STEVE INSKEEP, host:

That last piece of information helps to explain why the Catholic Church's opposition to the use of condoms is being challenged by the bishop of Rustenburg. That's a South African mining town and it's been hard-hit by the HIV/AIDS pandemic. Bishop Kevin Dowling says the Vatican's ban on condoms should end. He argues that condoms should be permitted to help stop the spread of HIV as NPR's Jason Beaubien reports.

JASON BEAUBIEN reporting:

It's been a bad morning at Bishop Dowling's health clinic in the Freedom Park squatter camp. Overnight, thieves ripped the door off the clinic with crowbars. The head nurse, Dorothy Setsoquay(ph), is a bit flustered when Dowling arrives.

Ms. DOROTHY SETSOQUAY (Nurse): OK, except that they broke into our clinic this mor....

Bishop KEVIN DOWLING (Rustenburg): They broke into the clinic, I heard.

Ms. SETSOQUAY: Last night.

Bishop DOWLING: Just...

Ms. SETSOQUAY: And then we were busy with the policemen the whole morning.

Bishop DOWLING: The whole morning.

Ms. SETSOQUAY: We started very late.

BEAUBIEN: The thieves got away with three blankets and a teakettle, but the staff has spent all morning clearing up the mess.

Bishop DOWLING: Oh, shame. I'm sorry. So you're starting clinic late today.

BEAUBIEN: The Freedom Park squatter camp stretches alongside a platinum mine in Rustenburg. It's a collection of shacks where some 20,000 people live with no electricity, no running water, and mostly no work. The slum has been hard-hit by HIV and AIDS. In 2003, 49 percent of the pregnant women who came into Bishop Dowling's health clinic were HIV positive. Last year, the percentage dropped slightly to 47 percent. Setsoquay says desperately poor women and girls are attracted to Freedom Park by the miners who live across the railway tracks in the mine-run hostel. She says the women stay in the shacks waiting for the shift to change at the mine.

Ms. SETSOQUAY: These men, most of them are married and they left their homes at home or their homes, then they come and stay with girlfriends in the shacks. So most of them are single mothers.

BEAUBIEN: The women in Freedom Park are so poor, Bishop Dowling says, they're forced into a form of prostitution, and in the process, many have become infected with HIV.

Bishop DOWLING: In conditions like this, the fundamental concern is how do you preserve and protect life?

BEAUBIEN: Dowling grew up a devout Catholic in Pretoria, South Africa. After working as a priest in the townships of Cape Town, he became the bishop of Rustenburg 15 years ago. He says in the early years of the AIDS pandemic, he struggled with the Catholic Church's position on condoms. But after watching the incredible suffering that AIDS was causing in Rustenburg, he concluded that the Vatican's ban on condoms was morally unacceptable. The 61-year-old Dowling also supports abstinence as a means to prevent HIV transmission, but calls for abstinence, he says, often ignore the reality of women's lives in places like Freedom Park.

Bishop DOWLING: They have no powers and the cultural dynamics that are at work in these communities simply mean that the male has the power to demand sex of her.

BEAUBIEN: As a result, women and their babies die horrendous deaths from AIDS, deaths, he says, that could have been prevented by condoms.

Bishop DOWLING: To me, that is an extreme for of injustice done to a human being whose life is precious to me, precious to God above all. And the challenge I sense as a faith person is God saying to me, `This person's life is precious. What are you going to do about it?'

BEAUBIEN: Bishop Dowling first publicly challenged the Vatican's stance on condoms in 2001. After that, the Conference of Southern African Catholic Bishops denounced Dowling's position, saying in a statement that condoms are an immoral and misguided weapon in the fight against HIV. HIV infection rates in this part of Africa are the highest in the world. In neighboring Botswana and Swaziland, for instance, more than 38 percent of adults are infected with the virus. The Southern African Bishops went on to say that condoms may even help spread HIV, arguing they encourage promiscuity.

Dowling is unfazed by the response of his peers. He's pushing forward with his AIDS work, including advocating condoms. He suspects other Catholic priests in places hard hit by AIDS are also encouraging condom use, but he says they're just not open about it. The Rustenburg diocese runs AIDS prevention, education and treatment programs from nine clinics. Near his residence on the grounds of the diocese, Dowling has overseen the creation of a 30-bed hospice.

(Soundbite of door closing; voices)

BEAUBIEN: On this day, a seven-year-old boy is in the lobby. He's curled up in the lap of a middle-aged woman who's also a patient. The boy is so emaciated that most of his muscles have wasted away. His skin is stretched taut over his cheeks, giving him the haunting, skeletal face of a famine victim.

Bishop DOWLING: The hardest thing is to watch the little ones dying here, like this little one here. It's very, very hard.

BEAUBIEN: Dowling created the hospice because he wanted a place where AIDS victims could die, in his words, `in peace and dignity.' When possible, the staff also try to save patients by getting them onto drug treatment. Nineteen-year-old Larata(ph) is one of the fortunate residents. When she was carried into the hospice three months ago, she'd come to die. She was so weak she couldn't walk. Three months later, she's still rail-thin, but with the help of Bishop Dowling, she stands up. Dowling holds her hand as she walks haltingly across the courtyard to a lounge.

LARATA: I have HIV-positive and ...(unintelligible).

BEAUBIEN: Sitting with Dowling and Sister Jabu(ph), one of the hospice nurses, Larata says she doesn't know how she got HIV. The strap of her floral dress keeps slipping off her bony shoulder. And while her body is still extremely thin, her face is round and her eyes are sharp and engaging. Nurse Jabu says Larata is making great progress.

Sister JABU (Nurse): She's so beautiful. I mean, she had to recover...

BEAUBIEN: Dowling believes if condoms were more widely available and more widely accepted, including by the Catholic Church, girls such as Larata could be spared the suffering that comes from HIV and AIDS.

Bishop DOWLING: What I'd like to see out of Rome primarily is a humble attitude that here we are facing a pandemic which has catastrophic effects on all facets of society, and therefore, we don't pretend that we can have a black-and-white answer that fits every aspect of people's lives.

BEAUBIEN: Bishop Dowling says he hasn't been reprimanded by his superiors for so stridently defying Catholic Church doctrine. Then he laughs and adds that he doesn't expect, however, that he'll get promoted out of this impoverished mining town anytime soon. Jason Beaubien, NPR News.

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