Condom debate targets prisons - Strategy to fight HIV faces uphill challenge

Condom debate targets prisons - Strategy to fight HIV faces uphill challenge
By Jeremy Manier
Copyright © 2007, Chicago Tribune
Published March 18, 2007

Prisons have a rate of HIV infection nearly five times greater than the rate nationwide, yet they are among the few places in America where condoms are almost impossible to get.

Those unsettling facts have spurred a growing campaign by lawmakers and public health advocates who are concerned that prisons may be a prime breeding ground for HIV and other sexually transmitted diseases.

The most recent effort to put condoms in Illinois prisons suffered a setback Thursday when a state House committee voted 6-5 against a bill that would authorize distribution of condoms to state inmates.

But officials with the AIDS Foundation of Chicago, which argued for the measure, said they hope to find a compromise with the Illinois Department of Corrections, one of the bill's main opponents. A U.S. House bill that would allow condoms in federal prisons was introduced in January, though so far Rep. Bobby Rush (D-Ill.) is one of only two co-sponsors.

Such efforts face daunting hurdles. Sexual contact is banned in most prison systems, and officials believe allowing condoms could undermine the rules and even lead to rape of inmates.

Yet supporters of condom laws say the reality is that homosexual behavior in prison is common, and inmates with no means of protection could contract diseases and infect others both in prison and afterward. Most public health experts consider condoms an essential part of HIV prevention efforts.

The objections to condom distribution seem detached from real life to Keith DeBlasio, who said he contracted HIV after being raped by another inmate at a federal penitentiary in Michigan, where DeBlasio was serving time for embezzlement and fraud. DeBlasio said his attacker probably wouldn't have agreed to use a condom, but making condoms available could prevent other prisoners from getting the disease.

"I was sentenced to 5 years, and I got a death sentence," he said.

Illinois state prisons have 511 inmates known to have HIV or AIDS among a population of 45,000, and studies in other states suggest many such prisoners are sexually active. A federal study last year in Georgia found that at least 88 inmates had contracted HIV while in state custody. Two-thirds of the infected men reported having homosexual contact with other inmates or prison staffers.

Only Vermont and several big cities allow condoms for at-risk inmates. A bill to permit condoms in California prisons passed that state's legislature but was vetoed in October by Gov. Arnold Schwarzenegger.

Though specific policies vary, most prisons that permit condoms either sell them in the commissary or let an outside group distribute them. The focus is on male prisoners because sexual transmission of HIV among women is not considered a major risk.

Some criticisms of the proposals to let prisoners use condoms recall the debate from the 1980s over promotion of condoms as a "safe sex" tool. Many religious groups argued then that condoms would encourage immoral or dangerous sexual behavior, though public health forces effectively won that debate.

Rev. Harold Bailey, former chairman of the Cook County Board of Corrections, said he believes the moral implications of condom use among homosexuals remain paramount.

"Anytime anyone puts two men together, which is against the law of God, then gives them permission to do it with a condom, that's despicable," said Bailey, who served as the county's jail chief until 2004.

"Having that sexual involvement, even with a condom, is not righteous," Bailey said. "If they're going to [have sex], they're going to do it on their own, and not with my permission. ... I'm not going to hell for nobody."

For the pro-condom side, the moral choice is to prevent disease. The issue has become a crusade for Rev. Doris Green, director of community affairs for the AIDS Foundation of Chicago.

Green, who argued for the condom bill in Springfield, said she's especially concerned about the risk to the African-American community, which accounts for about half of new HIV/AIDS cases nationally. She said she often worries about the 15 couples for whom she has performed weddings while the husband was behind bars. Any man infected in prison could bring the disease to his family.

"Those women need to be protected," Green said. "It's about more than just the prisoners."

Lobbyists for the union that represents the state's correctional officers said they oppose any condom proposal. Henry Bayer, executive director of the American Federation of State, County and Municipal Employees Council 31, said allowing condoms would hurt prison discipline.

"We don't want anybody to get STDs, but our members' job is to enforce the rules, and the rules say inmates should not have sex," Bayer said.

Michael Blucker, a former Illinois prisoner who said he contracted HIV after being raped at Menard Correctional Center, opposes condoms for inmates in part because "being gay isn't what God intended for us."

"Handing out condoms is like saying, `Go ahead, rape somebody," said Blucker, who in 1995 unsuccessfully sued the state over the assault.

Yet studies of prisons and jails where condoms are allowed suggest that most guards and inmates support those programs.

In the Washington, D.C., city jail, where officials distribute about 200 condoms each month, a 2002 survey found that 64 percent of correctional officers and 55 percent of inmates thought the effort was a good idea. The study, published in the journal AIDS Education and Prevention, found that only 13 percent of guards said condom distribution had caused problems in the jail.

"No major security infractions involving condoms have been reported in the jail since the inception of the program," the study's authors wrote. "There is no evidence that sexual activity has increased."

In Los Angeles, where the county jail started condom distribution in 2001, sheriff's department spokesman Steve Whitmore said the policy has caused "no significant problems."

Whitmore said L.A.'s program has gone forward even though sexual contact by inmates remains illegal. "It's against the law, but we're also cognizant of the realities. AIDS kills people," he said.

An outside group distributes the condoms, and jail officials do not know which prisoners get them, Whitmore said.

Some condom programs may have succeeded because they are narrow in scope. In L.A., condoms are distributed only to self-identified gay inmates, who live in separate housing from the broader jail population.

In reality, much of the high-risk homosexual contact in prison involves men who don't consider themselves gay outside prison, former prisoners and researchers said. About 1 percent of prisoners report having been raped.

According to an in-depth study the CDC published last year on HIV transmission in Georgia prisons, most sex among prisoners was either consensual or what the authors called "exchange sex." Those inmates said they use sex as a bartering tool to get cigarettes, drugs, food or protection from other inmates.

One striking finding of the Georgia study was that a third of HIV-infected prisoners said they had sex with male prison staffers, and one-fifth had sex with female staffers.

The CDC report called condoms an integral part of HIV prevention efforts outside prisons and suggested that states weigh the risks and benefits of allowing condoms.

Part of the urgency that Green feels stems from figures showing that African-Americans account for a growing proportion of HIV cases in the general population. Two-thirds of the inmates who contracted HIV in Georgia prisons are black, the CDC study said.

"It is a public health crisis," Green said. "And it is infecting the community we claim we want to save."

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jmanier@tribune.com