HIV question

[epan]

I came across a case recently, of a woman who is infected with HIV since birth. She acquired the infection from her mother who was infected prior to her birth.

This woman is engaged to be married. They intend to have children. They intend to practice safe sex, in order to avoid infecting the husband. I don’t know what they intend to do, in terms of impregnating her.

What would Church teaching say in this case. Would there be opposition to in vitro fertilization? How about a surrogate mother to carry the child through pregnancy? How about the husband’s use of condoms for disease prevention, when they do intend to have children? My guess is that the Church would prefer that the marriage not occur, and that the woman should live a chaste life.

 

[Mary_Gail_36]

I would contact the National Catholic Bioethic Center, to see if there are guidelines for couples where only one is HIV positive.

Condoms, in-vitro, and surrogate motherhood are not permitted by the Church. Other ethical options could exist, and the NCBC would probably have that info.

I know my own OB volunteers time in Africa and works with HIV + moms in order to prevent baby from being infected. So, I think at least that is possible, that moms can prevent infecting their babies.

 

[1ke]

I came across a case recently, of a woman who is infected with HIV since birth. She acquired the infection from her mother who was infected prior to her birth.

That is unfortunate. A real cross to bear, I am sure.

What would Church teaching say in this case.

Contraception is always immoral.

Would there be opposition to in vitro fertilization? How about a surrogate mother to carry the child through pregnancy? How about the husband’s use of condoms for disease prevention, when they do intend to have children?

All of these are intrinsically evil actions.

My guess is that the Church would prefer that the marriage not occur, and that the woman should live a chaste life.

If one marries one must fully embrace marriage and all that it entails, and not engage in intrinsically evil acts.

So, the decision is truly whether to marry or not when one has an incurable, deadly disease that can be passed to spouse and children. Even though the medical community has come a long way in this area, it is not 100%.

The Church would counsel prudence which might dictate not marrying. But marriage with such a condition is not prohibited.

 

[PennyinCanada]

If one marries one must fully embrace marriage and all that it entails, and not engage in intrinsically evil acts.

So, the decision is truly whether to marry or not when one has an incurable, deadly disease that can be passed to spouse and children. Even though the medical community has come a long way in this area, it is not 100%.

The Church would counsel prudence which might dictate not marrying. But marriage with such a condition is not prohibited.

Agreed.

Personally, if I had HIV, I would not marry. How on earth can you say you love someone and with full knowledge, put them in harms way, risk giving them this disease? Regardless if you are Catholic or not, believe condoms are a sin or not. If you are Catholic, look what kind of situation you are putting yourself and your spouse in. Condoms, surrogate mother, etc. I would look at how I can serve God in this short life and realize the sad conclusion that marriage would not be for me. It does not mean I cannot have a life full of blessing. This direction is cutting off the blessing of God as I pursue my own will to the harm of others. Love calls us to make better choices.

 

[NekoNecro]

Sadly and as unfair as it might be to the poor woman I think this is the case, other than NFP the Catholic Church explicitly forbids contraception under any circumstances. It doesn’t matter if the pregnancy could cause the woman death or that the man could catch HIV, there are no excuses.

With this in mind I’m actually quite surprised it isn’t included as an impediment to marriage as say impotence is.

It might be easy to condemn her for not signing up for a life of abstinence due to a condition she herself did not ask for or obtain by her own action, but unless you yourself are in her condition I really think you may need to yank that beam of wood out of your eye.

 

[JSSD]

Epan,

I have no idea the financial or coverage situation of this woman, but perhaps PrEP is an option.

cdc.gov/hiv/basics/prep.html

It isn’t completely accepted, ethics are debated, it often isn’t covered, and it is wildly expensive. It isn’t foolproof. It is one potential option (depending on their situation and her particular virus) that could avoid most of the questions (contraception, infection, in-vitro) you ask. Please have her consult her physician / HIV provider.

 

[Jared2914]

Well if they were Catholic they would not be able to use any “protection”. It must be natural. If they wanted kids, they would have to take the risk that the husband would get infected. There are some drugs that can be taken to reduce the chance of infection, but they aren’t perfect. I would assume they are allowed as long as they don’t mess with pregnancy. I know in Africa there is a drug given to women that reduces the chance that the virus is passed on to their children.

 

[epan]

I would contact the National Catholic Bioethic Center, to see if there are guidelines for couples where only one is HIV positive.

Condoms, in-vitro, and surrogate motherhood are not permitted by the Church. Other ethical options could exist, and the NCBC would probably have that info.

I know my own OB volunteers time in Africa and works with HIV + moms in order to prevent baby from being infected. So, I think at least that is possible, that moms can prevent infecting their babies.

My understanding is that viral can be reduced enough to reduce the odds of transmission. But this is not guaranteed, obviously.

Thanks for your suggestion.

 

[epan]

That is unfortunate. A real cross to bear, I am sure.

Contraception is always immoral.

All of these are intrinsically evil actions.

If one marries one must fully embrace marriage and all that it entails, and not engage in intrinsically evil acts.

So, the decision is truly whether to marry or not when one has an incurable, deadly disease that can be passed to spouse and children. Even though the medical community has come a long way in this area, it is not 100%.

The Church would counsel prudence which might dictate not marrying. But marriage with such a condition is not prohibited.

The marriage is invalid, if not consummated. So, I understand you to say that the husband must accept the possibility of HIV infection? Forgive me, but this position also seems immoral by any modern standard.

 

[epan]

Epan,

I have no idea the financial or coverage situation of this woman, but perhaps PrEP is an option.

cdc.gov/hiv/basics/prep.html

It isn’t completely accepted, ethics are debated, it often isn’t covered, and it is wildly expensive. It isn’t foolproof. It is one potential option (depending on their situation and her particular virus) that could avoid most of the questions (contraception, infection, in-vitro) you ask. Please have her consult her physician / HIV provider.

Thanks. I have been discussing a plan to put the husband on anti retrovirals to reduce the risk, and to try to get the potential mom down to an undetectable viral load. It may be possible to manage the case effectively.

I appreciate your link to PrEP. Thank you for the suggestion. Wildly expensive doesn’t work here, but another similar approach with what is available might work. If you know of any relevant case studies or research, please pass them along.

 

[epan]

Well if they were Catholic they would not be able to use any “protection”. It must be natural. If they wanted kids, they would have to take the risk that the husband would get infected. There are some drugs that can be taken to reduce the chance of infection, but they aren’t perfect. I would assume they are allowed as long as they don’t mess with pregnancy. I know in Africa there is a drug given to women that reduces the chance that the virus is passed on to their children.

Yes, ARV’s with zidovudine appears to reduce the risk to the baby by about 98%, though there are no robust trials to validate this modality.

 

[NekoNecro]

The marriage is invalid, if not consummated. So, I understand you to say that the husband must accept the possibility of HIV infection? Forgive me, but this position also seems immoral by any modern standard.

Since when has the CC cared about what the modern world or any other period of history’s moralists thought?

 

[1ke]

The marriage is invalid, if not consummated.

This is not correct.

A marriage is valid from the moment the couple exchange consent (ratum tantum). It becomes indissoluable when it is consummated (ratum et consummatum)

Can.* 1061 §1. A valid marriage between the baptized is called ratum tantum if it has not been consummated; it is called ratum et consummatum if the spouses have performed between themselves in a human fashion a conjugal act which is suitable in itself for the procreation of offspring, to which marriage is ordered by its nature and by which the spouses become one flesh.

Can.* 1141 A marriage that is ratum et consummatum can be dissolved by no human power and by no cause, except death.

Can.* 1142 For a just cause, the Roman Pontiff can dissolve a non-consummated marriage between baptized persons or between a baptized party and a non-baptized party at the request of both parties or of one of them, even if the other party is unwilling.

So, I understand you to say that the husband must accept the possibility of HIV infection? Forgive me, but this position also seems immoral by any modern standard.

Let me reiterate that the choice is to marry or not marry. No one “must accept the possibility of HIV infection” because there is no requirement to marry in this situation. Indeed prudence would dictate otherwise.

If the couple freely decides to marry and engage in intercourse then they can do so only in ways that are not sinful. It is possible for them to enter marriage and remain continent-- under spiritual direction-- but both parties must be willing and able to undertake the full conjugal life if either party desires it at any point during the marriage.

 

[JSSD]

Thanks. I have been discussing a plan to put the husband on anti retrovirals to reduce the risk, and to try to get the potential mom down to an undetectable viral load. It may be possible to manage the case effectively.

I appreciate your link to PrEP. Thank you for the suggestion. Wildly expensive doesn’t work here, but another similar approach with what is available might work. If you know of any relevant case studies or research, please pass them along.

Hi epan,

I don’t want to teeter too close to medical advice, but you are obviously a practitioner and I am a former infectious diseases pharmacist, so I think we’re just chatting here! (Mods, if inappropriate, please delete!)

Unfortunately, I don’t know of any case studies, but I’ll ask a colleague closer to this. I can say that Truvada (emtricitabine/tenofovir) got the indication because they paid for the study. Is that to say another cocktail wouldn’t work? I’m not sure I’d go out on that limb. In any case, what you indicate seems pharmacologically and scientifically sound to me (VL < 50). If your woman has a wild-type or minimally resistant virus, it would stand to reason that prophylaxing the husband with the same (hopefully affordable?) regimen might be successful, but again, obviously no guarantees.

In the 2nd/3rd world, I’d be concerned about supply chain for that cocktail, as you obviously cannot be interrupted. In any patient, I’m concerned with adherence.

To the “should they? / shouldn’t they?” marry question, I don’t know that this is a moral question. HIV/AIDS isn’t what it was, but, that may be different in this woman’s situation or epan’s location. In the US, it is basically a manageable, chronic condition which certainly alters your risk profile for cardiac, renal, and endocrinological issues, but a lot of folks are now dying with the virus than from the virus’s effects. For this woman, I know I can’t opine on should and shouldn’t, myself.

At least in the US, where cost is real but availability is less of an issue, my biggest personal issue with PrEP is that you take an expensive and definitely-not-benign drug combination……so that you don’t get infected and have to take an expensive and definitely-not-benign drug combination. I certainly get the risks, but at some level it is a little silly to me.

 

[PhiloMed]

Are you counseling an HIV discordant couple on marriage? Or are you asking a hypothetical question as to what the RCC would ask of someone with HIV?

As far as vertical transmission of HIV goes, there are currently very low rates because of the use of effective treatment in the mother, administering arv’s to the infant, recommendations to not breastfeed and other interventions. In my state we haven’t had a vertical ranks mission of HIV in over 10 years.

In regard to the partner, they would need to be in the hands of a medical professional to offer proper risk counseling. Even a non-detectable viral load in someone does not guarantee there won’t be transmission since we assume there is circulating virus but just at levels too low to be detected by the assay used.

 

[epan]

Since when has the CC cared about what the modern world or any other period of history’s moralists thought?

There are examples. One easy one is the morality surrounding money lending, which us still prohibited for Muslims. At one time, mainly Jews lent money in Europe. This was due to Christian prohibition of the practice. There are other examples.

I thought that Benedict II did once suggest that condom use might be acceptable as a lesser evil than the possible alternative consequences. Am I wrong about that? I believe he was addressing some of the problems regarding prostitution.

 

[epan]

This is not correct.

A marriage is valid from the moment the couple exchange consent (ratum tantum). It becomes indissoluable when it is consummated (ratum et consummatum)

Can.* 1061 §1. A valid marriage between the baptized is called ratum tantum if it has not been consummated; it is called ratum et consummatum if the spouses have performed between themselves in a human fashion a conjugal act which is suitable in itself for the procreation of offspring, to which marriage is ordered by its nature and by which the spouses become one flesh.

Can.* 1141 A marriage that is ratum et consummatum can be dissolved by no human power and by no cause, except death.

Can.* 1142 For a just cause, the Roman Pontiff can dissolve a non-consummated marriage between baptized persons or between a baptized party and a non-baptized party at the request of both parties or of one of them, even if the other party is unwilling.

Let me reiterate that the choice is to marry or not marry. No one “must accept the possibility of HIV infection” because there is no requirement to marry in this situation. Indeed prudence would dictate otherwise.

If the couple freely decides to marry and engage in intercourse then they can do so only in ways that are not sinful. It is possible for them to enter marriage and remain continent-- under spiritual direction-- but both parties must be willing and able to undertake the full conjugal life if either party desires it at any point during the marriage.

Thank you for clarifying the canon law.

hum, yes. If they choose to marry, then the husband must accept the possibility of infection. Though, with proper medication and safer sex practices, the risk is quite low. Your statement is from the Catholic point of view. Which I thank you for stating succinctly.

What I was wondering is whether motive is relevant? The intent of condom use, in this case, is not to prevent pregnancy, but to prevent disease transmission. The purpose is not contraceptive, but rather pro-conception, as long as the couple intends to have children.

 

[1ke]

What I was wondering is whether motive is relevant? The intent of condom use, in this case, is not to prevent pregnancy, but to prevent disease transmission. The purpose is not contraceptive, but rather pro-conception, as long as the couple intends to have children.

No. A good intent is not enough to make a bad action into a good one.

The Church has spoken specifically on condom-for-disease-prevention vis-a-vis contraception and the answer is negative.

 

[1ke]

I thought that Benedict II did once suggest that condom use might be acceptable as a lesser evil than the possible alternative consequences. Am I wrong about that? I believe he was addressing some of the problems regarding prostitution.

Yes, he spoke about it, but no he did not say it might be acceptable as a “lesser evil”. That was commonly reported but wholly wrong. What he said was that it shows that there is a moral awakening on the part of the person-- their desire to do good in not spreading disease-- but that the action remains intrinsically evil and is not a solution.

 

[epan]

No. A good intent is not enough to make a bad action into a good one.

The Church has spoken specifically on condom-for-disease-prevention vis-a-vis contraception and the answer is negative.

So, in the case of a mortal sin, then there is no requirement of intent?