The National Catholic Review
Dr. Daniel P. Sulmasy

This book is at least as interesting because of the process of its creation as it is because of its content. It was born of the efforts of a group of concerned scholars who have called themselves the Catholic Theological Coalition on HIV/AIDS Prevention, convened by Jon Fuller, S.J., and James Keenan, S.J. They began with local discussions that led to the commissioning of a series of papers from all over the world and finally to the creation of a book that encompasses a stunningly international array of Catholic theological voices, convened around a single issue. I am unaware of any previous theological project like it.

The topic may seem narrowthe morality of Roman Catholic involvement in the promotion of various means of controlling the spread of H.I.V. infection. Largely (but not exclusively) this concerns the use of condoms to prevent sexual transmission of H.I.V. and needle exchange programs to prevent spread through the use of dirty needles by injection drug users. But a remarkable feature of this book is that although this topic seems very narrow, the diversity of theological voices assures that it is never dull reading. The authors vary in the aspect of prevention they discuss (e.g., condom use within marriage, condom use by homosexuals, H.I.V. prevention education in schools). They vary in their ministerial perspectives (hospital chaplain, parish priest, health care professional, program director, seminary professor). They come from many nations (England, Ireland, Australia, Tanzania, South Africa, Kenya, India, Bangladesh, Egypt, Brazil, Costa Rica and others). They also vary in the theological angles they take on the topic (questions of social justice, questions of cooperation, the applicability of the principle of double effect, personalism and others).

The book is commendable for the generally very high quality of the essays, which is unusual in an edited volume. The essays are for the most part written in an accessible style and should not put off the theologically uninitiated. The use of over a dozen real cases anchors the discussion in reality and places the work squarely within the casuistic tradition. In a painful but not sensationalistic manner these cases bring the reader to understand both the worldwide dimensions of the H.I.V. epidemic and the personal dimensions of a small number of the millions of lives it is destroying. Sadly, too many complacent Americans continue to ignore the problems of developing countries. But after the news stories about natural disasters fade, poverty and H.I.V. remain. This book can help keep Americans and others in the developed world confident that H.I.V. can be contained, soberly aware of the fact that this is not the case in developing nations. Yet despite their realism, these essays never lose their theological dimension. Instead, the reader learns what theological ethics must really mean at the ground level in India, various African and South American countries, and throughout the developing world.

After the case discussions, the book addresses some of the fundamental theological themes raised by these cases, challenging tradition in all the ways that astute theologians, with their eyes fixed on the signs of the times, inevitably must do. Especially interesting in this section are the essays by Marciano Vidal, C.Ss.R., on Progress in the Moral Tradition, an essay by Roger Burggraeve on sexual ethics and an essay by Lisa Sowle Cahill, whose carefully crafted argument might be summarized in caricature as saying that, in the final analysis, It’s not about condoms. It’s about sexual and economic injustice, stupid.

There are some minor flaws. The tone at times is quite strident, especially in the last chapter. In addition, all the essays that state an unambiguous position on the use of condoms and needle exchange programs are favorably disposed toward these practices. Despite their awareness that this position is at variance with the teaching of many bishops, the editors fail to present any opposing viewpoints. They also fail to address some other important ethical issues in H.I.V. prevention, such as the ethics of using placebos in studies of drugs to prevent perinatal transmission of H.I.V. These studies have been conducted in developing countries despite the fact that such studies would be declared immoral in the developed world. They also fail to address other recent controversies in H.I.V. prevention, such as mandatory tracing of the sexual contacts of persons who test positive for H.I.V., or the failure of pharmaceutical conglomerates to allow the off-patent manufacture of their drugs for H.I.V. prevention at prices that might be affordable in the developing world. But then, the most welcome criticism of one’s book is always, I wish they had said more about....

Overall, this book is an impressive achievementboth because of what the authors say about the topic and because of the example it gives of the reflections of a truly world church, struggling with a truly worldwide problem, told by a truly world-class collection of theologians. It should be of great interest not only to theologians, but to clinicians, health policymakers and to all people of faith struggling to respond to the H.I.V. crisis.

Daniel P. Sulmasy, O.F.M., M.D., holds the Sisters of Charity Chair in Ethics at St. Vincent’s Hospital and is the director of the Bioethics Institute of New York Medical College.