE BAKER, JANICE SELAND, PAUL JACKSON, NATHAN JOHNSTONE, BARBARA McGREGOR, JOHN McCORMICK, SUSAN RAKOCZY IHM, KATHLEEN BOOTH, NOREEN BUSH, MYRTLE GOULD, PAT JONES, MOIRA McKESSAR, MARGARET PURKISS, SHEILA SMITH, MARGARET TANSKI, VERENA KENNERKNECHT, ANN MOORE, EMILIA CHARBONNEAU, MICHAEL MERLE, SR CECILIA SMIT OP, JOAN McGREGOR , STEPHANIE HENNESSY OP, THERESITA KRIENER OP, JUSTINA SCHILLING OP, BEAUTY MALETE, HELEN KEEN, ELIZABETH MARTINY, DR INGRID SKAKAL, PAUL FALLER, MARLENE JARDINE.

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