Sexual redemption in times of STD: Should condoms be allowed in prisons?
The biggest challenge to this serious issue of the public health of the most marginalized section of the society is the criminalization of homosexuality.
Alfred Kurai (name changed) is a convict for 6 years in a Zimbabwean prison serving his time on fraud charges. He has a wife and 2 children aged 6 and 8 and hopes to reunite with them soon after his release. But, he is part of the prison community’s men who have sex with other men but do not necessarily identify as gay.
"First, it was because I wanted food. Here and there I would trade sex for food with some male inmates. Knowing I would be behind bars for a couple of years taught me to do what I had to do to survive," Kurai said to The Herald, avoiding eye contact. "Even after the food situation improved I would seek sexual favors here and there, not because I am gay, but because a person has needs, and with a decade to serve, you need that companionship."
Over a 30 million men and women live in prisons all over the world every year. Among them, one third are pre-trial detainees who will return to their families within a few months or a year. However, HIV-AIDS is a major health challenge for prison authorities. According to a UN report (2013), globally, the risk of HIV and other sexually transmitted infections, hepatitis B and C and tuberculosis in prison populations is 2 to 10 times as high, and in some cases may be up to 50 times as high as in the general population.
However, prevention measures are lacking in most of the developed as well as the developing countries. In Zimbabwe, legislators and civil right advocates are currently debating whether to allow access to condoms in prisons to prevent the spread of HIV/AIDS and other sexually transmitted diseases. The debate comes after Lesotho, which has one of the highest HIV prevalence rates in the world, overlooked its criminalization laws on homosexuality to allow condoms in prisons in late 2017. The highest HIV prevalence rates worldwide is led by the East and South African countries with an estimated population of over 19.4 million infected people as reported by avert.org.
The biggest challenge to this serious issue of the public health of the most marginalized section of the society is the criminalization of homosexuality. Islamic countries like Iran, Saudi Arabia, and Pakistan have death penalties on same-sex unions. In most of the developing countries including India and a series of East African countries, homosexuality is a criminal offence amounting from 7 years to life imprisonment. Homosexuality is decriminalized only in western Europe, North America, and a few Asia-Pacific countries. But, only a handful have experimented with Sexually Transmitted Disease (STD) prevention measure inside the prisons. Kurai, who supports the proposed condom policy, says he has seen many fellows die in prison due to AIDS-related illnesses.
India, which has the third largest HIV infected population, has a total population of 2.1 million people living with HIV. In 2016 alone, 62,000 people died due to AIDS-related infection. In 2015, a study was conducted by the National AIDS Control Society (NACO) of men who have sex with men. Conducted across 12 Indian cities, the study found that 7% of the population tested positive for HIV. The legal status of same-sex conduct in India has fluctuated in recent years. In December 2013, India's Supreme Court re-criminalized adult consensual same-sex sexual conduct, after the Delhi High Court had decriminalized it in 2009. This raised fears about access to HIV prevention and treatment for men who have sex with men. However, in February 2016, India’s Supreme Court announced a review of the 2013 decision.
Recently, the NACO launched a prison intervention program which found that the infected population among the prison inmates is much higher than the general population and this is because of unsafe sex as well as drug abuse. According to a UPI report, in 1995 itself, a medical committee appointed by the Indian Council of Medical Research suggested that condoms be made part of prison’s health facilities. However, until as late as 2018, there was no action regarding this.
Among the developed nations, United States has a very high rate of STD-related epidemics. On October 14, 2007, Governor Arnold Schwarzenegger directed the California Department of Corrections and Rehabilitation (CDCR) to determine the ‘risk and viability’ of allowing non-profit or health care agencies to distribute sexual barrier protection devices like condoms to inmates in one state prison facility. His argument was that even though sexual activity in prisons is against the law, providing condoms to inmates is “consistent with the need to improve our prison health care system and overall health.” The pilot project opines that the World Health Organisation (WHO) and the United Nations Programs on HIV/AIDS recommend that prisoners have access to condoms during their time in prison. Studies have found no security problems or serious incidents involving a condom, no increase in sexual activity, and that when condoms are available inmates use them during sex.
In a study published (2002) by the AIDS Education and Prevention journal, researchers J. May and E. Williams found that 55 percent of inmates and 64 percent of correctional officers supported the availability of condoms at the Central Detention Facility in Washington DC. The objections, however, were mostly due to moral and religious concerns about homosexual activity. A 1-year pilot study (2014) of wall-mounted condom dispensing machines in one California state prison compared pre- and post-intervention rates of penal code violations related to sexual misconduct, contraband, controlled substances, and violence. The rates of penal code violations were unchanged or decreased compared to the pre-pilot year. Discreetly located condom dispensers were vandalized less frequently than those in plain view. The study suggested that distributing condoms using the pilot model would cost less than $2 per inmate annually. Condoms are available in two prisons and five county jail systems including the Los Angeles and San Francisco County jails in the United States and many prison systems worldwide.