Correspondence
The Pope and science
We strongly support the concept, re-
ported in your Editorial of Jan 26,1 that
“the Pope has shown signs of support-
ing science”. However, we disagree
with the opinion that “only progressive
Catholics remind us that science and
religion are not incompatible”.
We are Catholic doctors and nurses
with several years of experience in the
service of people with HIV/AIDS and
in the fight against the epidemic, in-
formed and sustained by our faith. Our
experience shows that the traditional
Catholic position on condoms and AIDS
is the most reasonable and scientifically
sound for the prevention of AIDS
epidemics.
We know how important condoms
can be in focal epidemics in high-risk
groups; there is limited or no direct
evidence, however, that the common
and popular prevention measures,
including social marketing of condoms,
voluntary counselling and testing,
and syndromic or mass treatment of
sexually transmitted infections, have
contributed to the reduction or slowing
down of HIV in generalised epidemics.2
Uganda has a record of success in the
fight against HIV/AIDS.3 Studies from
leading scientific journals show that
the major factor in the decrease of HIV
prevalence in Uganda was the reduction
in casual, multipartner sex: the B of
ABC. In Uganda, Kenya, and Zambia,
increases in abstinence behaviours
have been associated with falls in HIV
prevalence.4 All successful stories in
Africa have been preceded by declines
in casual and premarital sex, generally
registered 5–6 years before the evi-
dence of decline.5 The Catholic Chuch,
along with many others, has promoted
exactly this type of behaviour.
The “dialogue between scientists and
the Catholic Church” has always been
kept open, because many scientists are
Catholics and the progress of science
would be inconceivable without them.
Interpretation of the Catholic religion
as prejudicially against science is
simply against evidence.
www.thelancet.com Vol 371 March 29, 2008
We declare that we have no conflict of interest.
*Filippo Ciantia, George W Pariyo,
Daniele Giusti, Sam Orach,
Rose Busingye
ciantia.kampala@avsi.org
AVSI Kampala, Kampala, Uganda (FC); Makerere
University School of Public Health, Kampala, Uganda
(GWP); Uganda Catholic Medical Bureau, Kampala,
Uganda (DG, SO); and Meeting Point International,
Kampala, Uganda (RB)
1 The Lancet. The Pope and science. Lancet 2008;
371: 276.
2 Shelton JD. Ten myths and one truth about
generalised HIV epidemics. Lancet 2007;
370: 1809–11.
3 Green EC, Halperin DT, Nantulya V, Hogle JA.
Uganda’s HIV prevention success: the role of
sexual behavior change and the national
response. AIDS Behav 2006; 10: 347–50.
4 Bessinger R, Akwara P, Halperin D. Sexual
behavior, HIV and fertility trends: a comparative
analysis of six countries; phase I of the ABC Study.
Chapel Hill, NC: Measure Evaluation, 2003.
5 MEASURE DHS. Demographic and health
surveys. http://www.measuredhs.com/
(accessed March 10, 2008).
We were surprised to read your Jan 26
Editorial criticising Pope Benedict XVI
because of his stance on abortion and
condoms.1 Weeks earlier a full page was
laudatory of the “condom king”, a Thai
social marketer.2 Our concern is that
this reputed scientific journal might
compromise its prestige by indulging
in political-ideological agendas.
Effective population control of sex-
ually transmitted infections (STI)
requires more than condom-centred
approaches. Delaying sexual debut,
mutual monogamy, and, above all,
reducing the number of partners are
crucial. These epidemiological truisms
comprise the ABC strategy: abstin-
ence, be faithful to one partner, and
use condoms. Partner reduction and
delayed sexual debut, more than
condom use, have been of paramount
importance in curbing HIV epidemics.3
The simplistic message of “condoms
and only condoms” is an unfortunate
reductionism.4
The recent upsurge in youth infec-
tion rates in Thailand, despite massive
promotion of condoms, is consistent
with the observed trends in Spain,
where STIs are also on the rise despite
levels of condom use in young people
being the highest in Europe.5
If The Lancet wants to address the
Catholic Pope from a scientific per-
spective, it might be fair to acknow- The printed
ledge that reputable epidemiological
journal
research shows that Church proposals
such as those on human sexuality includes an
(no intercourse outside marriage image merely
and fidelity within marriage), play an for illustration
important part against STIs. In any case,
these are legitimate and respectable
AP
choices one can freely accept.
We declare that we have no conflict of interest.
*Miguel Ángel Martínez-González,
Jokin de Irala
mamartinez@unav.es
Department of Preventive Medicine and Public
Health, School of Medicine, University of Navarra,
31080 Pamplona, Navarra, Spain
1 The Lancet. The Pope and science. Lancet 2008;
371: 276.
2 Bristol N. Mechai Viravaidya: Thailand’s
“Condom King”. Lancet 2008; 371: 109.
3 Stoneburner RL, Low-beer D. Population-level
HIV declines and behavioral risk avoidance in
Uganda. Science 2004; 304: 714–17.
4 Genuis S. Are condoms the answer to rising
rates of non-HIV sexually transmitted infection?
NO. BMJ 2008; 336: 185.
5 Ross J, Godeau E, Dias S. Sexual health. In:
Currie C, Morgan A, eds. Young people’s health
in context: international report from the HBSC
2001/02 survey. Copenhagen: WHO Regional
Office for Europe, 2004.
I applaud a debate on science and
faith1 because it is reason—our ability
to become aware of all reality—that
depends on this dialogue. There is a trend
to identify reason with the methods of
natural sciences, and to dismiss other
forms of knowledge as subjective and
irrational. However, to approach different
questions, our reason needs a variety of
methods. For instance, building scientific
knowledge on the basis of past research,
assumed to be true, is not scientific
method: it is faith, an outstanding
method of reason, which comes to know
reality through a reliable witness.
Issues such as whether a living indi-
vidual of Homo sapiens species in the
14th week of gestation deserves inalien-
able human rights; or the promotion
of abstinence, fidelity, and condoms
only for high-risk sex, instead of just Submissions should be
made via our electronic
encouraging condom use2 involve not submission system at
only science, but our global approach to http://ees.elsevier.com/
reality, human dignity, and sexuality. thelancet/
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 Correspondence
Benedict XVI was prevented from
speaking at the University “La Sapienza”
in Rome, Italy, by a totalitarian minority
on the basis of a distorted quotation.3
In his lecture, he wrote that the danger
of the western world is that today,
precisely because of the greatness of his
knowledge and power, man renounces
the search for truth, so reason bows
to the pressure of interests and the
attraction of utility. “It is the Pope’s
task to safeguard sensibility to the
truth; to invite reason to set out ever
anew search of what is true and good,
in search of God…”.4
I declare that I have no conflict of interest.
Ana Martín-Ancel
amartina@hsjdbcn.org
Department of Neonatology, Sant Joan de Deu
Hospital, Barcelona, Spain
1 The Lancet. The Pope and science. Lancet
2008; 371: 276.
2 Shelton JD, Halperin D, Nantulya V, Potts M,
Gayle HD, Holmes KK. Partner reduction is
crucial for balanced “ABC” approach to HIV
prevention. BMJ 2004; 328: 891–93.
3 Ratzinger J. Wendezeit für Europa? Diagnosen
und Prognosen zur Lage von Kirche und Welt,
1st edn. Einsiedeln-Freiburg: Johannes Verlag,
1992: 59–71.
4 Benedict XVI. Lecture by the Holy Father
Benedict XVI at the University of Rome
“La Sapienza” 2008. http://www.vatican.va/
holy_father/benedict_xvi/speeches/2008/
january/documents/hf_ben-xvi_spe_20080117_
la-sapienza_en.html (accessed Feb 1, 2008).
In your Jan 26 Editorial,1 you comment
that “science and religion are not in-
compatible”. This statement makes
sense when we consider that both
science and religion aim to explain
reality. The difference, however, is that
science is based on a systematic method
of investigating reality, whereas reli-
gion is based on interpretation of
divine revelation. Both are subject to
human error. Nonetheless, in the words
of an emerging world religion, “there
is, and can be, no conflict between true
religion and true science”.2
Viewed from this perspective, com-
patibility of science and religion is not
about medicine getting along with
religious paradigms. Medicine is a
science that should be compatible with
religion, but not with religious dogma
plagued by a lack of consensus.
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I declare that I have no conflict of interest.
Nathalie Auger
nathalie.auger@inspq.qc.ca
Department of Social and Preventive Medicine,
University of Montreal and Institut National de
Santé Publique, Montréal, Québec H2P 1E2, Canada
1 The Lancet. The Pope and science. Lancet
2008; 371: 276.
2 Research Department of the Universal House
of Justice. Scholarship. Mona Vale: Baha’i
Publications, 1995.
HIV myths should not
be resuscitated
Having witnessed over the past
decade the “culture wars” described by
James D Shelton (Dec 1, p 1809)1 that
have impeded the global response to
HIV, it was disappointing to see his
negative contribution published on
World AIDS Day, 2007.
The ten “myths” presented as false
solutions to the problem of HIV can be
condensed into only one worthwhile,
although self-evident, comment:
there is no single answer to the HIV
pandemic. Only an extreme advocate
of one particular approach would
suggest otherwise.
Although presenting reasonable
arguments (albeit relying largely on
anecdote, suggestion, and previous
opinion pieces written by himself2,3 for
evidence), Shelton in fact makes just
one clear call—for a greater emphasis
on “be faithful”, or “partner limitation”
as he calls it. To suggest that this is a
new or neglected notion is highly ar-
guable, but to put it in opposition to
what he calls the myths regarding the
value of testing, working with men,
with adolescents, against poverty,
against condoms, and research into
better tools, is outdated, mistaken, and
dangerous.
His Comment resuscitates old con-
frontations between single-track re-
sponses to HIV, whether politically,
religiously, or scientifically driven.
A comprehensive response that re-
verses the tragic trajectory of the pan-
demic will not be based on the myth
of a monolithic approach—behav-
iour change or any other—but on a
coordinated, fully funded, multifaceted,
context-specific, and evidence-based
combination of all available strategies.
I declare that I have no conflict of interest.
Thomas Ellman
tomellman@aol.com
Médecins Sans Frontières, London EC1N 8QX, UK
1 Shelton JD. Ten myths and one truth about
generalised HIV epidemics. Lancet 2007;
370: 1809–11.
2 Shelton JD. Confessions of a condom lover.
3
Lancet 2006; 368: 1947–49.
Shelton JD, Cassell MM, Adetunji J. Is poverty
or wealth at the root of HIV? Lancet 2005;
366: 1057–58.
Given the controversy about “con-
currency” and partnership limitation,
seen by many in the context of the new
bilateralism, conservative approaches
to reproductive health policy, and so
forth, why James Shelton frames the
issues covered in his Comment1 in a
way that could antagonise is unclear.
Two points are notable in this piece.
First, although the fact that the
epidemic is still “raging” might sug-
gest to Shelton that something is
not working, he claims that this
comes “more than 20 years into HIV
prevention”. In reality, resources to
finance a robust global response to
HIV have only become available in
the past few years (figure).2 We have
therefore missed out on what might
have been 20 years of systematic
testing of what works, what does not,
and why in various country settings.
The raging epidemic we now
confront partly reflects our failure
to act; in the early 1990s, experts
identified that the key lessons learned
thus far were that players needed
to act early and invest generously in
strategies that were comprehensive,
well targeted, and encouraged co-
operation and collaboration from
different groups and sectors. Had we
done so, perhaps the importance of
concurrent relationships would not
have been overlooked so easily.
Second, Shelton acknowledges but
does not emphasise that substantial
progress is being made. In sub-Saharan
www.thelancet.com Vol 371 March 29, 2008