Kevin Dowling is the Catholic Bishop of Rustenberg, a mining town in South Africa's North West Province surrounded by informal settlements, where as many as 50 percent of pregnant women test positive for HIV.
In 1998, he and members of his diocese started Tapologo ("peace and rest" in Setswana), a community-centred HIV/AIDS programme, which is now providing home-based care, antiretroviral therapy, and in-patient care at a hospice. Dowling spoke to IRIN/PlusNews about his struggle to reconcile the Catholic Church's position on condoms with the realities of life for Rustenberg's shack dwellers.
"I think we're facing an enormously difficult challenge. The brutalisation of this society through apartheid and the hopelessness among so many youths who can't get jobs, a deep lack of self-esteem and just a fatalistic spirit, makes people shrug their shoulders and say, 'I'm going to get it [HIV] anyway'.
"We're trying to empower the women to have some say over their sexual lives, but that's not easy when they're dependent on survival sex - literally for survival. There's no way that women are going to be saved from certain death in this area unless they're economically and educationally empowered.
"The socio-economic and cultural realities mean the chance that we can have major success with behaviour modification is very, very small, even though we continue to try. I think the issue, then, comes down to: 'what is the best available means we have to protect life?' and at the moment it is only the condom.
"It's in conflict with the official Catholic Church position, but I've reflected on this for many, many years and I truly feel that in the case of this hyper-epidemic, the issue is, in the end, very simple: preservation and protection of life.
"You could get a Catholic man who's HIV-positive and he says, 'I'm not going to follow abstinence or be faithful to one partner', and he's transmitting a virus that could potentially kill every person he has sex with.
"What do I say to him? 'You can't use a condom because it's a contraceptive'? This kind of thing makes no sense to me, because you're not using a condom in that case for contraception; you're using it to prevent the transmission of a deadly virus, and to me that's essentially ethical and moral.
"I think the Vatican recognises [AIDS] as a serious problem, but to actually come out with [a change of position] - I don't foresee this happening, because it would mean admitting we've been wrong in the stance we've taken up until now, and a fundamental problem is how that would look to the world, and what that would do to Church authority.
"Ninety-nine percent of the staff and patients at Tapologo are not Catholic, and that's never been an issue for me. There's a deep religious spirit in the people, and that's a very important part of the healing process, enabling people to live positively with the disease.
"They need deep inner healing because so many of them face huge stigma and discrimination. I've been surprised how many people in their own religious communities have been told, 'You've got HIV, and this is a punishment from God'."
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