HIV continues to be a major global health challenge with 2.5 million new infections each year, 1.8 million of which take place in sub-Saharan Africa . Condoms play a key role in limiting the HIV epidemic by acting as a physical barrier and keeping down the number of new strains . In November 2010, in a historic shift, Pope Benedict XVI said that their use might be justified on a case-by-case basis to prevent the spread of HIV . This appeared to be a relaxation of a hitherto uncompromising Vatican ban on the use of artificial contraception . Whether Pope Benedict XVI's policy shift affected condom use by the 170 million Catholics living in sub-Saharan Africa, and to what extent, remains largely unknown. Here, we briefly describe condom use by Catholics in five HIV endemic countries in sub-Saharan Africa during Pope Benedict XVI's tenure, which lasted from April 2005 until February 2013.
We searched nationally representative household surveys conducted by the Demographic and Health Surveys (DHS) programme in sub-Saharan Africa, with survey waves completed at both ends of Pope Benedict XVI's tenure. We then identified countries with available data on ‘condom use at last sex’ and religious affiliation, conditional on Catholics representing one of three major religious groups nationally. Figure 1 displays condom use for Cameroon, Mozambique, Rwanda, Uganda and Zimbabwe (HIV prevalence, 2.9–14.9%). Condom use by Catholics ranged between 2.3% and 23.8% in women and between 6.0% and 38.3% in men. Rates in Catholics were similar as in Protestants, whereas they were higher in Muslims in Rwanda and Uganda, and lower in Muslims in Cameroon, Mozambique, and members of the Apostolic Sect in Zimbabwe. During Pope Benedict XVI's tenure, Catholics have increased condom use in Cameroon, Mozambique, Rwanda, Uganda and Zimbabwe, on average by 71.5% for men and women combined.
Sub-Saharan Africa is among the most religious areas in the world and boasts the fastest growing Catholic population . It is possible that Catholics in Cameroon, Mozambique, Rwanda, Uganda and Zimbabwe somewhat increased their condom use as a direct result of Pope Benedict XVI's policy shift or indirectly through the involvement of Catholic leaders, institutions and numerous organizations working locally. In addition, Pope Benedict XVI's policy shift may have dissipated some of the stigma surrounding condom use among Catholics. Further research, however, should aim to examine potential effects among specific groups at risk for HIV, spill-over effects between religious groups and the potential effects of a papal policy that would fully legitimatize condom use (rather than on a case-by-case basis). New evidence would prove instrumental as the incumbent pope shapes his policies.
This project was conducted with the support of the Takemi Program in International Health at the Harvard School of Public Health.
Conflicts of interest
There are no conflicts of interest.
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