Sexual activity is banned in American prisons and jails. Nevertheless, it still happens on a daily basis, because where there are humans, sex usually follows close behind.
Much of that sex, however, is unprotected, leading to dangerously high rates of STIs in prison — so California and Vermont have started providing condoms to inmates to address the problem. Vermont has been offering them since 1987, when the state recognized that the looming HIV/AIDS crisis could become an epidemic in correctional settings, and the Golden State picked up the torch earlier this year with a law mandating access to condoms across the system.
Notably, the San Francisco County Jail and some other facilities in California were already voluntarily offering condoms, sometimes against the wishes of staff. Supervisors argued, however, that it was unreasonable to leave prisoners at risk of preventable infections — making sex illegal doesn't mean it won't happen, it just makes it more dangerous.
The move is a form of harm reduction, recognizing that while sex may be forbidden, it's going to happen anyway, so it should be safe. Similar motives drive practices like needle exchanges in the outside world. Rather than allowing people to endanger themselves by engaging in illegal behaviors without adequate protections, public health officials intervene with protective supplies, whether they be clean needles or condoms.
Harm reduction isn't necessarily a popular approach in the United States, especially in conservative communities, which believe that offering things like safer sex supplies increases the incidence of sexual activity.
Numerous studies on the outside illustrate that this is not the case, with a particular focus on safer sex supplies for teens, a contested subject in some communities. On the inside, a pilot study in California prisons in 2011 found that providing condoms didn't create security risks, and if doing so could prevent STIs (the study didn't last long enough to make decisive comments on the subject), it might generate substantial savings for the California Department of Corrections. In addition, of course, to improving the lives of prisoners rather substantially.
The problem of HIV/AIDS and hepatitis C in prisons is not just an inherent public health issue, although it definitely is one. Inmates have an HIV infection rate that's five times higher than the general population. Many bring their HIV with them from the outside community, a reflection of the fact that severe economic disadvantages and HIV can become a feedback loop that pushes people into prison — as, for example, when low-income men turn to sex work, become HIV positive, and are incarcerated for working in the sex industry. 17 percent of HIV positive people move through the prison system annually.
Others acquire infections in prison as a result of sexual interactions with other prisoners, even people who know about their positive status and try to exercise due cautions. Prisoners report using plastic bags and saran wrap to protect themselves and their partners. Of the roughly two million people incarcerated and jailed in the United States, over 20,000 test HIV positive, and the number may be even higher—people cycle quickly through jails and some parts of the justice system, and thus may not be tested and treated for STIs.
It's a problem in prison, and it's a problem on the outside, where former prisoners bring HIV back to their communities, perpetuating high infection rates. That results in tremendous public health costs, as identifying and managing HIV can be quite costly, and when HIV positive patients use public assistance like government-funded health care programs, it represents a lifetime of treatment with a chronic illness that cannot be ignored. No matter the source of health care funding, living with a chronic illness like HIV can involve substantial sacrifices, and collectively, we should be reducing the incidence of infection as much as possible.
It's also, though, a tremendous racial problem. One in three Black men, and one in six Latinos, will go to prison in his lifetime. Similarly, Black and Latina women are much more likely to go to prison than their white counterparts. That results in a disproportionate exposure rate to STIs, but even that doesn't explain the unusually high rates of infection in minority men, which don't match with statistics in the civilian population: In prison, Black men are twice as likely to be diagnosed as Latinos, and five times as likely to be diagnosed as white men. Incarceration, already an injustice, becomes a sentence to a potentially fatal chronic infection for men of color, who emerge from prison to statistically lower income and fewer opportunities for economic advancement.
Which is where condom distribution comes in: By making condoms discreetly available, prisons can reduce the risk that their prisoners will develop STIs, which is a human rights issue as well as a practical one. Managing outbreaks can be costly and time-consuming, and HIV positive prisoners as well as those with AIDS suffer in prison along with their HCV+ counterparts because of spotty access to health care, like denial of preventative medications specifically designed to prevent progression of HIV to full-blown AIDS.
In the larger scheme of things, the racial injustice that puts people of color in prison at disproportionate numbers needs to be addressed. Mandatory sentencing laws, racial profiling, lack of access to quality defense attorneys, and other factors contribute to severe injustices within the system. But while such disparities exist, it's critical to be increasing the availability of safer sex supplies, and to find out why minority men are so much more likely to have HIV infections in prison settings.
People die across the system on a daily basis because they're neglected when they're clearly at risk from illness, other prisoners, or themselves. The stark statistics on HIV in U.S. prisons should be a compelling argument for the rest of the union, as well as the federal prison system, to join California and Vermont — every case prevented represents a huge ripple effect for the larger community.