SAFER SEX IN PRISONS

Sexual activities occur inside prisons, just as they do outside. Sexual experiences and pleasure are part of being human. In the same way that prisons are not drug free, neither are they sex free. In addition, prison life produces conditions that encourage the establishment of homosexual or lesbian relationships within the institution. The prevalence of sexual activity in prison is based on such factors as whether the accommodation is single-cell or dormitory, the duration of the sentence, the security classification, and the extent to which conjugal visits are permitted. Several studies have provided evidence that significant rates of risky sexual behaviour occur in correctional settings.

Despite the availability of condoms in prisons, knowledge of sexual risk behaviour and individual risk prevention is poor. Todts et al. (1997) reports that none of a group of Belgian prisoners who were having sexual contacts while in prison used condoms. Prevention offers have not been accepted. The reason might be that men having sex with men is not generally accepted by most of the prison population and prisons do not offer enough privacy where this behaviour does occur.

Sexual transmission of HIV, hepatitis B or other sexually transmitted diseases in prisons is a complex phenomenon, with taboos for all concerned: prison authorities, health personnel, and prisoners as well. Penetrative sex between male prisoners can take place in a whole range of situations, and not just between ‘gay’ inmates:

Self-identified heterosexual men having sex with men
True homosexual sex
Consensual sex
Circumstantial sex (prisoners pay with what they have)
Coercive sex
Rape and gang rape
Male sex work

There are many misrepresentations about the nature of sexual coercion inside prisons, and a lack of awareness of the problem. Making condoms accessible to inmates may be useful for some cases, but will certainly not prevent the sexual transmission of HIV in most cases of so-called “consensual” prison sex (see also Reyes 2000).

4.1 Condom availability in prisons
The WHO guidelines on HIV infection and AIDS in prisons (1993) recommend: “...Since penetrative sexual intercourse occurs in prison, even when prohibited, condoms should be made available to prisoners throughout their period of detention. They should also be made available prior to any form of leave or release.” It should be added that condoms should also be made available at conjugal visits (both official and unofficial).
The availability of condoms in European prisons differs widely in practice regarding the provision of and access to condoms. Perkins (1998) examined the accessibility of condoms in European prisons and found a wide range of different policies “...on a continuum spanning endorsement of free distribution within prison to total prohibition. Nine of the fifteen EU countries had clear policies allowing access to condoms for prisoners, in line with the WHO Guidelines. The other six took different positions on access, from the extreme of prohibition based on lack of recognition of the problem.” *5. In Scotland, Italy and Ireland, sexual activities are prohibited in prison and condoms as well as lubricants are not available for prisoners. They are handed out for home leavers and/or as part of the release pack.

(Perkins 1998, 33; Laporte 1997)

Different policies are applied in European prisons. Access via

Social workers
Medical unit
Priests
Prison shops
On prescription, where the prison doctor believes that there is a risk of STD transmission. (England/Wales)

Throughout the world, condom availability is a controversial issue due to the the fact that sexuality is the second major taboo in prison (after drug use). In 1995 in Australia, 50 prisoners launched a legal action against the state of New South Wales (NSW) for non-provision of condoms, arguing that “it is no proper part of the punishment of prisoners that their access to preventative means to protect their health is impeded.” Since then, at least in part because of the legal action, the NSW government has decided to make condoms available. Other Australian systems have also made condoms available. Others (South and Western Australia) sanction the provision of condoms but don’t actually provide them.

General information about condoms

Condoms, if used properly, are a good way to have sex safely or make love in a safe way. Although not 100% safe, condoms can prevent most STIs and unwanted babies.

Different types of condoms are generally available (but rarely in prisons):

With and without lubricant
Many people prefer to use a condoms in combination with a lubricant as the chance of tearing or slipping off is reduced. Often, a water-based lubricant is already put on the condom. With condoms suitable for anal sex, extra water-based lubricant is sometimes packaged separately.

Flavoured condoms
Most of the flavoured condoms marketed are not designed for vaginal use. Flavoured condoms are not lubricated and are most suitable for use in ‘blow jobs’. (fellatio).

Female condoms and dental dams
These condoms are not available in all European Union member states and not at all in prisons. They are expensive everywhere. Nevertheless, the female condom can be convenient for several reasons. It is inserted in the vagina, and a rubber ring inside the condom helps to keep the condom in the right position. The major advantage of the “Femidom” is that it can be inserted long before actual intercourse takes place.

Extra strong condoms
Extra-strong condoms are often referred to as ‘gay condoms’, which is actually incorrect because anal sex is also common among heterosexuals. Extra strong condoms are specially designed for anal sex. This type of condom is not considered 100% safe. The possibility of an ‘accident’, such as tearing of the condom, is considerable if it is not used properly. This type of condom is best used with extra lubricant.

Instruction on condom use

Check if you have the right condom:
Is it intended for vaginal or anal use? For anal use, only special, thicker condoms are suitable.
Is it big enough?
Is it an approved brand?
Check the expiry date

Open the package carefully in the middle:
Do not use teeth or scissors to avoid tearing the condom

Take out the condom:
Be extra careful if you have long fingernails
Make sure that you don’t hold the condom inside out

Pinch (squeeze) the semen reservoir at the tip of the condom, so that there is no air left. We do this because:
The chance that it will tear is smaller because the reservoir does not come under pressure
If the condom has no reservoir you can make one yourself by squeezing the air out of the top of the condom (1-3 cm).

Put the condom on top of the penis and unroll it carefully to the base of the penis
Wait until the penis is completely hard before putting the condom on.
When fully unrolled, there is less chance that the condom will slip off
Again, be careful with long nails

Be sure to use water-based lubricants
Always use lubricant for anal penetration
A non-water-based lubricant will dissolve the condom.
So do not use hand cream, body lotion, vaseline, oil or butter. If none of these things are available, use saliva instead!

Withdraw the penis carefully immediately after ejaculating
While withdrawing, hold the condom at the opening to avoid it slipping off
If you wait too long the penis becomes flabby, the condom slips off and semen drips out

Dispose the condom by putting it in a bin
Avoid using the toilet because condoms can stop up the drain

Wash hands

! Use a new condom each time you start fucking. Never use two condoms on top of each other as this can cause the condoms to tear.

QUIZ
Based on ‘Rate Your Risks’, Mainline Amsterdam (see References)

WHAT DO YOU KNOW ABOUT INFECTIOUS DISEASES?’ *6

Can you get AIDS from eating from somebody else’s plate? Is it dangerous if you prick yourself with a used syringe? What has the hepatitis C virus
to do with AIDS? In short, what do you know about health risks? Test your knowledge with this quiz.

1.    Water and soap kill the hepatitis B virus when cleaning a syringe?
A. Correct
B. Incorrect

2.    More than half of all injecting drug users are infected with the hepatitis C virus?
A. Correct
B. Incorrect

3.    Accidentally pricking yourself on a used needle is not dangerous?

A. Correct
B. Incorrect

4.    HIV is more infectious than the hepatitis B virus.
A. Correct
B. Incorrect

5.    By using the knife and fork of an AIDS patient, you can catch HIV yourself?
A. Correct
B. Incorrect

6.    Breathing-in someone else’s cough is enough to get infected with tuberculosis?
A. Correct
B. Incorrect

7.    Only someone with active hepatitis B can infect others with the hepatitis B virus?
A. Correct
B. Incorrect

8.    After having been bitten by someone else, you could be infected with the hepatitis B virus?
A. Correct
B. Incorrect

9.    Most drug users with HIV are also infected with the hepatitis C virus?
A. Correct
B. Incorrect

10. The risks of catching an infectious disease are greater for people who work in prisons?
A. Correct
B. Incorrect

QUIZ RESULTS

Add up the figures behind the answers you gave.
1.     A-0    B-1
2.     A-1    B-0
3.     A-0    B-1
4.     A-0    B-1
5.     A-0    B-1
6.     A-1    B-0
7.     A-0    B-1
8.     A-1    B-0
9.     A-1    B-0
10.     A-1    B-0
0-5 Points
Your knowledge of health risks is inadequate. This is a dangerous situation. Your lack of awareness could result in your becoming infected by a dangerous, even life-threatening virus.
6-8 Points
Your knowledge of health risks is pretty good but not quite good enough.
9-10 Points
You are well informed about health risks. If you combine your know-how with safe behaviour, the risk of infection due to personal wrongdoing or negligence on your part is very small.

The correct answers to ‘Rate your risks’ quiz:
1.    Water and soap kill the hepatitis B virus?
B -    Incorrect. Water and soap will not kill the hepatitis B virus.
2.    More than half of all injecting drug users are infected with the hepatitis C virus?
A -    Correct. 70% to 80% of all injecting drug users are infected with the hepatitis C virus.
3.    Accidentally pricking yourself on a used needle is not dangerous?
B -    Incorrect. The AIDS virus does not survive outside of the human body, except in a used syringe and in blood residue. In a syringe, the AIDS virus stays alive for periods longer than three weeks. hepatitis can also be spread through a contaminated needle. Accidentally pricking your self on an old needle is most definitely dangerous.
4.    HIV is more infectious than the hepatitis B virus?
B -    Incorrect. The hepatitis B virus is a hundred times more contagious than HIV.
5.    By using the knife and fork of an AIDS-patient, you can catch HIV your self?
B -    Incorrect. Although the HIV virus has been found in the saliva of HIV positive individuals, the concentration is too low to infect another person. In addition, the virus does not stay alive outside of the human body, or on glasses, cups, plates and cutlery.
You can therefore use the knife and fork of an AIDS patient without any er to yourself whatsoever.
6.    Breathing in someone else’s cough is enough to get infected with tuberculosis?
A - Correct. TB is spread through cough droplets. Turn away your face when someone coughs or sneezes in your direction.
7.    Only someone with active hepatitis B can infect others with the hepatitis B virus?
B -    Incorrect. Not only people with acute hepatitis B but also people with chronic hepatitis B can spread the virus.
8.    After having been bitten by someone else, you could be infected with the hepatitis B virus?
A -    Correct. The hepatitis B virus is found in blood and saliva. Therefore being bitten is dangerous.
9.    Most drug users with HIV are also infected with the hepatitis C virus?
A -    Correct. Most drug users are infected with the hepatitis C virus.
10.    The risk of catching an infectious disease is greater for people who work in prisons?
A -    Correct. The average number of people infected with a viral disease is larger in prison than on the outside. This is why prison staff members are considered a high-risk group.