The Quandary You Will Always Have With You

So a major new study comes out in the journal Lancet Infectious Diseases declaring that a common hormonal contraceptive doubles the risk of HIV transmission. Researchers at the University of Washington determined, by following 3,800 couples in seven AIDS impacted African countries, that the contraceptive (Depo-Provera, which is taken by injection every few months) increases the likelihood that women will become infected with HIV, and the likelihood that women already infected will transmit it to their male partners. Those who have relentlessly promoted such contraception might now be considering how to concede, sotto voce: oops, my bad!

Or will they? This study was not the gold standard – that is, it was not a randomized controlled trial explicitly designed to examine that specific linkage. But it is sturdy and bolsters in important respects previous studies that also indicated a connection between hormonal contraceptives and HIV transmission. Still other studies have conclusively demonstrated a link between contraception and other STDs. The strength and gravity of these findings, if not strictly conclusive at this stage, nonetheless dictate that the safest operating assumption should be that the contraceptive doubles the likelihood that the uninfected partner will contract HIV.

President Obama should therefore cease exporting these contraceptives – long a mainstay of foreign aid programs – though we can expect politicized dithering from health authorities about whether or not to even inform women, and men for that matter, of this risk. It’d be hard to call such a move reactionary, despite what some would no doubt say, considering that Obama personally apologized to the president of Guatemala recently because American medical researchers deliberately infected 1,300 Guatemalans with STDs such as syphilis in the 1940s.

Granted, this is not precisely the same thing. But we can now say with much, if not quite total, confidence that western funded contraception programs lead to more HIV transmission than would otherwise occur in their absence. Among those exposed to the virus and the contraceptive – not a small cohort (12 million African women use it) – we can expect roughly twice as many infections to accrue as we would without the contraceptive. This is now foreseeable. 

The inhumane Guatemalan scheme of the 1940s took eighty-three lives; what was then justified under the pretext of “science” is now rightly seen as an outrage. But there are always justifications. In this case, justifications are being called quandaries. Public Health authorities today will fend off outrage – over complicity with fueling a fearsome epidemic – as long as possible under the pretext of “family planning,” whether they resort to the overpopulation canard or to tragically high rates of maternal mortality. Even if it means knowingly causing eighty-three extra HIV infections a day – assuming that only a small proportion of Africa’s 2.7 million annual HIV infections is attributable to injectable contraception – you can always do some harm as long as you claim that contraceptives somehow do more net good. Malleable indeed is the utilitarian calculus, constant its compliance with the will of the powerful.

The New York Times stressed that these findings present a “quandary,” citing officials who depict preventing pregnancy in that part of the world as roughly on par with preventing HIV infection.  But this is a false dilemma. As I pointed out recently, we’ve made little progress against maternal mortality in Africa because maternal health programs have not focused on survival but devolved into “Family Planning” programs – which authorities seem not to want to relinquish at any price. 

Imagine if the vast sums of money now being spent on the carcinogenic steroids that also increase HIV transmission – injectable contraceptives – were spent on relatively basic measures to manage the conditions that cause the vast majority of maternal deaths; only a miniscule proportion of resources are presently directed towards those proper ends. Why, you’d kill two birds with one stone – reduce current levels of HIV transmission and save the lives of mothers and their babies when (real) complications do strike.

If that sounds reasonable, you need no nudging to appreciate why Pope Benedict XVI observes with repeated urgency that reason itself is under assault today – not just faith. (You can expect the usual attacks on him when he visits Benin next week.) The Public Health and Foreign Aid establishments are not just rejecting the Judeo-Christian tradition – but “dissing” Hippocrates himself, the esteemed pre-Christian father of Western medicine who gave us one of its most foundational principles:  Primum non nocere – First, do no harm.

Hippocrates, it must be stressed, also equated love for the art of Medicine with love of Humanity. You don’t have to be a physician and an artist, as St. Luke was, to recognize that pregnancy is not a disease – even if our own government, now attempting to require private employers to cover contraception and sterilization under the rubric of “preventive services,” would have us believe otherwise. Could it be that, in pursuing demonstrably harmful, neo-Malthusian contraceptive schemes, some measure of misanthropy lurks not far beneath the surface in our great halls of supposed philanthropy? 

The distressing capitulation of the healing professions to aggressive secularism’s assault on man is but one manifestation of the gravity of our present predicament. John Paul II felt that humanity is in the midst of its greatest historical confrontation – between “the Gospel and the anti-Gospel” – and that most Americans do not realize it. It is a trial not only for the Church, he stated in Philadelphia two years prior to becoming pope, but a veritable “test of 2,000 years of culture and Christian civilization.”  This too is not a quandary – it’s all hands on deck, to safeguard everything from individual human dignity to medical integrity to the rights of nations.

Matthew Hanley

Matthew Hanley’s new book, Determining Death by Neurological Criteria: Current Practice and Ethics, is a joint publication of the National Catholic Bioethics Center and Catholic University of America Press.