Condoms for prisoners: no evidence that they increase sex in prison, but they increase safe sex.

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by  Butler, Tony

Epidemiology
SHORT REPORT
Condoms for prisoners: no evidence that they
increase sex in prison, but they increase safe sex
Tony Butler,1 Juliet Richters,2 Lorraine Yap,1 Basil Donovan1,3
1KirbyInstitute,Universityof ABSTRACT and—when flavoured lubricant was available—to
NewSouthWales,Sydney, Objectives Todetermineiftheprovisionofcondoms make milk-shakes and to spread on bread.1 Most
NewSouthWales,Australia
toprisonersintwoAustralianstateprisonsystemswith maleprisonersreportnegativeattitudestowardmale
2SchoolofPublicHealthand
CommunityMedicine, differentpoliciesaffectssexualbehaviour.InNewSouth homosexuality.6
UniversityofNewSouthWales, Wales’(NSW)prisons,condomsarefreelydistributed, In this paper, we compare levels of consensual
Sydney,NewSouthWales, whileinQueenslandprisonsnonearedistributed. and non-consensual sexual activity as reported in
Australia Methods Weusedacomputer-assistedtelephone the Sexual Health and Attitudes of Australian
3SydneySexualHealthCentre,
interviewtosurveyrandomlyselectedprisonersinboth Prisoners(SHAAP)survey,5andtheuseofcondoms
SydneyHospital,Sydney,
NewSouthWales,Australia statesabouttheirsexualbehaviourinprison. intwostateprisonsystems,onethatfreelyprovides
Results Twothousandandeighteenmaleprisoners condomstoprisoners(NSW)andonethatdoesnot
Correspondenceto participated.Theproportionofprisonersreportinganal (Queensland).
ProfessorTonyButler,
sexinprisonwasequallylowinNSW(3.3%)and
TheKirbyInstitute,UNSW
Medicine,UniversityofNew Queensland(3.6%;p=0.8).Amuchhigherproportionof METHODS
SouthWales,Sydney, prisonerswhoengagedinanalsexinNSW(56.8%) We surveyed representative samples of prisoners in
NSW2052,Australia; thanQueensland(3.1%;p<0.0001)reportedtheyhad
NSWandQueenslandabouttheirsexualbehaviour,
[email protected] usedacondomiftheyhadhadanalsexinprison.
attitudestosexandknowledgeofsexuallytransmis-
Received02October2012 Sexualcoercionwasequallyrareinbothprisonsystems. sible infections.5–7 We chose these states because
Revised06December2012 Conclusions Wefoundnoevidencethatcondom NSWfreelydistributesaround30000condomsper
Accepted09December2012 provisiontoprisonersincreasedconsensualor
monthtoitsprisoners,whileQueenslanddistributes
PublishedOnlineFirst non-consensualsexualactivityinprison.Ifavailable,
none. These two states combined, house around
7January2013
condomsweremuchmorelikelytobeusedduringanal 60%ofAustralia’sprisoners.
sex.Condomsshouldbemadeavailabletoprisonersas
The methods for the survey have been published
abasichumanright. elsewhere in detail.5 7 Briefly, potential participants
wererandomlyselectedfromalistofallinmatesata
particular prison provided by the two Departments
INTRODUCTION of Corrective Services. Those selected were pro-
Earlier, we reported that the introduction of vided with a verbal explanation of the study by a
condoms into New South Wales (NSW, Australia) recruiterandgivenaprintedinformationsheetand
prisonsin1996didnotleadtomanyoftheadverse consent form to sign. Participants were reassured
events that had been predicted.1 Condoms were that the phone call would not be recorded or elec-
introduced into NSW prisons following a class tronicallyeavesdroppeduponbyprisonauthorities,
actionbyprisoninmates.Despitethisevidence,the and that they could withdraw at any time without
provision of condomsto prisoners remains conten- consequence. Each participant received $A10 as
tious and is uncommon globally,2 even though compensation for time lost while engaged in paid
condoms are known to be effective in reducing the workintheprison.
spread of HIV and other sexually transmissible Computer-assisted telephone interviews were
infections.3 conducted by a private social market research
Opponents(includingsomeprisoners)arguedthat company, and took place in a private space; for
condomsmight:(a)encourageprisonerstohavesex, instance, a legal visits room or consulting room in
(b)increaserapeinprisonbyprovidingsexualpreda- the health clinic. Interviews lasted, on average,
torswithprotectionagainstinfectionorleavingDNA about 30minutes. χ2 Statistics were used to
evidence, (c) be used as weapons against custodial compareproportions.
staff,(d)givetheperceptionthatmostprisonerswere
homosexual, and (e) lead to prisons being seen to RESULTS
condone promiscuity and homosexuality. Following Atotalof 2018prisoners respondedforaresponse
an exhaustive search by the NSW Department of rateof76.8%(range60%to100%).Atthetimeof
CorrectiveServicesovera10-yearperiod,onlythree the survey, 9500 men were in full-time custody in
officialincidents could befound ofacondombeing NSW prisons, and 5100 men were in Queensland
OpenAccess
Scantoaccessmore inappropriately used.1 However, prisoners in NSW prisons.8 We found that condom provision was not
freecontent
do report using condom kits (containing a condom, associated with higher levels of sexual activity.
lubricant, instructions on usage—all inside a plastic Indeed, slightly more prisoners in Queensland
Tocite:ButlerT,RichtersJ, bag)formyriadnon-sexualpurposes,suchasstoring (8.8%) than NSW (5.8%; p=0.01) reported sexual
YapL,etal.SexTransm tobacco,contrabandandotheritems,andhairties.45 activityinprison(seetable1).Overwhelmingly,the
Infect2013;89:377–379. The lubricant was used as a shaving aid, as hair gel, reportedsexualactivityinbothstateswasconsensual
ButlerT,etal.SexTransmInfect2013;89:377–379.doi:10.1136/sextrans-2012-050856 377
Epidemiology
Table1 SexualactivityreportedbymaleprisonersinNewSouthWalesandQueensland,Australia
Condomsavailabletoprisoners Nocondomsavailabletoprisoners
Characteristic NewSouthWales(n=1118) Queensland(n=900) pValue
Everhadsexualcontactinprisonwithinmate*,†
Yes(%) 65(5.8) 79(8.8) 0.01
No(%) 1045(93.5) 820(91.1)
Refusedtoanswer(%) 1(0.1) –
Nosexualexperienceatall(inprisonorthecommunity)(%) 7(0.6) 1(0.1)
Sexualpartnersinprison(ifhadsexinprison)
Mediannumber(range) 2(1–50) 2(1–2500) 0.9
Sexuallycoercedinprison†,‡
Yes(%) 27(2.4) 26(2.9) 0.5
No(%) 1084(97.0) 873(97.0)
Missing(%) 7(0.6) 1(0.1)
Everthreatenedwithsexualassaultinprison†
Yes(%) 64(5.7) 75(8.3) 0.05
No(%) 1053(94.2) 823(91.4)
Notsure(%) 1(0.1) 2(0.2)
Everhadanalsexinprison†
Yes(%) 37(3.3) 32(3.6) 0.8
No(%) 1081(96.7) 868(96.4)
Everusedcondomforanalsexwithanotherprisoninmate(ifhadsexinprison)
Yes(%) 21(56.8) 1(3.1) <0.0001
No(%) 7(18.9) 25(78.1)
Missing(%) 9(24.3) 6(18.8)
Consentedtofirstsexualcontactinprison(ifhadsexinprison)
Yes(%) 54(83.1) 70(88.6) 0.5
No(%) 10(15.4) 7(8.9)
Equivocal(%) 1(1.5) 2(2.5)
*Sexualcontactreferstoanysexualcontactincludingintercourse,kissingandtouching.
†Denominatorisallprisonerssurveyed(ie,1118meninNewSouthWalesand900meninQueensland).
‡Forcedorfrightenedintodoingsomethingsexuallythatyoudidnotwanttodo.
andconsistedmostlyofmanualororalsex.79Theproportionof introduction into prisons remains controversial and uncom-
prisoners reporting anal sex in prison was equally low in NSW mon,2 even though the arguments used to oppose condoms in
(3.3%) and Queensland (3.6%; p=0.8). A much higher propor- prison have no empirical evidence to support them, as others
tion of prisoners who engaged in anal sex in NSW (56.8% v and we have found.1 10 Civilised societies owe their prisoners a
3.1%; p<0.0001) reported they had used a condom if they had duty-of-care, including the right to protect themselves during
had anal sex in prison (see table 1). Sexual coercion was equally sexualactivity.
rareinbothprisonsystems(seetable1). Limitations of the SHAAP survey include: the use of self-
report and the possibility that some respondents may have
DISCUSSION under-reported both consensual sex and sexual assaults. We
These findings demonstrate that providing prisoners with usedabroaddefinitionofsexualassaultrangingfromunwanted
condoms is not associated with an increase in consensual or touchingorkissing,torape,whichhaveinflatedthenumbersof
non-consensual sexual activity, or even threats of sexual assault. prisonersreportingsexualassault.Similarly,wehadnoinforma-
Hardly surprisingly, we have demonstrated that condoms are tiononstructuralissueswhichmayhaveinfluencedsexualactiv-
much more likely to be used for anal sex if they are available, ity, such as housing in single cells and prison officersupervision
but the likelihood of anal sex is not increased. Despite the levels.
widespread acceptance of condoms in the community, their As advocated by WHO, the United Nations, the American
Public Health Association and the Public Health Association of
Australia, we believe that condoms should be made freely avail-
ableinprisons.11
Keymessages
Acknowledgements Wearemostgratefultotheprisonerswhofreelyand
▸ Wefoundnoevidencethatprovidingcondomstoprisoners willinglyprovideduswithintimatedetailsoftheirlivesinthehopethatthisresearch
canhelptobetterunderstandthesexualhealthofthisgroup.Wearegratefultothe
increasesconsensualornon-consensualsexualactivityin
followingwhoprovidedvaluableinputtothedevelopmentofthestudy:DrTony
prison. Falconer,MaxSaxby,FredRopp,JennyDouglas,JoanneHolden,ArianeMinc,
▸ Ifavailable,condomsweremuchmorelikelytobeusedby DebbiePittamandthemembersofthestudyreferencegroupforhelpintheearly
prisonersduringanalsex. stages.DrAlunRichardsandMrLukeGrantassistedinthedevelopmentofthe
▸ Condomsshouldbemadefreelyavailabletoallprisonersas SHAAPsurvey.
abasichumanright. Contributors TB,BD,JRandLYwereallresponsibleforthestudydesignand
writingthemanuscript.TBwasresponsiblefordataanalysis.
378 ButlerT,etal.SexTransmInfect2013;89:377–379.doi:10.1136/sextrans-2012-050856
Epidemiology
Funding ThisworkwassupportedbytheNationalHealthandMedicalResearch 3 HolmesKK,LevineR,WeaverM.Effectivenessofcondomsinpreventingsexually
Councilgrantnumber350860. transmittedinfections.BullWorldHealthOrgan2004;82:454–61.
4 ButlerT,MilnerL.The2001InmateHealthSurvey.Sydney:NSWCorrectionsHealth
Competinginterests None.
Service,2003.ISBN:073473560X.
Ethicsapproval ApprovalwasindependentlygrantedbytheNSWJusticeHealth 5 ButlerT,RichtersJ,YapL,etal.SexualhealthandbehaviourofQueensland
HumanResearchEthicsCommittee(GEN5/05),theUniversityofNewSouthWales prisonerswithQueenslandandNewSouthWalescomparisons.Perth:
HumanResearchEthicsCommittee(HREC05045),theNSWDepartmentof NationalDrugResearchInstituteandSchoolofPublicHealthand
CorrectiveServicesEthicsCommittee(Ref05/0882)andtheQueenslandCorrective CommunityMedicine(UniversityofNewSouthWales),2010.ISBN:
ServicesResearchCommittee. 978-0-9807054-0-9.
Provenanceandpeerreview Notcommissioned;externallypeerreviewed. 6 MalacovaE,ButlerT,RichtersJ,etal.Attitudestowardssex:acomparisonof
prisonersandthegeneralcommunity.SexHealth2011;8:355–62.
OpenAccess ThisisanOpenAccessarticledistributedinaccordancewiththe 7 ButlerT,MalacovaE,RichtersJ,etal.Sexualbehaviourandsexualhealthof
CreativeCommonsAttributionNonCommercial(CCBY-NC3.0)license,which Australianprisoners.SexHealthPublishedOnlineFirst:21December2012.
permitsotherstodistribute,remix,adapt,builduponthisworknon-commercially, doi:10.1071/SH12104.
andlicensetheirderivativeworksondifferentterms,providedtheoriginalworkis 8 PrisonersinAustralia.CatalogueNo.4517.0.Canberra:AustralianBureauof
properlycitedandtheuseisnon-commercial.See:http://creativecommons.org/ Statistics,2007.
licenses/by-nc/3.0/ 9 RichtersJ,ButlerT,SchneiderK,etal.Consensualsexbetweenmenandsexual
violenceinAustralianprisons.ArchSexBehav2012;41:517–24.
10 SyllaM,HarawaN,ResnickO.ThefirstcondommachineinaUSJail:thechallengeof
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