The title of this paper is deliberately provocative. At the end of the twentieth century, and furthermore at the end of the second decade of the HIV crisis, how can anybody question the validity of persuading prison administrations on the one hand, and politicians on the other, to agree to the distribution of condoms in prisons?
Can the ICRC, knowledgeable as it is after decades of experience visiting prisoners around the world, claim condoms to be irrelevant for prisoners?
The fact of the matter is that it is precisely this first-hand knowledge of prisoners and prison settings that provide the substance for this paper. The delegates and doctors of the International Committee of the Red Cross (ICRC) visit prisoners around the world as part of the organization’s regular activities.
This paper attempts to address the controversial issue of sexual practices in prison settings and the relevance of condoms in the transmission of HIV. The distribution of condoms to prisoners is to be discussed at this CHS conference in Sydney, as well as at an international meeting to be held shortly afterwards in the UK. Condoms are certainly not a primary concern of the ICRC. However, prison issues, particularly in relation to the health of prisoners, certainly
are, and HIV prevention falls within this area of concern.
The examples given here, drawn from ICRC experience in the field, are intended to demonstrate how different cultural settings may call for different solutions.
Discussions on sexual practices in prisons are difficult even with prison doctors. The subject is often taboo, and in many cases the actual practices are illegal in themselves. The author has tried to bring up the matter, including the pros and cons of condom distribution, with colleagues in various countries in Eastern Europe (ex-USSR) on the one hand, and in Africa on the other. In both
cases, and for completely different reasons, condoms are not being even
considered for prisoners. HoweverÔÇöand this is a source of some concernÔÇöin both regions many doctors seem to have the obviously erroneous conception that Europeans see condoms as “the” solution for preventing HIV transmission through sexual contacts among prisoners.
This paper will try to show that condoms will unfortunately not solve the problem of sexual transmission of HIV even in Western settings, let alone in the contexts mentioned. The important point to be made is that politicians, administrators and even medical staff unfamiliar with prison realities must not be lulled into complacency about HIV transmission just because of the advent of the prison condom dispenser.
It is also to be hoped that some international perspective will be gained from discussions on this theme, and that doctors and prison governors in the aforementioned countries will not receive erroneous messages from “the West” on what they suppose to be the real efficacy of condoms in prison settings.
The subject of sexual violence as an aspect of torture is another subject, and certainly a primary concern for the ICRC in its work with prisoners around the world. It has, however, different connotations, as it implies the deliberate use of sexual violence by a repressive authority, and shall not be dealt with here.
There is perhaps more documentation on sexual violence as a means of torture, than on its presence in “normal” prisons, as there are a great many centers for victims of torture that now treat patients having suffered such violence.
First it should be made clear that the author has no quarrel with the general idea of having condoms accepted in prison systems. In Europe, the issue of condoms has always given rise to considerable debate. In a very few countries, the Netherlands being a case in point, prison authorities are required by law to provide condoms free of charge to prisoners. In many ÔÇö indeed mostÔÇöother countries they are prohibited, as is any form of sexual activity between prisoners. Many prison medical services have been reluctant to advocate for the provision of condoms, as they do not want to appear as encouraging homosexual activity. A “middle-of-the-road” attitude of laissez-faire has been adopted in some prisons (including the Swiss canton of Geneva, the author’s home town), where condoms are made available by the prison medical service although their issue is not officially approved by the prison administration.
The question as to whether or not issuing condoms is going to have any major impact on the sexual transmission of HIV in the custodial setting is considered below from several different angles. The reasons given, by politicians and prison authorities, for their not being acceptable for prisoners in many countries have little to do with this type of argument. These reasons range from a global refusal to admit the acceptability of homo-sexual relations among prisoners, to arguments of “security”. The former has a lot to do with morals and religion, matters that will not be dealt with here. The main point is that
these considerations place a “taboo” on even talking about the subject, let alone dealing with it in a constructive way.
The “security” argument is somewhat difficult to pin down. Some prison officers argue that condoms could be used to strangle people, but fail to come up with actual examples of such use. Other, perhaps more probable, illicit practices cited are the use of condoms for smuggling in drugs and … liquor!
As the situation now stands in EuropeÔÇöthe attitude of England and Wales remains to be seen, as condoms have finally been accepted for prisoners, but only since the new Labour government came into powerÔÇöthe distribution of condoms is the exception and certainly not the rule. Furthermore, even in the Netherlands, arguably the most liberal country in this respect, the system is not working.
Condoms, available free in discreet baskets at the entrance of the medical office, are simply not taken [7]. Prisoners who personally request condoms do so in the privacy of the consultation and allege they are for “heterosexual sex in the parlors”.
The point being made here is that the distribution of condoms is indeed being discussed in Europe, and that prison administrations and doctors elsewhere are seeing this as a message and as a possible solution for HIV transmission within prisons. Their actual utility, particularly in the type of situations set down below, is perhaps less a topic of discussion.
The ICRC has been working in the countries of the former Soviet Union since 1989 and has had many contacts with prison administrations, prison medical services, related Ministries and non-governmental organizations dealing with prisoner issues. The transmission of HIV has yet to become a serious problem for prison administrations and health services, with the probable exception of prisons in the Moscow region. Although there is no way of ascertaining the prevalence of HIV infection inside the various prison systems, it is generally thought to be low. However, quite understandably, prison doctors are worried about HIV, and rightly see that the reality of violence within many prison systems calls at the very least for pre-emptive thinking about the various and most obvious forms of transmission. In order to understand this reality, some general background on
prisons in these countries is useful.
More relevant to the present issue than the actual official system is the internal hierarchy within the system. This complex power structure [12] is essentially the same throughout the countries of the former Soviet empire, with local variations. The system in itself is of Russian origin [13], but since in Soviet times prisoners were transferred all over the territory of the Union it subsequently became the norm everywhere. The well-established internal hierarchy among prisoners is best described as a “caste system”. It is within this system that violence among groups of prisoners can be extreme, and can involve sexual practices that put large numbers of prisoners at high risk of catching STDs and HIV.
As has been stated, HIV is not yet a major issue in most of these countries. The problem of prison violence, aggravated in many cases by extreme overcrowding and often abominable living conditions, is a very real one, and prison rape is an everyday reality for whole sectors of prisoners. No real epidemiological study of syphilis or other STDs has been carried out either, and such a step is unlikely in the near future. Even if the issue of condoms were an acceptable subject for discussion, which it definitely is not within what is a very “macho”
prison culture (and this includes even the medical staff), it is hardly
reasonable to suppose that their introduction would have any effect whatsoever in such a violent context. The real issues here are overcrowding (which makes any classification and physical separation of prisoners impossible) and finding ways of curbing violence among prisoners.
According to several studies conducted by health professionals and NGOs, the sexual abuse of male prisoners by other male prisoners is more than just a serious problem in US prisons. In maximum security prisons, where the majority of prisoners are in for very long terms and many of them have strictly nothing to lose, violence is a way of life. Various human rights groups have quite rightly begun to document this problem, as prison gang rape in the era of HIV can mean a death sentence for the victim.
Even in the more outspoken American society, where such topics as homosexual penetrative sex and fellatio scarcely raise an eyebrow among specialists, there is still uncertainty and some controversy relating to “circumstantial” homo-sexual practices in the prison setting. Many people, even medical researchers, still adhere to the viewpoint that coercive sexual practices in prisons amount in fact to homosexual activity, supposedly involving implicit consent. This notion is certainly erroneous and gives rise to confusion in the
analysis of prison conditions. Others tend to see sexual practices between men in prisons merely as a form of substitute for the lack of heterosexual sex.
Research in US prisons has shown that sexually coercive activitiesÔÇönot all involving actual rapeÔÇöare widespread. There are many other more subtle forms of sexual coercion and subservience, both relating to the core issue of violence.
In prisons all over the world, violence among prisoners almost always has a sexual component. In the US, however, the problem has become so great that an NGO based in New York City, called “Stop Prisoner Rape” (SPR), specifically concerned with prisoner issues, has produced in English and Spanish an informative brochure for male prisoners. It is available by mail, on the Internet or even in prison libraries, and describes in detail the issue of
“protective pairing”, or “hooking up”, as it is known in prison jargon. New prisoners are advised to “pair up” with a stronger prisoner as soon as possible after entering prison so as to avoid gang rape and other forms of sexual violence. Prison culture respects this sort of “partnership”ÔÇöwhich, however, implies sexual services rendered by the protected prisoner to his “man”. A discussion on HIV in African prisons would need an entire book in itself.
The confusion already mentioned between homosexual activities and circumstantial homo-sexual prison-related practices is a real issue in countries which have notÔÇöat least until recentlyÔÇöconfronted the problem, and which have a real and justified concern about the spread of HIV. Prison medical authorities in these countries are following the “condoms for prisoners” controversy in the Western medical journals.
In one central African country the senior prison medical superintendent, when drawing up local “Guidelines on the management of HIV/AIDS in prisons”, stated:
“Sex among men is a recognized right in a number of Western countries (…). In countries where homosexuality is a recognized human right, the practice is rampant in prisons (…). There is a worry that this problem may be slowly spreading in African prisons”.
Here there is clearly confusion between true homosexual behaviour, for which European and other Western countries do indeed recommend the use of condoms, and coercive sexual practices that are directly related to the prison setting and violence.
The official distribution of condoms as a preventive measure inside a prison is an oxymoron in relation to African prisons, as in most of these countries any homosexual activity is a punishable offence carrying a sentence of up to eight years’ imprisonment. The main point here is that circumstantial forms of sexual activity are mostly not recognized.
As long as coercive practices are ignored or simply neglected, concrete and sound proposals such as programmes for prisoners on “positive living” (education, advice on “risky behaviour” and pre-release counselling) will not be effective.
*This is an abridged version of a research paper for the International Red Cross
