There are times when priests, ministers and pro-life activists encounter what might be called the “ultimate hard case” involving condoms. This is the situation where a husband and wife are serodiscordant; one is HIV positive and the other is not. The question inevitably arises as to whether or not they may use condoms to prevent HIV transmission to the uninfected spouse in this very special case.
Before we consider this question, we should remember that all Culture of Death activists use the most extreme of the “hard cases” in order to advance their causes. Euthanasia pushers talk endlessly about people with terminal diseases in their last few days of life who are suffering intractable pain. Pro-abortionists only speak of cases where a pregnancy was the result of rape and incest, or which endangers the life of the mother. And “family planners” use married serodiscordant couples when pushing condoms.
As we have seen, condoms are a dismal failure — not only at preventing pregnancy, but also at stopping the transmission of HIV. In fact, as we have also seen, HIV/AIDS rates are highest in nations where the population of practicing Catholics and Muslims is the lowest.
Few studies have actually used live couples to test HIV transmission rates. One University of Miami Medical School study performed in 1987 showed that three out of 10 women whose HIV‑infected husbands faithfully used condoms contracted AIDS‑Related Complex (ARC) in an 18‑month period. This translates into an infection rate of 21 percent per year, 38 percent in two years, 51 percent in three years, 70 percent in five years, and 91 percent in 10 years.
However, more recent studies have found that the risk of HIV transmission is almost nonexistent if the HIV-infected partner has reduced his viral load to undetectable levels through the use of antiretroviral (ARV) drugs. This fact renders moot the question of using condoms to block HIV transmission — at least where these drugs are available at low or subsidized costs.
But this question is anything but moot to the vast majority of people who live in the developing nations of the world, where ARV drugs are either completely unavailable or priced out of reach. The monthly average wholesale prices of antiretroviral drugs, depending on their mode of action, ranges from $3,700 to $38,000 annually. Thus, ARVs are a hopeless dream for the hundreds of millions of people who earn less than $300 per month. It is clear that, for most of the poor population of Africa, Asia and Latin America, one quote in The Lancet applies in particular: “The possible consequences of condom failure when one partner is HIV infected are serious enough and the likelihood of failure sufficiently high that condom use by risk groups should not be described as `safe sex.’… Condoms have a substantial failure rate: 13‑15% of women whose male partners use condoms as the sole method of contraception become pregnant within one year.”
As previously shown, condoms fail one time in every sixteen uses. This is the rate for developed nations; surely the rate is much greater in poor countries, where manufacturing, inspection, storage and distribution processes tend to have looser safety and quality standards, and where proper instruction in the use of condoms is usually lacking.
Even the number one pro-abortion organization in the world — the International Planned Parenthood Federation — admits that “The risk of contracting AIDS during so-called ‘protected sex’ approaches 100 percent as the number of episodes of sexual intercourse increases.”
In a situation where a husband has HIV but his wife does not, and where ARVs are not available, there are only two possible choices: Total abstinence or a death sentence for the wife. This is a harsh reality which is imposed not by the Church, but by nature itself.
We must step back for a moment and define love. Quite simply, “love” is wanting what is truly best for the other person, and wanting to be with them in a way that is appropriate to the relationship. If we truly love someone, we will not want them to die a slow and lingering death just so that we can have sexual relations with that person.
Despite what the world teaches, not one person in the history of the world has died from not having sex. Rather, millions have died from having sex in risky circumstances.
In certain situations, the husband may have been aware that he was HIV positive on the day he married his wife. Although being HIV positive is not an impediment to marriage in and of itself, if the husband concealed the fact that he was HIV positive at the time of the marriage, an action against the validity of the marriage could most probably be brought on the grounds of fraud. If he contracted HIV through extramarital sex after marriage, there are legitimate grounds for separation of the spouses, according to Catholic teaching.
In cases where an HIV positive husband considers his right to sex to be more important than his wife’s right to live, she may legitimately refuse marital relations. A wife’s efforts to preserve her own life in this situation are not selfish because she is performing her just duty before God. The Catechism of the Catholic Church says that “Everyone is responsible for his life before God who has given it to him. It is God who remains the sovereign Master of life. We are obliged to accept life gratefully and preserve it for His honor and the salvation of our souls” [¶2280].
Sexual relations are a source of grace in a marriage, and promote a special bond between husband and wife. As strange as it may sound in today’s world, however, sex is not necessary for a person to live, and it is not even necessary in a marriage — particularly when the life of one of the spouses may very well be lost as a result.
Risk Reduction vs. Risk Elimination
The world’s leading experts from the Centers for Disease Control and the World Health Organization have acknowledged that abstinence before marriage and fidelity within marriage are the only means of completely eliminating the risk of infection from HIV and other sexually transmitted diseases. The CDCs have said that “the only strategies of prevention that are truly effective consist in (sexual) abstinence and sexual relations with a non-infected partner, while respecting reciprocal fidelity.” By contrast, condom distribution programs seek to merely reduce the risks of infection. Alfonso Cardinal Lopez Trujillo, the late, great prince of the Church and first head of the Pontifical Council for the Family, describes the objective of the Catholic Church: “Given the AIDS pandemic proportion, what the Church aims for is not mere risk reduction (which is actually transformed into risk augmentation if the real risks of transmission are not explained to the public), but rather risk elimination; not partial protection, but total protection; not relative protection, but absolute protection.”
The Church recognizes that we cannot eliminate a problem by encouraging or enabling the behavior that led to the problem in the first place. Serodiscordant married couples can, by their examples, provide a shining example of true love and leadership that can contribute substantially to the ending of the HIV/AIDS epidemic.
 “Evaluation of Heterosexual Partners, Children and Household Contacts of Adults with AIDS.” Journal of the American Medical Association (JAMA), February 6, 1987.
 “Undetectable Viral Load Essentially Eliminates Transmission Risk in Straight Couples.” AIDSMEDS Web site at http://www.aidsmeds.com/articles/heterosexual_ transmission_1667_23387.shtml, January 13, 2013.
 “Limitations to Treatment Safety and Efficacy: Cost Considerations and Antiretroviral Therapy.” Clinical Guidelines Portal at the National Institute for Health AIDS Info Web site, May 1, 2014; http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/459/cost-considerations-and-antiretroviral-therapy.
 Jeffrey A. Kelly and Janet S. St. Lawrence. “Cautions about Condoms in Prevention of AIDS.” The Lancet (Journal of the British Medical Association). February 7, 1987, page 323.
 Human Life International, Fact Sheet on Condom Failure, www.hli.org/Fact-Sheet-on-Condom-Failure.html, referring to as source Willard Cates, How Much Do Condoms Protect Against Sexually Transmitted Diseases?, in IPPF Medical Bulletin, 31 (Feb 1997) 1:2-3. See also Human Life International’s other fact sheets on condoms in www.hli.org/bbc.html.
 WHO, Estrategia Mundial de prevención y lucha contra el sida: Actualización de 1992. Ginebra: OMS, 1992 (WHA45/29), as referred to in Francisco Guillén Grima e Inés Aguinaga Ontoso, Efectividad de los preservativos en la prevención de la infección por VIH en parejas de personas seropositivas, in Med Clin (Barc) (1995) 105: 541-548.
 Cited by K. April et.al., in Qual è il grado effettivo di protezione dall’Hiv del profilattico?, in Medicina e Morale, volume 44 (1994):922.
 Human Life International. The Case against Condoms, 2003, paragraph 15.