The ethics of protection


Emboldened by a friend's blog as mentioned elsewhere, I wanted to start what may hopefully be not just my thoughts but a group conversation about something I've given little previous thought to, and you may not have even heard about. That subject? Microbicides. No, not "my crobicides" (as a friend hilariously thought the other night; sounds just like a weird disease, right?). Microbicides are actually one of the more promising areas of research and development in the fight against AIDS, which I had read about during the AIDS conference in Bangkok earlier this summer, and have learned even more about while freelancing for That Company.

Basically, microbicides as I understand them are a plant-based topical barrier that may protect women not only from disease but also impregnation. I don't have figures off the top of my head, but developing an actual vaccine for HIV/AIDS is still fairly far down the R&D pike. Scientists and pharmaceuticals are certainly working on it, but as Dr. Emilio Emini of the International AIDS Vaccine Initiative (IAVI) highlighted during a talk at the AIDS conference I attended in June, the disease is extraordinarily complex, resistant to immune-system attacks, and able to adapt. As a result, one of the most practical ways to contain spread of the disease in the short-term is focusing on ways to prevent contracting it.

This is where things get a little more complex. Activists critical of PEPFAR (the substantial AIDS funding package President Bush has created) charge the Bush administration with focusing more on abstinence than condoms, resulting in a solution that is religiously motivated (therefore illegitimate in their minds) and furthermore highly impractical. But also at the June AIDS conference, I was able to hear Dr. Mark Dybul, a representative from the State Department who gave a keynote address specifically about the scope and goals of PEPFAR. He stressed that abstinence is never encouraged in opposition to condoms, but that rather the Bush administration focuses on a united "ABC" attack: in which abstinence, condoms and monogamy are all used or encouraged in combination, depending on the needs of the situation.

The case for microbicides
But this is where problems arise — and where microbicides enter the picture. Condoms can be an extremely difficult and impractical form of protection given the need for the male partner's consent. And yet in a given sexual encounter, the woman is automatically more vulnerable to possible disease than the man — leaving aside all risks associated with her sole physical burden in the case of pregnancy. Steven Rhoads, writing in Taking Sex Differences Seriously:

"Women exposed to an STD are biologically more susceptible to becoming infected than are men exposed to an STD. For one act of intercourse, for example, a woman is more than eight times as likely to get HIV and about four times as likely to get gonorrhea as her male-partner" (108).

He goes on to describe how women furthermore experience "more serious consequences if they should become infected." Thus, women have a particular need for protection during sexual intercourse — which protection would ideally come in a form she need not depend on the man to use.

Before we get into the sexual-ethics issues typically raised by conservatives at this point, consider this. Not all women who might need protection do so for the sake of sanitizing the sexual activity that makes conservatives mad. In fact (though I need to get the statistics on this), I believe it is increasingly common for faithful wives to get HIV/AIDS (among other diseases) from a profligate husband who has been sleeping around with women — or men — with diseases. But for precisely the circumstances described, the wife is then in a very difficult position to demand her husband use a condom. They are married. He is her husband. Should not sex be unprotected? His infidelity is probably a secret — or at least a behavior he will not admit to her, even if she knows. Thus, the wife must struggle to look out for her own sexual and physical safety while still being the "good wife" her husband desires. It is particularly for this reason that microbicides have been pitched as such an important line of defense against disease.

Sexual ethics
But here things start to get nettlesome. In the last week or so, I contacted a politically active and conservative friend to get her thoughts on microbicides. After a few days, she responded via email that she hadn't been familiar with the treatment before my query, but based on initial research about them was not compelled by the case for further development. In addition to expressing concern about the unknown long-term effects on women's bodies and health, she advocated behavior modification of a different kind. One, that women should not allow their husbands to cheat, and two, that money would be more effectively used to discourage people from promiscuity:

"Contraception has had a devastating effect on our cultures because it has separated conception from sex. In vitro, surrogate parenting, etc has done even more. This separation of conception from sex has not liberated women. I contend that this has objectified women as sex objects. Will this microbicide further the objectification of women by making them not demand fidelity from their husbands? I believe the problem is not AIDS, it is rampant sexual infidelity. This sexual infidelity spawns violence against women. Rather than giving them Band-Aids against AIDS, I believe that we should be pouring our efforts and money into the real problem, and thereby truly helping women."

Therefore, she concludes that developing products like microbicides, which only reduce the risks of such activity — and, further, increase our cultural separation between procreation and sexual activity — merely worsens a societal problem.

Basically, in other words, my friend advocates a kind of "moral" solution, as opposed to a medical one, arguing that the medical solution is in fact ideologically charged with a morality of its own, and one which she find objectionable. Let it be said that I have a lot of respect for this woman, and am in many ways in sympathy with her convictions and the passion with which she holds them. However, I disagree with an assessment in which technologies or inventions are judged by the behaviors with which they are associated. Just because the internet serves a vehicle for internet porn dow not render it inherently evil. People are the problem, not the medium (although it undoubtedly carries in it a part of our brokenness). Furthermore, I am uncertain about the degree to which we Christians should attempt to impose our values and approach to life on the world around us. Note that I said impose. I'm not implying silence or a retreat from cultural engagement, but imposition — attempting to write ourselves into the governing order — is something different (and personally I think Constantine's institutionalization of the church resulted in its weakening). Thwarting the development of something which may help in the fight against AIDS — and therefore effectively denying access to such a treatment — is an implicit criminalization of sexual activity, based entirely on the Christian boundaries outside of which sex becomes sinful. And I'm not sure that that's right.

I'm not sure that it's right for the factual reason that not all women who might use such protection are necessarily having "sinful-by-Christian-standards" sex, and I'm not sure that it's right for the philosophical reason that denying access or thwarting development strikes me as an imposition of a "justice" that should be rightly administered by God. And that is probably the crux of the issue. To what extent do Christians wait for God to carry out the consequences of disregarding His moral order (living in blatant challenge to His character), and to what extent do we seek to incorporate His moral order into the very fiber of our society?

The reach of 'right' and 'wrong'
First of all, what morality or system of right-and-wrong could be deemed strictly "Christian" is hard to say. Even if you take as basic a rubric as the Ten Commandments, certainly there are some tenets all would agree on regardless of the source from which they're taken. But even in the Ten Commandments, manifest problems arise. "Thou shalt not kill" becomes a law that's probably one of the most basic (although I'm no legal theorist or historian). But "Have no other gods before Me" is clearly religious and would seem to have no place in the public sphere. If those are the two extremes among the ten, the others prove more dicy. Many we take to be merely reasonable admonishments for good behavior — treatment of one's parents and neighbors, for example. But what about adultery (and how is it even defined?)? Under Muslim law cheating is criminalized as the most-serious Hadd crime. And since in non-secular Muslim countries there's no separation of church and state, adultery therefore becomes a state offense (as is, according to my source, false accusation of adultery).

I'm sure if I'd gotten a J.D. instead of an M.A., much of what I'm crudely alluding to here would've been covered in first-year legal theory. But it comes down to this: which actions does the community have a right to forbid and therefore punish? And I guess I'm asking that both in the secular sense of community-as-public, and the religious sense of community-as-congregation. In the former (American context assumed), adultery is not an issue unless the President lies about it in office. But in the latter context, adultery is an issue. In fact, in my old church a man was subjected to discipline not because he'd had an affair, but because he'd been sleeping with his girlfriend and failed to respond to previous pleas from church leadership to desist. Yeah, folks, some churches actually go that far with discipline — and I don't necessarily disagree with their right to do so. Having set up such a contrast between communities, the point I'm driving to is how Christians, who dwell in both communities, handle the differences between the two. To what degree do we attempt to mold the larger, former community on the model of the latter — particularly in the instance of actions that are punished?

In the Christian public sphere, "punishment" usually follows a structured sequence of increasingly urgent confrontations supposed to be focused on restoring the health, well-being and obedience of the perpetrator. But when actions deemed "sin" in the Christian public sphere get taken into the secular public sphere, the kind of punishment involved often becomes an implicit or explicit criminalization. Christian "punishment" as I understand it is not so much focused on administering God's justice as it is trying to restore that person to right relationship with God through the intervention and (if necessary) subsequent distancing of community. Secular punishment, however, does tend to focus more on an administration of justice. Therefore, trying to criminalize in the secular sphere certain matters deemed sin in the Christian sphere strikes me as sometimes verging on impatience with a judgment only God has the right to carry out. If Christians on the further right exchange in heated debate about this issue, I'm not aware of their doing so.

During my last year of graduate school, I took a fascinating seminar called "Religion and 'the Secular'." But rarely in that space did we consider the difference between the public-private split in secular, American life, and the public-private split in American religious life. In retrospect, paying closer attention to such issues might have resulted in some of the most fruitful lines of inquiry, considering it's where some of the thorniest issues emerge. It's there in debates over abstinence education and its disputed efficacy, and I think it's also there in this issue of microbicides.

Conclusion: a possible application
While I am very hopeful that some among my readers will see fit to "jump in" here with various comments on the matter, I want to conclude by briefly sketching my own, tentative thoughts. And in venturing a position, I have not so much in mind the cheesy WWJD bracelets of late-90s American fame, but Jesus' encounters with women like the one at the well (John 4), and the one caught in adultery (John 8). When Jesus meets the first woman, it starts out as chit-chat over water — although of course he's not just shooting the breeze at all. From there they rapidly progress to thirst of the soul and Jesus soon cuts directly to how the woman is really trying to fill and quench her soul: relationships. She, of course, senses disaster and immediately changes the topic to the less-personal, locally controversial. But Jesus is driving to the point of who he is rather than how she should change (perhaps because the power for change exists only because of who he is), and so he lets her take the detour.

I once studied this passage rather carefully in a small Bible study with my parents and brother (I think I heartlessly dubbed this section "Ho, ho, ho"). But I never remember noticing an obvious omission: the point at which Jesus tells her to "go and sin no more," as he does with the adulteress. Because he doesn't say that to her. In fact, the main impact of their conversation is that he notes certain facts about her relational status, leaving the woman and the reader to draw their own conclusions about what she might need to do about this. I'm not prepared to extrapolate from this some sort of "rule" about which sexual sins one confronts and how, but I find Jesus' merciful candor remarkable. And in light of it, I'm hard put to believe Jesus would take a view as extreme as that of my friend's on the issue of microbicides. What it seems to me he would do is face some brutal realities.

Women are victims of violence. Conception and sex are frequently separated, as my friend rightly notes (though differently, depending on the culture), and generally the consequences for women are not positive. Although Steven Rhoads argues the point more subtly, and by many allusions to research often based on evolutionary psychology, his conclusion is the same as my friend's. The sexual revolution (probably most to blame for separating conception from sex in America), has only made it harder for women. We can never fully make that separation, therefore it is our bodies which bear the greatest strain of imposing that wall. But if there is a once-preventable flood approaching, is the most compassionate answer to stop from building the dam that could stop it because the victim could — and should — have prevented the flood? Does one furthermore take resources that could have built the dam, and spend them teaching others how to prevent floods? Or do you divide the resources between long-term preventative education, and short-term, emergency fixes?

Some women have very difficult, painful marriages. For whatever reasons, their husbands aren't faithful. I am not convinced it is always — or even often — within their power to prevent this. While I do think women can be very wily creatures in the face of oppression, I'm not sure how much even the most canny wife can do to prevent contracting AIDS from an unfaithful husband without the help of something like microbicides. Yes, the spread of AIDS is doubtless fueled by the "sexual infidelity" my friend describes, but I don't recall Jesus ever issuing calls for obedience and righteousness before first providing rescue and healing.

Let's say I wanted to help a frightened wife concerned about what her husband's cheating means for her health. Which path will get me farther in possibly helping her really change — if I spend time trying to teach her how she can better curb her husband's betrayal, or if I first win her trust by helping her try to inconspicuously protect her own body? Obviously, I think the latter will. By first addressing her immediate, physical need, I earn the right to be her friend. This in turn enables me to get more involved in her life and start talking about the deeper anguish, which is the brokenness in her marriage. And that, at last, might make a space in which to talk about her deepest need, for Jesus. Even were the woman that worst thing in conservative eyes — a prostitute — I'm not sure the answer is denying her protection so she will change careers or die from her mistake. It's like the failure of U.S. efforts to curb the coca production in Peru. Increasing (or refusing to offset) the costs of production (in this case, disease) doesn't produce real change the way providing a viable substitute would. Coca production continued because the farmers were told stop, but were given few meaningful alternatives with which they could continue to support themselves. Likewise, denying sex workers protection is not going to be as effective in bringing about life-change as would a deeper engagement that first addresses immediate needs and over the long-term seeks change of heart and life.

Christians, I believe, are called to find a path that is somehow simultaneously idealistic and realistic without being strictly either in the classic sense. And our solutions to the problems of HIV/AIDS and promiscuity must straddle this paradox as well. As far as I can tell, that means combining support for practical, short-term focused solutions (like microbicides) with "idealistic," long-term focused solutions like seeking to prosper God's radical remaking of broken communities.

posted @ 03:31 AM on Fri - October 8, 2004 remark! Email |  as quoted:
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