By Greg Tartaglione, SIECUS Program Research Intern
Arleen A. Liebowitz, Nina Harawa, Mary Sylla, Christopher C. Hallstrom, Peter R. Kerndt, “Condom Distribution in Jail to Prevent HIV Infection,” AIDS and Behavior (May 2012).
Researchers analyzed data from a 2007 survey of a custody unit for self-identified gay and transgender inmates at the Los Angeles County Men’s Central Jail where inmates received one condom per week from a not-for-profit organization. The purpose of the analysis was to estimate rates of new HIV infections when condoms were available, versus when they were not.
The analysis included previous research on condom availability to interpret additional variables: for example, whether male inmates who reported having sexual contact with men (referred to in the article as “MSM”) were more likely to engage in anal sex after the start of a condom availability program; and whether inmates would even be willing to use condoms. Results were subject to ‘sensitivity analyses’– techniques that account for the lack of conclusive evidence surrounding these and other variables.
The study aimed to evaluate the long-term cost benefits for corrections facilities if they were to implement true HIV prevention programs, versus the potential medical expense of treating inmates diagnosed with HIV. The study took into account the cost to the jail for providing condoms and program staff, as well as the impact on medical costs and HIV transmission rates if existing limitations on condom availability were reduced or eliminated.
- The researchers estimated that greater condom availability could avert 1 out of 4 HIV infections.
- Over the long term, an expanded condom availability program could save the jail nearly $75,000 in projected HIV-related medical care expenses alone over more than 30 years, not including expenses saved from reduced need to treat other sexually transmitted infections.
- Increased condom availability would still be cost-saving for the jail even if costs to administer the program were ten times higher than observed.
As of 2008 (the time that the original data-gathering was concluded) there were 1.4 million men in U.S. ‘corrections facilities’ (jails and prisons) – a 400% increase over the number incarcerated in 1980. This rapid inmate population increase is just one reason why there is a critical need for research to investigate ways to inhibit high-risk behaviors which lead to the transmission of HIV and other STIs in these settings. A small number of U.S. corrections facilities have made condoms available to inmates, but there is little data on their impact. This study is unique in its analysis of the effectiveness and costs of such programs.
In most corrections facilities in the U.S., sexual contact among inmates is classified as a felony – inmates are the responsibility of the state and so are not legally allowed to give consent. For this reason, condoms are most often considered contraband in jails - proof of intent to engage in illegal activity. Some opponents of condom availability in jails and prisons believe that condoms would also enable inmates intent to smuggle drugs or other contraband.
However, consensual and nonconsensual sexual contact is a fact of inmate life. Inmate populations often account for higher than average rates of HIV and STI transmission, partly due to the lack of available protection from STI transmission.
Corrections facilities are responsible for the medical health of detainees and are obligated to act within their power to prevent outbreaks of disease. Treating HIV and AIDS is costly in contrast with inexpensive primary prevention methods such as condom availability. Because of high recidivism rates in jails, primary prevention can also reduce HIV and other STI transmission when inmates are released back into communities. This study suggests that because a lifetime of HIV treatment and medical care is so expensive, “even small reductions in HIV transmission result in cost savings to society.”
Since condom availability programs only become more effective when a higher percentage of sexual acts are protected, the researchers suggest that Los Angeles County replace limited weekly condom availability with unlimited availability to reduce HIV transmission as much as possible.
Since federal, state, and local corrections departments typically forbid their staff from politically advocating for harm-reduction policies and programs that acknowledge sexual activity among inmates (and staff), it is essential that sexuality educators join with advocates for prison and jail reform to make the case for condom availability in U.S. corrections facilities. Inmates should have 1) rights to be informed of their health risks and 2) access to disease prevention resources, including comprehensive sexuality education to decrease stigma and risk-taking behaviors surrounding inmate sexual contact.
Educators and advocates can cite this study to argue for better public funding of HIV/STI prevention initiatives, especially in jails and prisons, as such programs can reduce treatment costs both within and beyond high-density infected corrections populations.
 Barclays Official California Code of Regulations Title 15. Division 3007: Sexual Behavior. Thompson Reuters. Accessed June 30, 2014 at https://govt.westlaw.com/calregs/Document/I5F0FBA40FAE311DEAB9F840E8C11CEE5?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)&bhcp=1.
 Liebowitz AA, Harawa N, Sylla M, Hallstrom CC, Kerndt PR (2012). Condom distribution in jail to prevent HIV infection. AIDS and Behavior: 17(8): 2695-2702. Accessed July 7, 2014 at http://link.springer.com/article/10.1007%2Fs10461-012-0190-5.