New Debate Is Sought on Use of Condoms to Fight AIDS

ROME, April 21 - Pope Benedict XVI is known to be conservative on social issues, and no one expects his Roman Catholic Church to soften its opposition to birth control. Still, a rising number of Catholics, in the Vatican and outside, are urging the new pope to revisit what was probably his predecessor's most divisive position -- his opposition to condom use in the fight against AIDS.

As Pope John Paul II fell ill and his influence waned, a number of high church officials and theologians began tentatively -- but publicly -- to suggest that the church should accept condoms in certain circumstances to stem the spread of AIDS, as a pro-life medical intervention.

"I believe condoms need to be debated, and I believe theologically their use can be justified, to prevent the transmission of a death-dealing virus," said Bishop Kevin Dowling of Rustenburg, South Africa, an impoverished diocese of miners and poor women who sell their bodies to feed their children, where H.I.V. rates in prenatal clinics approach 50 percent.

"I see these young women and their babies, and the desperation and the suffering, and I think, 'What would Jesus want?"' he said in an interview. "There's no way he could condemn someone like this."

The new pope has said nothing about the issue. But the bishop said, "At the very least, I think it would be healthy for the church to discuss this openly, to be humble and to be seen struggling in the face of this very serious disease."

In much of the developing world, Catholic charities and local churches provide much of the medical treatment and care, so the Vatican's views have enormous impact. Official church policy is that the spread of AIDS should be fought with sexual abstinence and fidelity in marriage.

Several cardinals have also implicitly -- if not explicitly -- challenged Vatican policy in supporting the limited use of condoms to combat AIDS in recent months. Theologically, they contend that in such situations, condoms are lifesaving medical devices rather than a form of contraception.

When it comes to thinking about condoms, "what seems to be happening is that these practical applications are getting more discussions, and going on at a higher level," said Brian Johnstone, a professor of moral philosophy at the Alfonsian Academy in Rome. "A lot of high-level people are suddenly speaking out, saying that condoms could be justified in certain difficult situations."

In an interview with an Italian news agency in February, Cardinal Georges Cottier of Switzerland said that "the use of condoms in some situations can be considered morally legitimate," particularly to stem the spread of H.I.V. and AIDS in Africa.

Cardinal Javier Lozano Barragán, the Vatican's top health official, has said twice in recent interviews that it would be allowable for a woman married to a man with H.I.V. to use condoms "in self-defense" just as the church found it acceptable to use deadly force to fend off an attack.

International health officials, who have clashed with the church over its no-condom policy, say they have seen hints of movement recently. While the church preaches abstinence to prevent the spread of AIDS, medical groups and many governments regard condom use as the only method that reliably prevents sexual transmission of the virus that causes it.

"What is really good is that on the ground we are now starting to see a lot of debates about condoms among the clergy," said Dr. Peter Piot, executive director of the United Nations AIDS program, noting that he was "surprised" this February to have been invited as the guest of honor at a Vatican conference on health care.

Dr. Piot said there was no way to estimate how many people had become infected with H.I.V. because Catholic teachings had persuaded them not to use condoms, but he said, "When bishops in Latin America or Africa speak out against condoms, that must have a serious negative impact."

Dr. Laura Ciaffi, adviser on H.I.V. for Doctors Without Borders-Switzerland, said, "What happens in practice depends a lot on local authorities."

"In some places they let us give people the choice, even if they won't distribute condoms themselves," she said. "In other places, it is much more difficult, and patients who are religious won't accept condoms because of the message of the church. So a change in policy would be very welcome."

For priests in the field, the church's policy has caused moral quandaries.

In 2000, the Rev. Valeriano Paitoni, a priest who has won numerous awards for his two decades of work with H.I.V. and AIDS patients in São Paulo, Brazil, was sent a letter of condemnation by his archbishop after he said he had handed out condoms at his three shelters.

In Rustenburg, South Africa, Bishop Dowling has made the policy decision that the diocese's huge network of H.I.V. clinics would include in its counseling both a talk about the virtues of abstinence and faithfulness, and instruction in how and when to use condoms.

"We decided we at least had to give women the chance to choose a lifesaving method," he said.

In Italy -- where the vast majority of Catholics use contraception -- priests who hand out condoms to people at risk for H.I.V. often try to avoid challenging the church publicly.

The Rev. Liugi Ciotti is founder and president of Gruppo Abele, a widely praised charity that runs drop-in centers for prostitutes and drug addicts in the northern city of Turin that has passed out thousands of condoms.

But when called for an interview, his spokeswoman said he "wouldn't release interviews on the subject of condoms," insisting that his role as the group's president was a lay role, distinct from his role in the church.

"Many priests and bishops live with great perplexity and great anxiety because they are immersed in the reality of the AIDS situation," said the Rev. Leonardo Zega, a priest in Rome who is the former editor of the magazine Famiglia Cristiana. "The position of the church couldn't change with this pope, but it is a moral question that will have to return to the center of debate with his successor."