679 Letters to the Editor The Vatican and the Cairo conference on population and development SIR-The Vatican’s vigorous campaign against the UN conference on population and development (see Lancet editorial, August 27, p 557) is causing widespread unease among many who are committed Catholics. As a State it has a voice at Cairo and it is clear that, despite the widespread rejection of Humanae Vitae by western Catholics, it intends to use its power to enforce policy even in stricken countries where its teaching has no real moral importance. In its preparations for the conference the Pontifical Council for the Family has published a document,’ which makes no mention of the stress felt by millions of individual women who do not want and often cannot sustain another pregnancy. They make much of fostering her dignity but nothing of respecting her judgment; nor do they acknowledge her desperation when she finds herself pregnant against her wishes. They say that artificial contraception has "grave repercussions on a woman’s health" but ignore the death toll of women from excessive childbearing, or of those driven to self-induced abortion. Their assertion that modern contraceptive methods act as abortifacients is rejected by many Catholics and theologians of undoubted integrity, who would question the term abortion where no pregnancy has taken place. The so-called natural family planning condoned by the Church has been shown in many reputable trials to be ineffective in countries where education is rudimentary and feminine hygiene is poor. In cultures where the woman is subservient to her husband it simply does not work. The Church is, of course, correct when it points out that improving social conditions and reducing infant mortality will lower the birth-rate whether contraceptive advice is available or not: there is less urgency to add to the family when the parents are confident that their existing children will survive. Unfortunately scepticism is raised about the Church’s sincerity in advancing such arguments when its intransigence on the issue of contraception is considered. Likewise, with respect to AIDS, the Church’s proscription of condoms for reducing the danger of HIV infection is clearly based on its unbending condemnation of contraception. Rome has never declared any opposition to the search for a vaccine or a cure, nor has it every prohibited the treatment of other sexually transmitted diseases. The Catholic Church has, indeed, a high tradition of compassion to those who fail to uphold its high moral standards or who are the victims of the failure of others. In the face of such unrealistic advice on the containment of the AIDS epidemic and of its insistence on natural family planning methods only, the Church cannot be reminded too often that in many African countries male sexual freedom is condoned, that polygamy is a cultural norm, and that the status of women is low. The Vatican has gone to extraordinary lengths to ensure that language contrary to its teaching is excluded from the final Cairo document. Many Catholics fear that by acting in this way the Holy See is risking the credibility and authority of the whole church. Joyce Poole Ednam East Mill, Kelso TD5 7QB, UK 1 Pontifical Council for the Family. Ethical and pastoral dimensions of population trends. Città del Vaticano: Libreria Editrice Vaticana, 1994. Rapidly evolving HIV-1 infection in lung of AIDS patient SiR-HIV-1 strains vary in their cellular tropism, and a multitude of phenotypic variants exist.’ It has been suggested that progression to AIDS correlates with the emergence of rapidly growing syncytial-forming HIV variants.’ HIV has been detected in the lungs of AIDS patients2 but little is known about the biological properties of these isolates in contrast with isolates derived from peripheral blood lymphocytes. We report rapid changes in HIV isolates obtained from the lung sequentially from a single patient. A 27-year-old man presented with Pneumocystis carinii pneumonia (PCP). After treatment with co-trimoxazole he remained unwell and a second bronchoscopy was done. Two months later a third bronchoscopy was done for new respiratory symptoms. He subsequently developed cytomegalovirus retinitis and colitis and further respiratory symptoms and had a further bronchoscopy. At each bronchoscopy, HIV isolation by use of co-culture with cord blood leucocytes3 was done on paired peripheral blood and bronchoalveolar lavage, and the amount of HIV proviral DNA was measured by quantitative polymerase chain reaction (PCR) and viral copy number was determined (table). p24 antigen was measured in co-culture supernatants to determine the time when viral replication could be detected. Between the first and second PBL=peripheral blood lymphocyte, BAL=bronchoalveolar lavage. N/D=not done, N/A=not available. Table: Laboratory investigation on peripheral blood and bronchoalveolar lavage cells