January 6, 1991

As Ireland Battles AIDS, the Church Is Called a Roadblock

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By SHEILA RULE, SPECIAL TO THE NEW YORK TIMES

UBLIN -- This nation is playing out the tragic drama of AIDS, and tradition, Roman Catholic orthodoxy and ignorance are among the grim protagonists, advocates in the fight against the disease say.

Ireland does not appear to have as serious a problem as many other countries; it has proportionally far fewer cases than the United States and even fewer than other European countries, official statistics indicate. But advocates say the situation is troubling because conservative attitudes arising from Roman Catholicism both predispose this country to the spread of AIDS and hamper its prevention.

Catholicism dominates Irish society, with 90 to 95 percent of the population of 3.5 million people professing affiliation with the church. Efforts to promote the use of condoms have been opposed because they clash with the church's teachings. The distribution of clean needles to drug addicts has run into similar church-led opposition on the ground that it promotes drug abuse.

'Attitudes Have to Change'

In line with church teachings, abortion is illegal here, making it more likely that mothers with AIDS will pass on the disease to babies. Homosexuality is outlawed as well, leading some campaigners against AIDS to conclude that many gay men are disguising their sexual orientation by marrying and having children, and perhaps further helping the disease's spread.

Some political observers say that the election in December of Mary Robinson, a political outsider, as the first woman to be Ireland's President may signal a liberalizing of attitudes, although the presidency is a largely ceremonial post. A member of the small, leftist Labor Party, . Robinson campaigned hard for the liberalization of laws on divorce, contraception and homosexuality.

"Attitudes have to change in Ireland," said Brian Murray, chairman of a voluntary organization, Cairde, that helps AIDS victims. "Otherwise, there will not be tolerance of the use of condoms or clean needles. Attitudes arising from Catholicism have produced a very conservative moral ethos that decries the use of condoms in any context. Governments try to fall in behind public opinion and public opinion is led by the church on these issues."

The Government says it is working hard to stem the disease's spread and points to its compulsory AIDS education program in secondary schools and its financing of a drug-treatment center in Dublin that offers condoms, clean needles and counseling.

The church, too, offers materials to help teachers educate students about the dangers of AIDS. It emphasizes monogamy and abstinence.

Church and Morality

"The Catholic Church, as is widely known, promotes the view that sexual morality, if observed, would prove to be a great antidote to the spread of AIDS," said Des Cryan, a spokesman in the Catholic Press and Information Office. "And the general attitude in Ireland, not just among Catholics, but the general attitude is that they basically oppose free, clean-needle schemes because they think it would contribute to drug abuse."

Government statistics put the number of people here diagnosed as having AIDS at 172 as of October. Nearly 1,000 more were said to be infected with the HIV virus, which causes the disease, but doctors and advocates say that there could actually be three times as many cases.

World Health Organization figures show that for 1989 there were 1.3 diagnosed cases of AIDS reported here for every 100,000 people while the United States had 13.3 per 100,000.

Here, about 60 percent of people with the virus and nearly half of those with AIDS are intravenous drug users, representing the sad legacy of cheap heroin dumped into the poor housing projects of Dublin and other European cities in the early 1980's.

The spread of the disease among homosexual men is viewed by officials as a lesser problem and statistics show only 135 infected with the virus.

Those active in fighting AIDS say the country's conservative, church-influenced attitudes have led to the failure both by church and Government to develop practical and comprehensive programs against the disease.

The state-financed program for drug users, which includes outreach workers, is faulted for its location in a fashionable section of Dublin, which critics say leaves it inaccessible to people in deprived areas where drug abuse flourishes.

Sexual Orientation Disguised

The Government has not directed an AIDS education campaign at homosexual men. James Walsh, the state AIDS coordinator, said the rate of homosexual infection slowed in Ireland as it did in other countries after gays started employing safer sexual practices in the mid-1980's.

But some advocates say the actual number of cases of AIDS infection among gay men is not 135 but closer to 2,000. Because homosexuality is illegal, they say, many homosexuals disguise their sexual orientation, marry and have children.

Official statistics are also viewed as misleading in another way. Anti-AIDS campaigners say that because of largescale emigration, especially among people between the ages of 18 and 35, many Irish citizens infected with the virus could be in other countries.

The Irish characterize their country as a large village of sorts -- family-oriented, relatively slow to change but edging toward greater secularism.

Many young people who ignore the church's moral arguments against risky sexual and drug activities still share traditional values like the importance of having a family.

At St. James's Hospital, which treats most of Dublin's AIDS cases, the state's only AIDS consultant said that half of the 120 women there infected with the virus wanted to get pregnant, despite counseling about the disease. The consultant, Dr. Fiona Mulcahy, said the other half insisted that they did not want to get pregnant, but less than a third used contraception.

Amniocentesis Unlikely

Scientists think that about 40 percent of babies of infected mothers will themselves be born with the AIDS virus and die, and that the rest will lose their mothers. Official statistics show that Ireland has 69 babies infected with the AIDS virus.

Family planning experts say it is still nearly impossible to obtain amniocentesis -- the medical procedure that can trace fetal abnormalities -- because detection of defects could lead to a woman seeking an abortion.

Similarly, until 1979 it was illegal to provide contraceptive services and information; condoms can now be legally sold only at pharmacies, doctors' offices, clinics that treat sexually transmitted diseases, state health boards and family planning centers.

The Roman Catholic Church offers what it calls a "resource pack" as a guide to help teachers discuss AIDS with secondary school students.

The material says that condoms, if used correctly, reduce the risk of infection but provide nothing like complete protection. It says that "sexual intercourse expresses the total, unconditional self-giving of husband and wife, with openness to the procreation of new life," and that the "use of contraceptives contradicts this truth and is, therefore, morally wrong."

The Government began its AIDS education program this school year over the objection of Catholic bishops who viewed it as morally aimless. Walsh said that the program seeks to promote mutual fidelity in sexual relationships. Students are advised that if they do take risks, condoms provide highly effective prevention.

A Challenge to the People

Walsh says that some people have criticized this approach from the opposite extreme of the bishops, as slanted too heavily toward trying to instill sexual morality.

Campaigners against AIDS say that to prevent the disease from taking a grim toll, the Irish must challenge the church and other symbols of authority.

David Esson, who runs a self-help group for AIDS victims called Irish Frontliners, said, "Irish people are conditioned in such a way that no matter how big the biggest wrong, they do not speak out against authority, be it the church, a Government minister, a policeman or a teacher."

"They accept what is happening," he said. "This means that we have lost quite a lot of people so far to AIDS and we are going to lose quite a lot more."