The Church would be well served if everyone doing works of mercy in her name were as clearheaded and holy as St. Vincent de Paul. The Missionaries of Charity live up to that ideal in trying to help people actually or potentially afflicted with AIDS. But some working in that field seem to misunderstand charitable apostolate and perhaps betray the Church even as they act in her name.
Divine revelation is not mere information to satisfy human curiosity. God is love. In revealing, he invites people to form a close relationship with himself. Not only his words but his amazing deeds show his love, and call people to respond and enter into ongoing communion. When Jesus announces the kingdom, he both manifests compassion and verifies his message by signs, such as curing the sick and feeding the hungry. But he does not cure all the sick or feed all the hungry, though he could. He loves us so much that he wants more for us than good health and full bellies. He lays down his life to save us from sin and death—and bring us into God’s everlasting, heavenly kingdom.
The Church never acts on her own in carrying on Jesus’ mission. Jesus is always with her when she preaches and teaches, administers the sacraments, and does charitable works. Thus, she fulfills his command to spread the Gospel and makes him really present, manifesting his love to each of his brothers and sisters in every nation until the end of time. When Catholic charitable agencies properly feed the hungry or provide health care, those who receive help meet Jesus, learn how much he offers, and are given a new opportunity—perhaps a unique one—to respond to his love and share in his kingdom.
In 1943, the bishops of the United States established Catholic Relief Services (CRS) to help suffering people overseas, regardless of their race, creed, or nationality. Acting faithfully as the Church’s agent, CRS served Jesus well for many years, during which its charitable works helped many suffering people experience his love, and surely helped him lead some of them all the way home.
In 1986, CRS began an HIV/AIDS program. The agency reports that it “now supports more than 250 HIV and AIDS projects in many underserved areas of the developing world.” With these projects, CRS policymakers claim to be faithfully fulfilling Jesus’ and his Church’s mandate: “Since the Church promotes integral human development, it does not restrict itself to a medical response to the HIV epidemic but extends its care to include the social, emotional, development, and spiritual needs of those affected by HIV and AIDS.”
The quotations in the preceding paragraph are from a document, “CRS’ Position on the Prevention of Sexual Transmission of HIV,” dated December 2007 and e-mailed to CRS country representatives on January 11, 2008 by Jennifer Overton, the agency’s senior technical advisor for HIV, who was in charge of preparing it. In her cover letter, Ms. Overton makes it clear that the guidance the position paper provides is authoritative: “The document was approved by the ELT [Executive Leadership Team] and should be used to guide CRS supported programming.”
In a story in Our Sunday Visitor (February 17, 2008), Russell Shaw and John Norton brought to light the CRS position paper with its cover letter. They interviewed some CRS executives and Archbishop Timothy Dolan, chairman of the CRS board, and reported their initial responses. My curiosity aroused, I closely studied the position paper on which the Shaw-Norton story was based.
The introduction to the position paper states that it provides “updated information about the effectiveness of some preventive methods. CRS’ policy has not changed.” One wonders whether the same policy has been in effect since 1986.
Some statements in the position paper are reassuring. It states: “All HIV programs supported by CRS promote abstinence until marriage, and mutual fidelity within marriage” and develops that point repeatedly—for example, by adding: “These behaviors are the only means that completely avoid exposure to the risk of sexually transmitted HIV infection. These specific behaviors have always been the cornerstone of the Catholic Church’s teaching with respect to human sexuality.”
The paper also reports with approval protests against the promotion of condoms as encouraging sexual activity outside marriage, warns that consistent and effective condom use is not easily achieved, and points out that there are many places where condom use has increased and HIV has not declined, “but in every country worldwide in which HIV has declined there have been increases in Abstinence and/or Be faithful behaviors (A&B).”
With respect to providing information about condoms, the position paper states: “CRS does provide complete and accurate information about condoms to its partners as part of its HIV activities.” (According to the Shaw-Norton OSV story, CRS partners “include local Catholic churches as well as other faithbased and secular groups.”)
The position paper goes on to say that the information is provided “in the context of the Catholic Church’s teaching on sexuality and condom use” and adds that “CRS does not finance, promote or distribute condoms.” The paper reassuringly explains: “CRS wants to ensure that partners are not giving inaccurate, misleading or no information at all on condoms—and that the focus and priority remain on abstinence and fidelity.”
Those statements do not show that the CRS policy on providing information about condoms is unsound. Nevertheless, that policy is troubling.
The CRS position paper distinguishes between promoting condoms and giving information about them by saying: “Promoting condoms means suggesting, encouraging or urging people to use a condom during sexual intercourse to prevent HIV transmission; providing full and accurate information means giving the fact [sic] about condom use including the benefits, risks and failure rates.”
But providing information about condoms’ benefits is likely to lead to their use. Condoms are designed to prevent bodily fluids from mixing when people engage in sexual activity. Giving information about condoms’ benefits to people who wish both to engage in sexual activity and to prevent the bodily fluids from mixing encourages those people both to engage in the sexual activity and to use condoms.
In explaining the importance of providing information about condoms, CRS policymakers clarify their intent: “Individuals at risk of HIV transmission need access to the best teaching on prevention and the latest evidence on risk reduction in order to make fully informed decisions in order to prevent infection and reduce the risk of transmission of HIV.”
Even if information about condoms’ risks and failure rates is included, however, information about their “benefits” will not significantly reduce the likelihood of transmitting HIV unless it leads to their consistent and correct use by those engaging in the risky behavior. So, CRS policymakers seem to intend to encourage such people to use condoms consistently and carefully—i.e., seem to promote their use of condoms.
The position paper articulates CRS’ own policy by quoting two sentences from a document of the United States Conference of Catholic Bishops: “People need education and motivation, so that they will choose wisely and well. Providing information that is both accurate and appropriate is a logical and necessary starting point.” Those two sentences appear in the USCCB November 1989 document, Called to Compassion and Responsibility: A Response to the AIDS Crisis. However, the two sentences were taken out of context for use in the CRS position paper.
In the relevant passage of their 1989 document, the bishops point out that one of many problems with the response to AIDS was “the refusal to discuss publicly the direct link between sexual activity and intravenous drug use on the one hand and HIV/AIDS on the other.” Their proposed solution: “People must be shown the right thing to do and encouraged to make right choices.” The bishops insist on “lasting changes in the way people act,” say nothing about condoms, and unblinkingly affirm “that to eradicate some diseases, people must desist from the behavior that spreads them.” In that context, the sentences about “providing information” quoted in CRS’ position paper do not warrant the claim that the bishops support providing information about condoms.
Although CRS policymakers do not have the support of the USCCB 1989 document their position paper quotes, they could claim the support of a December 1987 document—not issued by the USCCB as a whole but only by its administrative board—“The Many Faces of AIDS.” That document said that public educational programs “could include accurate information about prophylactic devices [i.e., con-doms] … as potential means of preventing AIDS. We are not promoting the use of prophylactics, but merely providing information that is part of the factual picture.”
That statement was considered unsatisfactory by many US bishops and was severely criticized by Cardinal Joseph Ratzinger, then prefect of the Congregation for the Doctrine of the Faith. In a letter to the US bishops, Cardinal Ratzinger indicated that public programs providing such information not only tolerated evil but facilitated it. He then added:
The problem of educational programs in specifically Catholic schools and institutions requires particular attention. These facilities are called to provide their own contribution for the prevention of AIDS, in full fidelity to the moral doctrine of the Church, without at the same time engaging in compromises which may even give the impression of trying to condone practices which are immoral, for example, technical instructions in the use of prophylactic devices.
This letter was published in Origins (July 7, 1988), and along with it Origins reprinted the paragraph from “The Many Faces of AIDS” that supports providing information about condoms. But Cardinal Ratzinger’s letter guided the development of the USCCB’s November 1989 document—the one from which the two sentences used in the CRS position paper are taken out of context.
It is hard to believe that CRS policymakers have been unaware of this history of the US bishops’ thinking on preventing the transmission of HIV.
HIDING THE CRS LOGO
As witnesses to God’s revelation in Jesus, the bishops do not need to put the lamp of their teaching under a bushel basket. But the CRS position paper requires that those who implement its policy on providing information about condoms do just that: “Any written educational material that contains information about condoms must not carry the CRS name or logo” (the underlining and the bold type, here and later, are theirs). I do not see how CRS policymakers can reconcile their need to distance the Church from such material with their responsibility to carry on a charitable apostolate in the Church’s name.
The position paper also inadvertently indicates that not all CRS’ partners agree with its policy on providing information about condoms. If partners “do not want to provide information on condoms,” CRS cannot insist that they provide it, but “can decide to discontinue support to a project if it does not comply with CRS’ policy on full and accurate information.” If partners supply inaccurate information, CRS staff should “provide information to educate” them, and find out why they aren’t using it: “Is it that they are not aware or that they are just ethically opposed? After discussing with the partner, if they do not change the information they are providing, CRS would be compelled to discontinue funding as per CRS’ policy.”
CRS policymakers seem to consider intolerable any partner’s noncompliance with their views about providing information regarding condoms. If some partners are unwilling to submit due to a conscientious objection, they are just ethically opposed.
Orders from CRS’ headquarters in Baltimore apparently have not been universally well received. Perhaps some partners have been insulted by what they perceived as American condescension as well as repelled by some of the “educational” materials offered by CRS officials. One example of those materials is a “Flipchart for Client Education” mailed out by the AIDSRelief team to some CRS partners in October 2007.
In a video on the CRS website— http://crs.org/zambia/aidsreliefvideo/— Ken Hackett, president ofCRS, explains the origin of AIDSRelief: “Afew years ago, we started a program in both sub-Saharan Africa and the Caribbean. It covered nine countries. We called the project the AIDSRelief project, and basically it was an attempt to extend both antiviral therapy and support to people in need in those nine countries.” The video explains that CRS now “leads a five-member consortium that implements the AIDSRelief project.”
The flipchart was mailed out on a CD, along with related materials. With the CD, Jared M. Hoffman, an executive at CRS’ Baltimore headquarters, sent a cover letter, which he signed as “AIDSRelief/Chief of Party” and addressed to “colleagues” in many countries. The letter explains that the flipchart is a tool “based on an earlier WHO” (World Health Organization) product meant for use “by health facility and community health workers” counseling people with HIV, their families, and communities. In adapting WHO’s material, AIDSRelief Zambia collaborated with the Zambia Ministry of Health and the Johns Hopkins Center for Communication Programs.
Hoffman states: “The comprehensive and accurate information on prevention contained in this material is consistent with CRS policy, and we are confident that the flipchart will be useful in all settings, requiring only minor adaptations to ensure cultural competence.” Hoffman also points out that “CRS has ownership rights of the document” and “any changes to the flipchart must be consistent with CRS policy, and therefore, it will be necessary to verify your proposed adaptations with Sister Phyllis Hughes in PQSD prior to printing and distribution.” (The Shaw-Norton OSV story refers to Sister Hughes as the “manager of CRS’ HIV/AIDS unit.”)
The label on the disk does not identify its source. Hoffman explains why: “CRS has chosen not to include the CRS or AIDSRelief logo on the flipchart, due to the potential sensitivity of the information contained in these materials among Church partners.” He anticipates objections: “If you are concerned about the reactions of the Bishops and the Church in your country, we would be glad to provide you with support in presenting this information to your partners.”
While the first section of the flipchart begins promisingly with “Safer sex behaviour – Abstinence” (p. 25), it at once points out: “Partners who abstain from sex can still enjoy other expressions of affection. Remember hugging and kissing will not transmit HIV” (p.26) and shows a couple, dressed but lying together, exploring “other forms of sexual pleasure” (p. 27). It defines “safer sex”: “Safer sex expressions are sexual activities which do not allow semen, fluid from the vagina, or blood to enter the anus, vagina or the mouth of the partner” (p. 28)
In a page on “Counseling young adolescents,” the information the flipchart offers is: “Delay sexual activity. If in an intimate relationship, explore other forms of sexual pleasure (massage, touching, hugging)” (p. 35). Similarly, women with HIV are informed that they can still have a fulfilling life with their “partners”—i.e., husbands or men to whom they are not married—if they “choose to abstain from sexual intercourse and focus on other ways to please each other — for example, touching, cuddling, or massaging each other” (p. 118). Thus, obtaining sexual pleasure by what is euphemistically called “massage” is presented as acceptable for both young adolescents and married couples.
In “Section 1: Prevention,” the treatment of condoms begins: “Referrals for condoms” (p. 45). It provides a bit of information: “Condoms, when used consistently and correctly, have been shown to reduce the risk of transmission of HIV, STIs and HIV re-infection.” It immediately adds: “Explain to the client where condoms are available and where they can get more information” (p. 46). It goes on with precise directions, illustrated with graphics of cartoon figures, for using and disposing of male condoms (pp. 47-48) and female condoms (pp. 49-50). The section is rounded out with an enthusiastic testimonial by a condom user: “Being HIV+ shouldn’t stop you enjoying sex” (p. 51). Why not? “We use condoms every time we have sex,” and: “In the absence of condoms, we use other means of getting sexual fulfillment such as kissing, stroking or licking sensitive places” (p. 52).
Also significant is what is missing from the flipchart. While it is repeatedly stated that only complete abstinence provides 100 percent assurance that sexual activity will not transmit HIV, the flipchart nowhere says what the failure rate of condoms is.
The CRS position paper states: “Some studies show that, with consistent condom use, the HIV infection rate among uninfected partners was less than 1 percent per year” and cites a 2001 document of the National Institute of Allergy and Infectious Diseases that reported a summary of 12 studies of people who said they always used condoms and experienced 0.9 incidents of HIV transmission per 100 persons, which means that in an average group of 111 people, one each year would experience HIV transmission.
Those odds might not sound bad, but people using condoms to try to prevent HIV transmission are likely to do so for many years, not just one. If a physician offered long-term treatment without warning patients of similar odds of an important bad side effect, he or she would be guilty of malpractice.
Moreover, the flipchart never mentions another important fact about condoms included in the CRS’ position paper: “There are many obstacles to consistent and correct condom use.” People persuaded by “education” like that provided by the flipchart think they can enjoy safer sex if they use condoms, and resolve to use them. But as with other resolutions, people often break that one. So the real-life chances of HIV transmission by people who undertake to use condoms are much greater than the already bad odds cited above. Consequently, promoting condom use as “safer” sex is likely to be self-defeating, as is clear from CRS’ own position paper’s report about the comparative impact of promoting abstinence and condoms in various countries around the world.
Considering both what the flipchart includes and what it omits, it is hard to imagine an “educational tool” more effective for “suggesting, encouraging or urging people to use a condom during sexual intercourse to prevent HIV transmission”—in other words, for promoting condoms. Are the bishops and other CRS policymakers aware of what AIDSRelief is offering its partners around the world?
THE NEED TO INVESTIGATE
Since CRS is an agency of the United States bishops, its officials should act as their agents. If CRS officials have been pretending to follow the bishops’ policy while disregarding it, they have betrayed their responsibility and misled the bishops. Any bishop would fire a real estate agent who did that to him.
As the bishops’ agency, CRS acts in the person of the Church. CRS officials should be managing a charitable apostolate of the Catholic Church in the United States. But they have been distributing material on which they have prohibited putting the CRS logo. If they are doing what they cannot make clear that the Church is doing, how can they be conducting a charitable apostolate in the Church’s name? But if and insofar as they have not been conducting a charitable apostolate in the Church’s name, they are betraying the Church herself— not only the bishops but all the faithful, and even Jesus himself, the Church’s Head.
Moreover, it seems that some partners have been pressed to cooperate despite their conscientious objections. Negative reactions of bishops and churches in other countries seem to be regarded as a problem to be dealt with rather than as expressions of conscientious judgment to be respected.
Faithful Catholics who have donated to CRS in recent years for AIDS relief did so because they expected the program to be carried out in a distinctively Catholic way. Had they not expected this, they could have donated to a secular organization fighting AIDS. If CRS officials have used donations otherwise than they have led donors to expect, CRS officials have misappropriated those funds.
Finally, even by secular standards, people encouraged to use condoms to prevent the transmission of HIV have been ill-served. Genuine charitable apostolate in regard to the prevention of HIV transmission helps save lives but also does something infinitely more important, namely, offers everyone it reaches help to rise from the life of this corruption to the life that never dies. However, the opposite was offered if, as it seems, people who should have received loving service in the Church’s name were scandalized in the strict sense by being encouraged to continue engaging—or worse, as early adolescents, to begin engaging—in sinful sexual activity rather than to live chastely.
What has been going on at CRS must be investigated. The CRS board is ultimately responsible for its operations. I urge the board to begin by examining the items described in this article, which are posted on the Catholic World Report website (catholicworldreport.com). The questions those items raise suggest many further questions.
Every CRS board member has many other responsibilities. To ensure an adequate investigation and for credibility’s sake, the board will need to employ one or more appropriate, competent, independent agencies, as the National Review Board used the John Jay College of Criminal Justice to conduct studies bearing on clerical sexual wrongdoing. Any agency employed should be given access, within the limits of canon and civil law, to CRS records, publications and unpublished materials, employees, and partners.
In my judgment, the investigation should not be limited to the promotion of condoms, but should extend to CRS practices and activities in general. It should look for deviations from civil law, canon law, relevant policies of the USCCB, and good business practices with respect to abuse of resources and other matters. If wrongdoing is found, the inquiry should try to determine which executives or other employees are responsible.
When the inquiry is completed, the results should be published, and the board should see to it that future CRS operations be transparent. In fact, regardless of what an inquiry turns up, it seems clear that CRS officials have not been fully open and above-board about what the agency is doing. That lack of accountability must end.
If the appearances of betrayal with respect to condoms are verified or other serious wrongdoing is found, those responsible should be fired and replaced by capable people with a good understanding of Catholic charitable apostolate and a firm commitment to act as faithful agents of the Church.
The few members of the CRS board I know personally are conscientious people. In particular, Archbishop Timothy Dolan, who became chairman of the board in November 2007, was a fine rector of the North American College, and I am sure he is a good bishop.
If there has been betrayal at CRS, the evil is not unlike the clergy sexual seduction scandal, especially insofar as it spiritually harms those who should be served. I trust Archbishop Dolan, unlike Cardinal Bernard Law, will not compound any wrongdoers’ wickedness by looking the other way, and I hope that other board members will cooperate with him in doing their duty.
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