This paper focuses on condoms, a harm reduction method endorsed by public health officials for prevention of HIV transmission since the advent of the disease. Condoms are highly efficacious in preventing the transmission of HIV and other sexually transmitted infections. According to UNAIDS, scientific data overwhelmingly confirm that male latex condoms are highly effective in preventing sexual HIV transmission.11 The Institute of Medicine, a body of experts that acts under a Congressional charter as an advisor to the US government, noted in 2001 that scientific studies have shown that comprehensive sex and HIV/AIDS education and condom availability programs can be effective in reducing high-risk sexual behaviors.12
Despite overwhelming evidence that condom use prevents the transmission of HIV, US prison officials continue to limit the availability of condoms to incarcerated persons. Less than 1 percent of US correctional facilities provide condoms to inmates.13 These policies stand in stark contrast to the public health approach taken by prison officials in Canada, Western Europe, Australia, Ukraine, Romania, and Brazil, where condoms have been available to inmates for years. Moreover, several large urban jails in the US as well as one state have provided condoms to inmates, either through medical staff or more general distribution. Where institutional policy provides for condom distribution, no correctional system has yet to find any grounds to reverse or repeal that policy.
Moreover, leading correctional health experts in the US endorse condom distribution in prisons and jails. The National Commission on Correctional Health Care (NCCHC), the nations primary standard-setting and accreditation body in the field of corrections, has endorsed the implementation of harm reduction strategies, including condom distribution, in US prisons and jails. The Commission states, While NCCHC clearly does not condone illegal activity by inmates, the public health strategy to reduce the risk of contagion is our primary concern.14 Further, the American Public Health Association Standards for Health Services in Correctional Institutions (3rd Edition, 2003) recommends that condoms be available for inmates in order to prevent the transmission of infection.
Some corrections officials have been concerned that condom distribution would negatively affect institutional security. As discussed below, several recent evaluations of condom distribution programs in correctional settings provide evidence that security concerns are not well founded.
Condom Distribution Programs: Washington DC
A recent study examined the condom distribution program in effect since 1993 at the Central Detention Facility in Washington, DC (CDF).15 The study found that the CDF housed approximately 1400 adult males, 100 adult females, 40 juveniles, and processes an average of 2800 inmates per month. It was staffed by 551 correctional officers. Condoms were provided free of charge through public health and AIDS service organizations. Inmates had access to the condoms during health education classes, voluntary HIV pre-test or post-test counseling, or upon request to members of the health care staff. Approximately 200 condoms were distributed each month according to inventory audits.
Both inmates and staff were interviewed about their opinion of the condom distribution program. The findings indicate that 55 percent of inmates and 64 percent of correctional officers supported the availability of condoms at the CDF facility. Objections related primarily to moral and religious concerns about homosexual activity. Thirteen percent of correctional officers said that they were aware of institutional problems associated with condom distribution, though none provided descriptions of those problems. No major security infractions related to condoms had been reported since commencement of the program. There was no evidence that sexual activity had increased, based upon staff interviews as well as a review of disciplinary reports for the relevant period. The researchers stated:
The Canadian correctional system incarcerates approximately 13,000 inmates in 58 facilities, including 8 maximum security, 20 medium security, 17 minimum security, and numerous community correctional centers. In Canada, distribution of condoms in all institutions operated by the Correctional Service of Canada (CSC) is part of a Management of Infectious Disease policy that identifies as its objective To contribute to public health and a safe and healthy environment through a comprehensive infectious diseases program. In implementing this policy the CSC states that it will be guided by public health principles in managing infectious diseases in the penitentiary environment.17 In April 1999, two years after commencing a program under which both condoms and bleach were made available, the CSC issued an evaluation of this program. The CSC concluded:
Condom Distribution Programs: Australia
Similar findings resulted from a study of the effect of condom distribution in the prisons of New South Wales, Australia, a largely urban province that includes the city of Sydney. The research focused upon concerns that had been expressed in 1996, when the program was initiated, that condom distribution would result in increased homosexual activity, and increased security disturbances. The findings indicated a decrease in reports of both consensual male-to-male sex and male sexual assaults during the period 1996-2001; that the contents of condom kits were used for concealing contraband items, primarily tobacco, and that this was not associated with an increase in drug use in the prison; and that only three minor incidents involving the safety of staff had occurred during this time. The researchers acknowledged that other factors such as educational prevention programs may also have influenced the decline in sex and sexual assaults, but concluded:
Several large urban jails, including the Los Angeles and San Francisco County jails, make condoms available to inmates. San Francisco Sheriff Michael Hennessey was a strong supporter of Californias legislation permitting condom distribution in prison, which passed in 2005 but was vetoed by the Governor.20 In an editorial opinion letter published in the San Francisco Chronicle, Sherriff Hennessey stated that correctional officials should do everything we can to prevent sexual activity in custody, but we shouldnt turn a blind eye to the reality that it occurs. Further, he noted that the risk of contraband smuggling was much greater from routine contact between inmates and outside visitors than from the availability of condoms inside the facility.21
11 Joint United Nations Programme on HIV/AIDS (UNAIDS), 2004 Report on the Global AIDS Epidemic: 4th Global Report (2004), p. 75.
12 Institute of Medicine, No Time to Lose: Getting More from HIV Prevention (Washington DC: National Academy Press, 2001).
13 Weinbaum, supra.
14 NCCHC Position Statement, Journal of Correctional Health Care, vol. 11, no. 4 (2005).
15 J. May and E. Williams, Acceptability of Condom Availability in a US Jail, AIDS Education and Prevention, vol. 14, (Supp. B) (2002). P. 85.
16 Ibid, at 89.
17 Correctional Services of Canada, Commissioners Directive, Management of Infectious Diseases, Policy Bulletin 181 (November 4, 2004).
18 Correctional Services of Canada, Evaluation of HIV/AIDS Harm Reduction Measures in the Correctional Service of Canada, April 1999, p. 54.
19 L. Yap et al, Do Condoms Cause Rape and Mayhem? The Long-Term Effects of Condoms in New South Wales Prisons, Sexually Transmitted Infections (STI) Online, December 19, 2006, http://sti.bmj.com/cgi/content/abstract/sti.2006.022996v1 (accessed February 1, 2007).
20 Michael Hennessey, Health-positive bill for prisoners (and the people who love them), San Francisco Chronicle, April 19, 2005.