To activists concerned about AIDS and prisoners' rights, it's an urgent, commonsense step that should already be nationwide policy — letting inmates have condoms to reduce the spread of sexually transmitted diseases behind bars.
Yet their efforts have run headlong into a stronger political force: Authorities' desire not to encourage inmates who flout prison rules against sex. Only one state, Vermont, and five cities regularly hand out condoms to inmates. Mississippi does so only for inmates receiving conjugal visits from their spouses.
Left out are the vast majority of America's 2.2 million prisoners — many held in facilities where sex between men is common and the risk of STDs is far higher than in the general population.
"I realize this is not a comfortable topic for many people, but it's one we simply cannot afford to ignore," said Rep. Barbara Lee, D-Calif. "When more than 90 percent of incarcerated people return to our communities, taking a head-in-the-sand approach to the fact that our prisons have become a breeding ground for HIV/AIDS poses a serious public health risk."
Despite such warnings, recent efforts to expand behind-bars condom access have gone almost nowhere. Prison officials contend that condoms can be used to conceal drugs, and law-and-order politicians scoff at what they depict as a step that would encourage both consensual and coercive sex.
"Removing the freedoms of criminals is in itself a deterrent," said California Assemblyman Paul Cook. "Allowing condoms into prisons simply sends the wrong message and confirms what we all suspect: Our prison system has serious and severe behavioral and inmate-control issues."
A measure introduced by Lee in Congress this year to allow condom access in federal prisons has made little headway. A bill in Illinois failed to clear a legislative committee in March. And a bill in California was vetoed last month by Gov. Arnold Schwarzenegger, who said the proposal conflicted with prison regulations banning sexual activity.
Yet Ron Snyder, an HIV-positive Californian who served 19 months in the state's prison systems for embezzlement, said sex was widespread despite the rules. Some inmates used rubber gloves as makeshift condoms, and some supervisors allowed romantically involved men to share cells, he said.
Schwarzenegger, in his veto message, offered a ray of hope to advocates of condom access. He described it as "not an unreasonable public policy" and instructed corrections officials to assess the feasibility of a pilot program at a yet-to-be-selected state prison.
Snyder predicted a "tough struggle" to extend any such program systemwide because of staff attitudes. Many of the correctional officers are from rural areas, "and they assume men don't have sex with men," he said. "They just don't understand the picture."
California already is home to two of the local condom programs, at jails in Los Angeles and San Francisco. New York, Philadelphia and Washington, D.C., also have programs — New York's dates back to 1987.
In Los Angeles, the condoms are distributed by an activist group, the Center for Health Justice, only in a special unit reserved for gay men who ask to be assigned there. San Francisco, for nearly 20 years, has allowed prisoners to be issued condoms by the health staff; distribution was expanded in April in the form of a condom-dispensing machine placed in a jail recreation hall.
Mary Sylla, the Center for Health Justice's policy director, said there have been no security problems in either city.
"If there was a case of somebody doing something horrible with a condom, we would have heard about it — it would be all over the corrections community," she said. "But it doesn't happen."
Though disappointed by Schwarzenegger's veto, Sylla is hopeful that a pilot program will indeed get started in the state prison system. She said corrections officials already had visited the Los Angeles unit to see that local program in action.
But Sylla acknowledged that the cause is tough to promote.
"It's easy to make fun of," she said. "People don't like to think about prisoners having sex, even though everybody knows it goes on."
Vermont's Corrections Department, although it holds relatively few HIV-positive inmates, has been making condoms available in prisons since 1992 — even though sexual activity remains officially prohibited.
"It's a courageous position that Vermont took then and continues to have now," said the department's health services director, Dr. Dolores Burroughs-Biron.
Under the program, inmates are granted a single condom at a time if they request one from a nurse. Burroughs-Biron said there had been no reports of any security problems.
But corrections officials insist there are dangers. Glenn Goord, New York State's former corrections commissioner, told the Legislature that inmates use condoms to transport drugs within prison grounds. He also said condoms might embolden prison rapists, who could use them to avoid leaving DNA evidence after their assaults.
There is no authoritative U.S. data on the extent of HIV behind bars, but the federal Centers for Disease Control did conduct a detailed study in Georgia which found that 856 male inmates — about 2 percent of the state's total — were HIV-positive, and that 76 of them apparently got the virus while in prison.
The CDC report, published last year, suggested that lawmakers consider the condom policy.
Patrick Sullivan, the CDC epidemiologist who led the study, said sex among inmates was common in Georgia despite being prohibited. He said many of the sexually active inmates used condoms — or some improvised substitute — even though they were considered contraband.
In several foreign countries — including Canada, Australia and much of Western Europe — condoms have been freely distributed to prisoners for years without security problems.
Though activists are convinced condom access would reduce STD transmission, they are cautious in making specific health claims.
"I don't know how we'd ever be able to prove how much they reduce HIV," said Ron Snyder, who now works for the Center for Health Justice. "But if we could affect one or two people who wouldn't bring it back to their women when they get home, that's dramatic impact right there."