United States


[Plaintiff L.T. is] a skinny, white, passive, non-violent, short timer, who is blind in his right eye. . . . On 1-25-97, at aproximately 2:00 A.M., plaintiff went into the bathroom of seven (7) barracks and inmate C.Williams followed after. Plaintiff used the urinal and as he turned, inmate Williams pulled a shank (glass knife) from a book and threatened to poke plaintiffs other eye out and kill him if he did not let Williams fuck the plaintiff. Williams then told plaintiff to go to the rear corner of the bathroom, pulled a small bottle of lotion from his pocket and made plaintiff rub it on his penis. Williams then put the shank to plaintiffs throat and said "turn around and pull those pants down," which plaintiff did for fear of his life if he did not. Williams then raped (penile penetration to anus) the plaintiff with the shank at plaintiffs' throat, pressing it and saying "shut up bitch" when plaintiff began to moan and wanting to scream from the pain. After climaxing and wiping himself off, Williams said "If you ever tell anyone, I or one of my gang members will kill you, in here or in the world." . . . . Plaintiff suffered great physical pain, although short lived, and continues to suffer severe emotional and psychological mental anguish as a result of being raped . . . . Plaintiff has taken, and was just re-prescribed, anti-depressant medications which do not seem to help. Plaintiff believes this incident alone . . . has caused a nervous disorder, his inability to concentrate and a worsened memory, and the lack of energy or desire to do the simplest of things, inexpressable humiliation, raging anger, etc. etc.; all of which plaintiff does not see any drugs, counseling or monetary relief from the defendants being able to cure.(301)

L.T.'s experience of rape was violent, painful, and humiliating. The rape itself was physically agonizing, the resulting rectal soreness lasted several days, and L.T.'s intense fear of contracting HIV persisted for months. But worst of all, for him, was the devastating psychological impact of the attack. Racked by continuing nightmares, depression, and thoughts of suicide, L.T. believed that the rape had irretrievably damaged his psyche. Formerly a friendly person, he found himself retreating from social contact, becoming angry, suspicious, and reclusive. Despite the mental trauma he suffered, he received no counseling while incarcerated, nor did he succeed in obtaining legal assistance in his subsequent court challenge to the abuse. Without having secured psychological treatment or any measure of accountability for the violent injustice he had endured, L.T. was paroled from prison in late 1998. His case is all too typical.

Some inmates contract HIV as a result of prison rape; for them, the consequences of the assault may be deadly. Other inmates are killed or seriously injured during the violent physical attacks that sometimes accompany rape. But all inmates who are raped suffer psychological harm.

Although invisible, the psychological effects of prison rape are serious and enduring: they raise important questions regarding the failure of prison authorities to take effective measures to prevent such abuse. The physical brutality of rape is deplorable. Nonetheless, the physical impact of such abuse is often less devastating, and far less permanent, than its psychological impact. Indeed, many instances of non-consensual sex occur through coercion, threats or deception: they may not leave physical marks, but deep and permanent psychological injury.

Physical Effects and the Threat of HIV Transmission

The physical effects of a sexual assault obviously vary according to its circumstances: whether, for example, the incident involved a violent attack, whether there was anal penetration, and whether a lubricant was used. As described in chapter V, a forcible rape that occurs as part of a larger physical assault may be extremely violent. Prisoners with whom Human Rights Watch is in contact have suffered rape-related injuries ranging from broken bones to lost teeth to concussions to bloody gashes requiring dozens of stitches. A few, like former Texas inmate Randy Payne, were killed during sexual assaults.

Another Texas inmate who tried on several occasions to fight off sexual assaults told Human Rights Watch that he could map out on his body the consequences of resisting his abusers:

    To give you an idea what I mean . . . I now have scar's where I've been gutted, under the right side of my chest below my heart, where my neck was cut open and under my left arm. That's not the many minor cuts and wound's I can't include in this letter because of lack of time & space.(302)

The medical records of several other prisoners with whom Human Rights Watch has been in contact portray a similar picture of physical savagery. And, in itself, forced anal penetration may cause intense pain, abrasions, soreness, bleeding, even, in some cases, tearing of the anus or transmission of the HIV virus.

The Threat of HIV Transmission

Transmission of HIV, the virus which causes AIDS, is a serious threat to victims of prison rape. In 1994, an Illinois inmate, Michael Blucker, claimed that he contracted HIV from being repeatedly raped at the Menard Correctional Center. He tested HIV-negative after being sent to Menard in May 1993, but was HIV-positive when tested again the following April. Blucker filed suit against the Illinois Department of Correction, prompting Rep. Cal Skinner, Jr., an Illinois state representative, to introduce legislation to protect prisoners against rape.(303) As Representative Skinner warned, victims of prison rape face the possibility of an "unadjudicated death sentence," subverting the intent of the criminal justice system.

Several other prisoners with whom Human Rights Watch is in contact state that they have contracted HIV through forced sexual intercourse in prison. K.S., a prisoner in Arkansas, was repeatedly raped between January and December 1991 by more than twenty different inmates, one of whom, he believes, transmitted the HIV virus to him. K.S. had tested negative for HIV upon entry to the prison system, but in September 1991 he tested positive. During the relevant time period, K.S. made numerous requests for assistance to prison officials, describing the sexual abuse and asking for protection.

K.S. brought suit in federal court against the prison officials who failed to protect him.(304) At trial, the warden testified that it was the prisoners' own responsibility to fight off sexual abuse--that prisoners had to let the others "understand that [they]'re not going to put up with that."(305) Despite ample evidence that K.S. had been left to fend for himself against numerous stronger inmates, the jury decided in favor of one official while the court ruled in favor of two others as a matter of law. The court's decision was later reversed on appeal,(306) and as of this writing K.S.'s lawsuit is still pending. K.S. remains incarcerated and is being treated for HIV. As for his attackers, K.S. reports, two "got punitive isolation time. The rest are still raping other inmates."(307)

The threat of HIV transmission is particularly acute given the high prevalence of the virus among prisoners. In 1997, an estimated 35,000 to 47,000 prisoners were infected with HIV and another 8,900 had AIDS.(308) AIDS is currently the second leading cause of death among prison inmates.(309) Between 1991 and 1995 approximately one in three inmate deaths was attributable to AID-related causes, compared to one in ten deaths outside the prison setting. Exacerbating the danger of HIV transmission is the lack of preventative measures, with little attempt made to educate prisoners about HIV/AIDS and few risk reduction devices available (such as condoms, clean needles, and bleach).(310)

Psychological Impact

Rape's effects on the victim's psyche are serious and enduring.(311) Inmates like L.T., whether they fall victim to violent sexual attacks or to more subtle forms of sexual abuse, leave the prison system in a state of extreme psychological stress, a condition identified as rape trauma syndrome. Given that many people in such condition leave prison every year, it is important to consider the larger consequences of prison rape. Serious questions arise as to how the trauma of sexual abuse resolves itself when inmates are released into society.

Victims of prison rape commonly report nightmares, deep depression, shame, loss of self-esteem, self-hatred, and considering or attempting suicide. Some of them also describe a marked increase in anger and a tendency toward violence.

Shame and the "Loss of Manhood"

The shame I experienced can't be described.

--A prisoner in Illinois.(312)

Victims of rape are likely to blame themselves for their predicament, leading to intense feelings of shame. As described previously, situations of unwanted sexual contact in prison run the gamut from violent gang rapes to subtle forms of psychological coercion. Even where extreme violence is used, the victim often worries, deep down, that he did not put up enough resistance. Indeed, there is some sense, under the unwritten code of inmate beliefs, that a real man "would die before giving up his anal virginity."(313) By the very fact of surviving the experience, therefore, a prisoner may worry he deserved it: that he has, at the very least, been proven to be "a punk, 'pussy,' or coward by not preventing it."(314) Although this view is not universally held--many prisoners recognize that it is the perpetrator alone who bears responsibility for their victimization--it is still widespread among inmates.

Obviously, victims of incidents of coerced sex that did not involve overt violence are even more likely to feel complicit in their own abuse. Many of them report thinking obsessively about how they could have avoided the situation, what they did wrong. They speak of profound feelings of shame and embarrassment over how they could have "allowed" the abuse to happen to them. In a letter to Human Rights Watch, a Colorado inmate whose fear enabled his cellmate to maneuver him into unwanted sexual contact, admitted, "If the truth be known, it shames me to even talk of this."(315) His feelings are typical.

In what is perhaps an unconscious effort to shield themselves from responsibility for prison abuses, correctional authorities seem to encourage such attitudes, frequently "blaming the victim" themselves. Unless a prisoner is visibly injured from a sexual assault, guards often intimate that the sex was consensual: that the prisoner actually invited it. Raped inmates frequently say that they are treated scornfully by guards who do not bother to hide the fact that they despise prisoners who are so "weak" as to be victimized. "Stand up for yourself and be a man," is a common refrain. Gay prisoners, particularly those with stereotypically feminine characteristics or mannerisms, report that guards are especially likely to ignore their claims of sexual abuse. Some guards, in fact, appear not to even recognize that gay inmates have the right to refuse other inmates' sexual advances, viewing homosexuality as a sort of open invitation to sex. As one prisoner, who is not actually gay, remembered: "I had an officer tell me that 'faggots like to suck dick, so why was I complaining.'"(316)

The tendency to misread victimization as proof of homosexuality appears to be common to guards and prisoners alike. In addition to feelings of fear, depression, and self-hatred, many prisoners have expressed a more specific anxiety about the loss of gender identity, fearing that their "manhood" has been damaged or eroded. As one sexually abused prisoner confessed: "I feel that maybe some women might look at me as less than a man. My pride feels beaten to a pulp."(317)

M.R., a Texas inmate who was nearly killed by his rapist, described this reaction, which he saw as unavoidable: "Men are supposed to be strong enough to keep themselves from being raped. So when it does happen it leaves us feeling as though our manhood has been stripped from us and that we are now less than what we once were."(318)

That which is "less than a man" for these prisoners is, to be specific, a homosexual man, albeit a homosexual defined according to the idiosyncratic rules that govern in the prison context. As described previously, the meaningful distinction in prison is not between men who engage in sex with men, and those who engage in sex with women; instead it is between what are deemed the "active" and "passive" participants in sex. Homophobia is rampant in prisons, but rather than targeting all men who have sexual contact with other men, it is focused against those who play the "woman's role" in sex: specifically, men who are anally penetrated, who perform fellatio on other prisoners, or who masturbate them.

Once a prisoner has been forced into such a role, he may easily be trapped in it. The fact of submitting to rape--even violent, forcible rape--redefines him as "a punk, sissy, queer." Other inmates will view him as such, withholding from him the respect due a "man." Having fallen to the bottom of the inmate hierarchy, he will be treated as though he naturally belongs there.

The belief that rape damages one's innermost self is strong among inmates. Indeed, for the perpetrators of rape, this belief provides a compelling reason to commit the act: rape appears to be the most powerful way to injure and degrade its victims. But what comes of the victims' conviction that they have been fundamentally damaged? Human Rights Watch's research suggests that at least some minority of prisoners who endure sexual abuse will turn violence on themselves or others.

Depression, Anxiety and Despair

I go through nightmares of being raped and sexually assaulted. I can't stop thinking about it. I feel everyone is looking at me in a sexual way.

--A prisoner in Texas(319)

Psychiatrists have identified "rape trauma syndrome"--a variant of post-traumatic stress disorder (PTSD) characterized by depression, severe anxiety, and despair--as being a common result of rape.(320) In their correspondence and conversations with Human Rights Watch, victims of prison rape frequently alluded to these symptoms, stating they felt depressed, paranoid, unhappy, fatigued, and worried. Feelings of worthlessness and self-hatred were often expressed. Exacerbating the psychological stress of their situation, many victims of prison rape feel that they remain vulnerable to continuing abuse, even believing themselves trapped in a struggle to survive. The fear of becoming infected with the AIDS virus also preoccupies victims. "Catching Aids and Hiv is a major concern for everyone," an Arkansas inmate emphasized. "There is no cure."(321)

Rape trauma syndrome was first diagnosed outside of the prison setting, looking at women victims, and most research on it has continued to focus on non-incarcerated women. Experts have distinguished three stages in the aftermath of rape, corresponding to its short-, intermediate- and long-term impact. While not all rape survivors exhibit these symptoms in the order described, the typology provides a useful general outline. The short-term reaction to rape is characterized by a range of traumatic symptoms, including nightmares and other forms of sleep disturbance, intense fear, worry, suspicion, major depression, and impairment in social functioning. In the second stage, victims often experience depression and self-hatred, as well as social and sexual dysfunction. The long-term effects of rape, which may surface a year or more after the assault, often involve destructive or self-destructive behavior; common symptoms are anger, hypervigilance to danger, sexual dysfunction and a diminished capacity to enjoy life.(322)

According to one study, only 10 percent of rape victims do not show any disruption of their behavior following the assault. Some 55 percent of victims display moderately affected behavior, while the lives of another 35 percent are severely impaired.


Suicide attempts are a not uncommon response to rape, particularly among prisoners who feel unprotected and vulnerable to continuing abuse. Nineteen inmates who corresponded with Human Rights Watch, including eight interviewed in person, reported that they attempted suicide as a result of rape in prison, and many more reported considering suicide.(323) Indeed, some inmates tried to kill themselves more than once. The following account is typical:

    I have been getting sexually assaulted at [Prison X] by two inmates. I tried to commit suicide in hopes of releaving the misery of it. . . . I was made to perform oral sex on the two inmates for exchange of protection from other inmates. . . . I reported the action of the inmates to the Unit authority but did not get any help so that is when I slashed both my wrists in hope of dying.(324)

Another prisoner told Human Rights Watch:

    I did nine years from March 1983 to November 1991. In that 9 years I was raped several times . . . . I came back to prison in 1993. In 1994 I was raped again. I attempted suicide. . . . The doctors here in the prison say "quote" major depression multiple neurotic symptoms, marked by excessive fear, unrelenting worry and debilitating anxiety. Antisocial suicidal ideation, self-degradation, paranoia and hopelessness are characteristic, "unquote."(325)

The case of Rodney Hulin, Jr., a seventeen-year-old Texas prisoner, is sadly illustrative of the problem. Hulin was repeatedly raped over a two-month period by older inmates. In January 1996, just after he wrote to his father saying he was tired of prison life and tired of living, he attempted suicide by hanging himself in his cell. Although the attempt was discovered before Hulin was dead, he was left in a coma and died four months later.

In general, suicide rates in prisons and jails are well above those in the outside community. Suicide ranks third as a cause of death in prison (after natural causes and AIDS), while it is the leading cause of death in jails.(326) From 1984 to 1993, the rate of prison suicide was more than 50 percent higher than the national average outside of prison.(327) Notably, "victimization" and "conflicts within the [prison] facility" are two of the main problems that experts have identified in specifying the stressful factors that result in inmate suicide.(328)

These figures are much more striking when one considers the practical difficulty of committing suicide in prison. Unlike in the outside world, where an individual can easily isolate himself from other people for hours or days at a time, in prison a person is rarely out of earshot of others, or even out of their sight. Indeed, in today's prisons, many inmates are double-celled or live in crowded dormitories, unlikely places for a suicide attempt to pass unnoticed. Although drugs are dispensed in prison, they are more closely regulated than outside of the prison setting. Most prison suicide attempts, even those in which the inmate is determined to kill himself, are likely to be unsuccessful. Human Rights Watch was unable to obtain comparative statistics on attempted suicides, but would suspect that, in comparing prison numbers with numbers outside of prison, the rates are even more disproportionate than those involving accomplished suicides.

Anger and the Cycle of Violence

[I]n 1991 I was raped by the Arizona "Aryan Brotherhood" a prison gang. I didnt tell the guards, I was scared & alone. The guards knew about it, because they told me they are going to move me, & so they did, but to a worst prison. Where I got into it with more "ABs". . . . I am a 26 year old White Boy who don't have anybody, but a lot of anger! . . . . Back to a little more about my Rape. The guys didnt get caught in the Act somebody told the guards and they asked me if I was alright. Then moved me . . . . I wanted to go back to the yard and kill them that did it!(329)

In the aftermath of rape, prisoners often harbor intense feelings of anger--anger directed first at the perpetrators of abuse, but also at prison authorities who failed to react appropriately to protect them, and even at society as a whole. Some prisoners have confessed to taking violent revenge on their abusers, inspired both by anger and by a desire to escape further abuse. The best and sometimes the only way to avoid the repetition of sexual abuse, many prisoners assert, is to strike back violently. Simply put, to prove that one is not a victim, one must take on the characteristics of a perpetrator. Since violence, in the prison setting, is almost a synonym for strength and virility, a readiness to use violence confirms one's "manhood."

A Texas inmate explained the dynamic in the following way:

    It's fixed where if you're raped, the only way you [can stop the abuse is if] you rape someone else. Yes I know that's fully screwed, but that's how your head is twisted. After it's over you may be disgusted with yourself, but you realize you're not powerless and that you can deliver as well as receive pain. Then it's up to you to decide whether you enjoy it or not. Most do, I don't.(330)

Summing up the situation in a phrase, he emphasized: "People start to treat you right once you become deadly."

Beyond encouraging violent behavior from its victims, prison rape also evokes violence from those prisoners with no direct exposure to it. Many inmates, including those who are relatively non-violent by nature, resort to violence as a protective shield against rape, to prove that they are not to be bullied. Studies have found that even the vague, indeterminate possibility of rape is a powerful impetus for prison violence.(331)

In a letter to Human Rights Watch, one prisoner even cited fear of rape as being among the causes of rape itself, sketching an oddly circular picture of the phenomenon. He said: "One reason [for prison rapes] is the insecure, weak inmate preying on another weaker inmate, to make an impression of toughness or ruthlessness that he hopes will discourage other inmates from doing the same thing to him."(332)

Numerous prisoners have described to Human Rights Watch the aggressive postures that they have adopted as a safeguard against rape. By reacting violently to the slightest show of disrespect, inmates believe that they can avoid the slippery slope that leads to rape. A quick resort to violence is, in their view, necessary to prove that they are ready and equipped to protect themselves.

In the prison context, even the most trivial incident can be perceived as a critical test of an inmate's "manhood." Violence may ensue at the slightest provocation. The following incident--in which, as this inmate put it, he had to prove to everyone that he was "not going to be anyone's punk"--is typical:

    one night 4 weeks into my prison stay i was tested by a very big north amerikkkan prisoner. he attempted to lay a bully game down on me by taking my seat in the lounge room. which led to me resorting back to my street warfare attack which was my only choice to set a solid example that i am not to be played with. The end result was he being put in the hospital, broke jaw/nose, an me having a broke wrist an a battery case.(333)

Besides reacting violently to other inmates' perceived aggressiveness, prisoners in fear of being raped frequently resort to preemptive violence in order to escape to a lock-up unit where they will be protected from attack. Desperate for a transfer to safer surroundings, such inmates purposely act out violently before corrections staff. As one described:

    I was sexually assaulted by 4 inmates (black). I went to staff. I was shipped to another unit. I refused to go to my housing assignment due to I was being put back into a life threatening condition. So I started to threaten the first black inmate I came into contact with. I was put in prehearing detention. That's September 15, 1995. I started possessing a weapon and threatening black inmates. That was the only way staff would keep me locked up in a single cell.(334)

Interestingly, even though violent behavior in prison constitutes a disciplinary infraction and can, in serious cases, result in criminal prosecution and more prison time, corrections officials frequently urge inmates to employ violence to defend themselves from attack. Past studies have found that prison staff counsel prisoners to respond to the threat of sexual assault by fighting the aggressor.(335) Inmates have often reported to Human Rights Watch that guards warn them, "no one is going to babysit you"--letting them know that they have to "act like a man," that is, to react violently to aggressive sexual overtures.

Another contributing factor to violence may be the acute shame that victims commonly experience. Indeed, psychiatrist and prison expert James Gilligan, describing a theory of violence, argues that shame is the primary underlying cause of the problem.(336) Driven by shame, men murder, rape, and punish others. In describing prisons as fertile territory for the shame-violence relationship, Gilligan's observations are consistent with prisoners' reports of their experiences. As one Vermont inmate told Human Rights Watch, "When I came out of prison, I remember thinking that others knew I had been raped just by looking at me. My behavior changed to such cold heartedness that I resented anyone who found reason to smile, to laugh, and to be happy."(337) This man later committed rape after release from prison in what he said was a kind of revenge on the world. K.J., another inmate with whom Human Rights Watch is in contact, similarly believes that it was the trauma of being raped while in jail--unrelieved by any psychological counseling--that led him to later commit rape himself. "I was just locked in shame," he said, explaining the downward spiral that culminated in his rape of two women. "It seemed like rape was written all over my face."(338)

The anger, shame and violence sparked by prison rape--though it may originate in the correctional setting--is unlikely to remain locked in prison upon the inmate's release. As one prisoner emphasized, reflecting upon correctional officials' failure to prevent several rapes in his institution:

    [The guards here believe that] the tougher, colder, and more cruel and inhuman a place is, the less chance a person will return. This is not true. The more negative experiences a person goes through, the more he turns into a violent, cruel, mean, heartless individual, I know this to be a fact.(339)

The brutal murder of James Byrd, Jr., in Jasper, Texas, spurred renewed consideration of the impact on society of incarcerating so many of its citizens in places of violent sexual abuse. Byrd, a disabled African American, was killed by three white men, two of whom had been released from Texas prison the previous year. While in prison, the two men acquired a deep hatred of blacks. They joined a white prison gang and covered themselves with racist tattoos. Reflecting on the sexual violence and racial conflicts that plague prisons in Texas, some commentators viewed the two men -- and the horrific crime they committed -- as the creations of the prison system. In an article subtitled "Did the Texas penal system kill James Byrd?" writer Michael Berryhill noted that the two men's racism "seemed intimately tied to their sexual fears," and that they "seemed obsessed with asserting their masculinity and repudiating homosexuality."(340) He concluded that the hatred evidenced in the Jasper killing was the predictable result of conditions in the state's prisons.

Prison reformers have a clear stake in asserting that prison abuses have a deleterious impact on the world outside of prisons, the logic being that even if the public cares not a whit for the suffering of inmate victims everyone agrees on the desirability of preventing abuses against victims out in society. Unsurprisingly, many reformers have asserted that stopping sexual abuse against prisoners is imperative for pragmatic as well as humanitarian reasons. According to this view, rape not only injures the victim's dignity and sense of self, it threatens to perpetuate a cycle of sexual violence.

    You take a guy who's been raped in prison and he is going to be filled with a tremendous amount of rage . . . . Now eventually he is going to get out. Most people do. And all the studies show that today's victim is tomorrow's predator. So by refusing to deal with this in an intelligent way, you are genuinely sentencing society to an epidemic of future rapes.(341)

The claim that prison rape begets further crimes is not universally accepted. Daniel Lockwood, a criminologist who has written extensively on the topic of prison sexual violence, disputes the notion that victims of abuse, embittered by the experience, vent their hostility on the public when released from prison.(342) He states there is "little reliable data" to support such claims, deriding the idea as a "damaging myth."

Evidently, no longitudinal studies have been conducted to specifically document the subsequent criminal history of victims of prison rape, and further empirical research would be of value. Nonetheless, it is clear that the effects of victimization are profound, and that, left to fester, the psychological injury of rape leads some inmates to inflict violence on themselves and others.

Inadequate Treatment

In disregard of the Supreme Court's 1978 ruling that prisoners have the right to adequate medical care for their "serious" medical needs, many prisoners receive inadequate health care, particularly mental health care. While most prison rape survivors in contact with Human Rights Watch say that they were provided medical treatment for any physical injuries received during the assault, only a minority said that they received the necessary psychological counseling. Yet, by all accounts, rape trauma syndrome is a serious and potentially devastating psychological disorder, demanding careful and sympathetic treatment. Indeed, one appellate court has affirmed that a prison's failure to make adequate psychological counseling available to rape victims violates the U.S. constitution's prohibition on cruel and unusual punishment.(343)

301. Excerpt of a pro se complaint filed in federal court by a prisoner in Arkansas, January 14, 1998.

302. Letter from W.M. to Human Rights Watch, September 13, 1996.

303. In January 1998, a federal jury rejected Blucker's argument that two prison staff members, including a prison doctor, had been "deliberately indifferent" to the risk that Blucker would be raped. The previous August, a different jury had ruled in favor of five other prison employees in Blucker's suit. Carolyn Starks, "Former Inmate with AIDS Virus Loses Suit against Prison Officials," Chicago Tribune, January 24, 1998. Blucker, who is married, was paroled from prison in 1996.

304. Few prison inmates can afford to pay for legal counsel in suits challenging ill-treatment in prison. (See chapter on legal context.) The vast majority of prisoners' claims, therefore, are filed pro se, as attorneys do not generally find prison litigation on a contingency basis to be financially viable. This reflects both the legal obstacles to such litigation and the lack of sympathy for prisoners among the public and the judiciary, which, from a lawyer's perspective, translates into low prospective damage awards. Indeed, in Human Rights Watch's experience, the only individual cases in which prisoners have succeeded in finding private lawyers to represent them are those involving HIV transmission, suggesting that only when prisoners' lives are directly and unequivocally at issue is there much hope that their injuries will be legally recognized.

305. K.S. v. Sargent, 149 F. 3d 783, 785 (8th Cir. 1998).

306. See K.S. v. Sargent, 149 F.3d 783 (8th Cir. 1998). A related decision is Billman v. IDOC, 56 F.3d 785 (1995), in which the court stated that a prison official could be held liable for assigning an inmate to a double cell with another inmate who was known to be a rapist and was HIV-positive. Ibid., pp. 788-89.

307. Letter to Human Rights Watch, December 13, 1996.

308. Lawrence K. Altman, "Much More AIDS in Prisons Than in General Population," New York Times, September 1, 1999 (describing results of study commissioned by the National Commission on Correctional Health Care).

309. U.S. Department of Justice, Bureau of Justice Statistics, "HIV in Prisons and Jails, 1995," February 1998.

310. See Elizabeth Kantor, "AIDS and HIV Infection in Prisoners," in The AIDS Knowledge Base (Lippenkott, Williams & Wilkins: New York, 1999); Nancy Mahon, "New York Inmates' HIV Risk Behaviors: The Implications for Prevention Policy and Programs," American Journal of Public Health, vol. 86, no. 9, September 1996, p. 1211.

311. Recognizing this, the European Court of Human Rights has declared that the abuse "leaves deep psychological scars on the victim which do not respond to the passage of time as quickly as other forms of physical and mental violence." Aydin v. Turkey, Judgment of 25 Sept. 1997, Eur. Ct. of H.R., para. 83.

312. Letter to Human Rights Watch, March 28, 1999.

313. Letter to Human Rights Watch, October 31, 1996.

314. Letter to Human Rights Watch, November 4, 1996.

315. Letter to Human Rights Watch, October 12, 1997.

316. Letter to Human Rights Watch, September 10, 1996.

317. Letter to Human Rights Watch from E.R., October 10, 1996. Another inmate with similar fears said, "I feel like I am no longer a 'man', at least not recognized as one on the inside." Letter to Human Rights Watch from P.E., March 6, 1999.

318. Letter to Human Rights Watch, March 30, 1999.

319. Letter to Human Rights Watch from J.D., November 5, 1996.

320. See, for example, Burgess and Holmstrom, "Rape Syndrome," American Journal of Psychiatry, vol. 9 (1974), pp. 981-86.

321. Letter to Human Rights Watch, September 23, 1996.

322. L. Cohen and S. Roth, "The psychological aftermath of rape: Long-term effects and individual differences in recovery," Journal of Social and Clinical Psychology, vol. 5 (1988), pp. 525-34; Stephen Donaldson, "Rape Trauma Syndrome in Male Prisoners" (undated).

323. The 1994 Nebraska prison study reported that over one-third of inmates targeted for sexual abuse had thoughts of suicide after the incident. Struckman-Johnson, "Prison Sexual Coercion," p. 74.

324. Letter to Human Rights Watch from D.E., May 14, 1998.

325. Letter to Human Rights Watch from R.H., September 10, 1996.

326. Lindsay M. Hayes, "Prison Suicide: An Overview and Guide to Prevention," National Institute of Corrections, June 1995, p. 1.

327. Ibid., p. 32.

328. Ibid., p. 70. The rate of jail suicide, approximately nine times that of the general population, far exceeds that of prison suicide. Ibid., p. 1. Yet a number of precipitating factors exist in the jail context--including the initial crisis of incarceration and shame over the alleged offense--that distinguish it from the prison context. Although prison rape, or the fear of rape, may play a role in some prisoners' suicidal response to detention, it is only one of many factors that come into play during these first stages of incarceration.

329. Letter to Human Rights Watch from W.W., December 31, 1996.

330. Letter to Human Rights Watch from W.M., September 13, 1996.

331. See, for example, Lockwood, "Issues in Prison Sexual Violence," p. 98.

332. Letter to Human Rights Watch, September 21, 1996.

333. Letter to Human Rights Watch from L.Q., December 3, 1997.

334. Letter to Human Rights Watch from J.D., November 5, 1996.

335. Daniel Lockwood, Prison Sexual Violence (New York: Elsevier, 1980), pp. 53-54.

336. James Gilligan, Violence: Our Deadly Epidemic and its Causes (New York: Grosset/Putnam, 1996).

337. Letter to Human Rights Watch from B.E., October 26, 1996.

338. Human Rights Watch telephone interview, October 22, 1999. When describing the rape of one woman, he added, "I remember being extremely angry."

339. Letter to Human Rights Watch from R.L., October 21, 1996 (emphasis in original).

340. Michael Berryhill, "Prisoner's Dilemna," The New Republic, December 27, 1999; see also Joseph L. Galloway, "Into the Heart of Darkness: A Texas Prison's Racist Subculture Spawned the Grisly Murder in Jasper," U.S. News & World Report, March 8, 1999 (noting that one defendant's lawyer stated that he believed his client was raped in prison).

341. Stephen Donaldson, the late president of Stop Prisoner Rape, as quoted in Ellis Henican, Special Report: Prison Rape--Every Man's Worst Fear Becomes a National Scandal, Penthouse Magazine (August 1995), p. 30; see also Robert W. Dumond, "The Sexual Assault of Male Inmates in Incarcerated Settings," International Journal of the Sociology of Law, vol. 20 (1992), p. 147 (asking "is it not reasonable to assume that some [raped inmates] will leave prison more embittered, angry and violent? . . . . How many innocent victims will fall prey to inmates full of rage and anger at a system that did not protect them?"); Wooden and Parker, Men Behind Bars, p. 116-17 (expressing concern over "the potential ramifications to society" of releasing raped inmates, and urging that such inmates receive proper psychological care "to stem the possibility of their becoming future assaulters"); Heilpern, Fear or Favour, p. 18 (stating that "[t]hose who have been sexually assaulted in prison will be released as time bombs, waiting to obtain their revenge in inappropriate and destructive ways").

342. Daniel Lockwood, "Issues in Prison Sexual Violence," in Michael C. Braswell, Reid H. Montgomery, Jr., and Lucien X. Lombardo, eds., Prison Violence in America, 2nd edition (Cincinnati: Anderson Publishing, 1994), p. 99.

343. LaMarca v. Turner, 995 F.2d 1526, 1534, 1543 (11th Cir. 1993).

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