Bishop Kevin Dowling of Rustenburg, South Africa, has made a name for himself defying the Roman Catholic Church's absolute ban on condom use. He determined the church's views were unacceptable after witnessing the AIDS epidemic up close for 16 years in a mining town west of Pretoria. There, impoverished women living in tin shacks sell their bodies to feed themselves and their children. Most contract the deadly HIV virus from having unprotected sex. Since opening his first AIDS clinic in 1996, Dowling now oversees nine clinics that treat nearly 1,000 adults and children with lifesaving antiretroviral drugs.
Arriving in Washington on the eve of the pope's visit, Dowling met with White House officials yesterday in an effort to get more funds for hospice care for AIDS patients in their final weeks of life. (Congress is in the midst of reauthorizing the President's Emergency Plan for AIDS Relief [PEPFAR] with plans to increase the five-year funding package from $30 billion to $50 billion.) He also sat down with U.S. News to explain why he believes preventing the spread of HIV must come before religious idealism. Listen now or download and . Excerpts:
Where do your views diverge from the pope's?
I don't believe I have the right to impose on the people I serve the particular official position of the church in terms of, for example, the use of condoms to prevent the transmission of a deadly virus. The platinum mines near Rustenburg have brought in thousands of job seekers from around South Africa and countries to the north. Sadly, so many single women have wound up in the worst poverty, living in shacks, engaging in sex for money. It's not prostitution in my view but simply a mechanism for them to survive. I believe the one way they can take control, in the desperation they're in, is by demanding that the men they have transactional sex with use a condom. In the U.S., far less than 1 percent of people is infected with HIV, so most Americans don't know anyone with AIDS. What's the situation like where you live?
It's tragic. Every week, there are scores of funerals in my area, mostly young people who were born with HIV. In traditional rural villages, about 15 percent of people are infected with the HIV virus, but that's rapidly increasing. In Rustenberg, the infection rate is 25 to 30 percent, and at one of our large clinics, nearly 50 percent of pregnant women tested positive for HIV in 2004. What do you do to try to stop the spread of HIV? Hand out condoms?
I don't have to hand out condoms since the South African government distributes them for free everywhere. I've spent my time building relationships with nurses and community leaders who know how to communicate, especially to teenagers. We give them full, accurate, and nonjudgmental information about HIV: what it is, how you get infected, its consequences, and what ways you have to protect yourself, including information about condoms. We tell them that although condoms aren't 100 percent effective, they're very successful at preventing HIV transmission if you use them consistently, carefully, and correctly every time. Are there particular cultural challenges to implementing change in sexual practices?
Very much so. In South Africa, even more than in the United States, there are enormous pressures on young men to engage in sexually irresponsible behavior and "lay" as many girls as they can. In this strong patriarchal system, women are in a vulnerable position, feeling that they have to simply submit. We try to work with women to build up their self-esteem and make them aware that they're of infinite worth in God's eyes. We also have groups that go into primary schools to teach about sexuality in terms of honoring yourself and taking responsibility for others if you already have the virus. But we need scientific studies to see whether what we're doing is truly having an impact. Is there talk among church officials about overturning the ban on condoms?
Cardinal Carlo Maria Martini has made statements supporting condom use in a marriage where one partner is HIV positive, recognizing that it shouldn't be demanded that a husband and wife cut off their sexual relationship. So I do think a principle has been established that condoms can be used to prevent the transmission of HIV. I don't think my own statements in support of condom use have made any kind of shift, but I think we all recognize that it's a very difficult question that needs to be grappled with. Some worry that as soon as you open the door a little bit, you're allowing people to be promiscuous in their behavior. But I don't believe this is the case. I'm not saying my position is the right one, but I do think there needs to be a more formal dialogue within the church.