Disturbing New Evidence on Contraception and AIDS in Africa

A few weeks ago, I wrote on the impact of Catholic social teaching on AIDS rates in Africa. I showed there that the most Catholic parts of sub-Saharan Africa tend to have lower (sometimes, dramatically lower) rates of HIV infection than their non-Catholic counterparts.  This proved true both by region, and by country.  There are plenty of reasons that this might be so:

• that the acceptability of contraception encourages people to have risky sex;
• that Catholics are less likely to have sex outside of marriage, or use intravenous drugs;
• that Catholic countries have better HIV treatment programs, since the Catholic Church is the largest institution in the world providing direct AIDS care; 
• or that Catholic countries are unique in some unrelated way, such that the correlation is unrelated to causation.

Whatever the case, it certainly seems that when folks like Polly Toynbee claim that the Catholic Church's “ban on condoms the church has caused the death of millions of Catholics and others in areas dominated by Catholic missionaries, in Africa and right across the world,” she has absolutely no idea what she's talking about.  We just don't see millions more dying in Catholic countries than non-Catholic ones.  If anything, the evidence seems to suggest that the Catholic Church's social teaching is saving countless lives.

Since publishing that post, my conclusions received support from an unexpected place: the New York Times.  A Times news article provided one more reason that contraception-happy regions are facing a higher AIDS rate: namely, that one of the most popular forms of hormonal contraception (known in the US under the brand name Depo-Provera) is actually increasing the spread the AIDS:

The most popular contraceptive for women in eastern and southern Africa, a hormone shot given every three months, appears to double the risk the women will become infected with H.I.V., according to a large study published Monday. And when it is used by H.I.V.-positive women, their male partners are twice as likely to become infected than if the women had used no contraception.

The article goes on to note that this is probably the effect it's having on women everywhere.  Just look at the graph to the right to see how grim the numbers really are.

The Times article shows a response that's a little disturbing at first.  Public health officials have been devastated by this news, and arne't sure whether to continue to prescribe a drug that probably spreads AIDS.  Their logic seems to be that AIDS is bad, but so is the prospect of more African women getting pregnant.  In the words of one of the officials interviewed, “This is a very difficult dilemma.”

While that sounds at first like some pretty disturbing eugenics language, it probably isn't.  More likely, these officials are concerned about the fact that, as Simcha Fischer explains, having children in Africa is still a disturbingly dangerous affair.  While “the maternal death rate in the US is about 8 per 100,000 women. In African nations, the rate is as high as 1,100 per 100,000.”

But the solution to this, as Fischer notes, is providing basic medical resources for pregnant women, not preventing them from getting pregnant.  That approach just papers over the deadly serious problem.  After all, no matter what happens, women will continue to get pregnant, and the need to provide them with adequate (even basic) healthcare will remain.

Public health officials need not accept the Hobson's choice between AIDS and maternal death. Instead, what's needed is for more public health organizations to follow the lead of the Catholic Church: (1) discourage extra-marital sex and drug use and (2) provide much-needed healthcare.