Aids In Africa.

South Africa Bishop says condoms must be permitted

By Scott Calvert,

Baltimore Sun Foreign Staff
Originally published April 10, 2005

PHOKENG, South Africa - Someone dies, on average, every other day in the adobe building next to Bishop Kevin Dowling's residence.

Since the Catholic AIDS hospice opened its doors six months ago, the disease has claimed 93 patients whom antiretroviral drugs couldn't help: men and women in their prime, boys and girls, new mothers, a baby.

"Shame, shame," Dowling murmured as he held the hand of Omphometsi Senne, a frail 9-year-old boy who the staff hopes will not become the 94th.

Faced with so much death, Dowling has embraced any tool he can find to prevent it, including condoms. He has been steadfast, even passionate, despite rebukes from fellow bishops and the Vatican's unwavering opposition to contraception.

In the AIDS era, Dowling maintains, the Roman Catholic Church must realize that it is naive to preach only abstinence and fidelity. In South Africa, one in five adults is infected with the human immunodeficiency virus, which causes AIDS, and many poor women have few options other than prostitution, making them more vulnerable.

"In this case," says the 61-year-old bishop, "condoms are used to stop the transmission of death. This is a pro-life stance."

Dowling does not know whether the next pope will alter the church's teachings against the use of contraceptives. When he publicly promoted condom use four years ago, as governments in the region have done, the bishops conference of South Africa, Botswana and Swaziland denounced such advocacy as an "immoral and misguided weapon" in the fight against acquired immune deficiency syndrome.

"It's kind of a feeling of being alone and alienated, not part of the group," Dowling says of the chill from his fellow bishops. "That's OK with me because I believe in the position I've taken, because I can't forget these people."

The other bishops condoned the use of condoms only when an infected person wants to protect an uninfected spouse.

"Condoms may even be one of the main reasons for the spread of HIV/AIDS," the bishops wrote. "Apart from the possibility of condoms being faulty or wrongly used, they contribute to the breaking down of self-control and mutual respect."

Dowling argues that those values broke down long ago among the 46,000 parishioners in his diocese, a region west of Pretoria that is dependent on platinum mines.

Dowling is most concerned about women. The clinic staff makes sure women know about condoms, though the bishop acknowledges that some women feel powerless to insist on their use.

"If you can protect some lives and prevent some people from being infected," Dowling said, "that is worth all the struggle."

Dowling recently visited the AIDS clinic the church opened eight years ago, a structure built of old shipping containers equipped with doors, in the bleak squatter camp of 5,000 shacks known as Freedom Park.

Three hundred people there are taking antiretroviral drugs in a program the diocese developed with help from Baltimore-based Catholic Relief Services and paid for by an American aid program.

Celinah Mokholela and her 2-year-old daughter, Karabo, were recently at the clinic for a checkup. Antiretroviral tablets, which have been available at the clinic since last year, keep the 39-year-old and her daughter alive. But the stark living conditions - no electricity in Mokholela's 12-by-15-foot shack, no running water, no balanced nutrition - compromise their future.

Mokholela believes she contracted HIV from one of the mineworkers who gave her financial support. Karabo was conceived when her boyfriend, who was drunk, demanded unprotected sex.

"I couldn't say no," she said, wiping away tears. "I was staying in his shack. He was giving me food. Most of my life was under him. To run away, I would have to be a prostitute."

She lives with Karabo and her 14-year-old son, Thuto, in the shack, decorated with a poster of a smiling former President Nelson Mandela. A $30 monthly government grant helps with food.

"I don't want any boyfriends now," Mokholela said between coughs caused by tuberculosis. Gesturing at her daughter, she said, "I hope I can live until she's 10. I will teach her as I've taught my son that I am [HIV-]positive. He must be aware. He must use a condom to be alive."

Empowering women is one of Dowling's goals. The church helps train women to make bead jewelry and traditional African art to sell at the nearby Sun City resort. If they can earn money, the logic goes, they might be less at the mercy of men.

Dowling's team also works with the Impala Platinum Ltd. mining company to raise miners' awareness of the dangers of unsafe sex - for them and their partners - and change their attitudes about women and condoms.

Dowling emphatically agrees that abstinence before marriage and faithfulness are ideal. But the clinic also distributes information on condoms because not everyone will follow the path condoned by the church. Condoms are not distributed, Dowling says, but are freely available.

The Catholic Church's proscription against condoms, in his view, undercuts the church's good work on AIDS. "What is the church known for? Its stance on condoms," he said. "On the one critical issue of protection of life, it takes a very hard position."

Some women in the diocese applaud Dowling's stance. Hilda de Bees, a nurse who manages the hospice, said of the condom, "If you use it, you are being saved from a lot of disease. I can see what it does. I'm not looking at it just from a religious perspective."

Omphometsi, the 9-year-old whose hand Dowling held, has come to the hospice for a second time.

If Omphometsi's parents had used a condom, he probably would not be there today. Asked how he squares that with Catholic teaching that all life is precious, Dowling responds, "I feel intense pain, suffering about that issue. We're trying to make a dent."