In recent years condoms have been promoted by some stakeholders here and elsewhere as an antidote HIV-transmission among prison populations. The best evidence from around the world, however, suggests that the issue in not so simple.
At a Corrections Health Services Conference held in Australia back in 1997, Dr. Hernan Reyes of the International Committee of the Red Cross (ICRC) presented a global perspective on the issue, which concluded that:
“The issue of condoms for prisoners concerns only the tip of the very ugly iceberg of sexual violence in prisons. Sexual transmission of HIV infection (and other STDs for that matter) will not be eliminated by making condoms available.”
In the years since the above finding the circumstance of HIV transmission within prisons and corresponding arguments for and against condom distribution within correctional facilities have not changed very much.
Where condoms have been widely introduced into prison systems, such as in the UK and Netherlands, the outcomes have been debatable and certainly not convincing to the global community.
In the USA as of April 2010 only ten correctional systems (out of several thousand at state and local level) were reported to allow for the distribution of condoms in their facilities, despite the existence of many pilot programmes and studies dating back to the 1980s [Source – PBS].
While the issue of condoms in prisons in many African and Islamic countries in particular has been associated with deep seeded opposition to homosexual behaviour, in those countries where so-called “Gay rights” are legally and socially accepted the focus of debate has rather been on the efficacy of condoms in the context of the harsh reality of sodomy practices among actual prison populations.
To put it bluntly anal sex:
ÔÇó Is generally considered to be risky behavior by medical professionals, even in consensual heterosexual as well as homosexual contexts;
ÔÇó Anal sex in prison populations is more often coercive and as such places its participants at far greater risk;
ÔÇó The efficacy of using condoms to reduce risk in the context of anal sex is not the same as for vaginal sex (which is why there exists elsewhere in the world so-called “gay condoms”); and The efficacy of using condoms in prison settings to reduce the health
risks associated with anal sex is generally considered to be much more problematic than would be the case in non-prison settings.
Further to the above, it is the law in many if not most jurisdictions around the world, including those which otherwise take a more liberal view towards homosexuality, that sexual relations between prisoners, more especially male inmates, is forbidden.
While it is globally recognized that sexual encounters between prisoners frequently do occur, such incidents are more often than not viewed as a challenge to both the authority of correctional officers and the well being of the incarcerated under their supervision.
Many correctional institutions, including ones rated as being rehabilitative
facility benchmarks, thus remain adverse to sending conflicting messages by allowing for the distribution condoms, while at the same time undertaking disciplinary interventions aimed at reducing if not eliminating the scourge of forcible sodomy among their wards.
Debate on the issue of condoms in prisons is of course not one sided. There continues to exist widely differing views among health professionals and other informed stakeholders.
What remains clear is that the distribution of condoms is seen as much less of a priority among those administrators and experts who are most actively engaged in correctional institution issues, than those who place condoms and/or homosexual rights at the centre of their HIV advocacy efforts.
An example from what might be considered to be a more “progressive” critique of persistent calls for prison condom distribution is contained in an influential 2006 American study “Condoms in Prison: The Ethical Dilemma” by Professor Robert E. Fullilove (Associate Dean for Community and Minority Affairs at Columbia University’s Mailman School of Public Health), who observed that:
“Should condom distribution be the primary tool of prevention? I would argue it need not be. We already know that significant numbers of sexually active men are not skilled at using condoms effectively. Thus, providing condoms without the HIV educationÔÇöincluding a broad range of topics and risk factors such as unsafe tattooing practicesÔÇömeans that we are not doing our utmost to assure that the distribution results in satisfactory condom use. Further, there is evidence that in many facilities, condom distribution would cause problems for the inmates who requested them.
“Sex behind bars may be prevalent in most prisons, but sex between inmates is illegal in almost every state. Thus, requesting a condom might be considered probable cause for investigating whether or not an inmate is engaged in illegal activity. Ex-prisoners have insisted, in informal conversations with me, that accepting a condom might result in reprisals by prison officials who are not always fair in their treatment of the incarcerated population. Accepting a condom, in other words, might cause greater harm than good in some facilities.
Finally, if our prisons are a reservoir for HIV infection and AIDS, then appropriate and aggressive medical interventions are probably a more urgent ethical imperative than distributing condoms.”
Prof. Fullilove’s study thus concluded that:
“Distribution of condoms is not the primary ethical obligation we confront as we consider strategies to reduce the burden of high HIV/AIDS rates in jails and prisons. The time when such a strategy might have worked has passed.”
*Dr. Ramsay is Head of Government Communications
