Sex behind the prison walls

In a randomly selected sample of 789 inmates, 15% of females and 5% of males reported consensual sex, while 2% overall reported non-consensual sex, within New South Wales (NSW) prisons in the past year. Awareness of sexual assaults on others was much higher, indicating a need for policies to protect prisoners. Although sex is widely believed to occur within prisons, there is a dearth of research and the issue remains taboo for many prison authorities.1,2 As part of a wide-ranging survey of the health needs of prison inmates in NSW, Australia,3-6 we asked 789 randomly selected prisoners a number of questions about sexual activity while in prison: 20 (15%) of females and 34 (5%) males reported that they had engaged in consensual sex, while two (2%) and 15 (2%) respectively reported being subjected to non-consensual sex in prison. Of the 42 males involved in either type of activity, seven had engaged in both consensual and non-consensual sex. Both of the females who had engaged in non-consensual sex also reported involvement in consensual sex. We cannot exclude the possibilities that the higher proportion of females reporting consensual sex stemmed from less reluctance to report it or from females defining ‘sex’ more broadly than males. Even the concept of consensual is not straightforward: an inmate who agrees to partner a stronger prisoner solely for protection purposes may report this as consensual sex. A higher proportion of male prisoners who were survivors of childhood sexual abuse (CSA) reported involvement in consensual activity in prison compared with those with no history of CSA (13% vs. 4%, OR=3.7, 95% CI=1.8-7.6, p=0.001); and for females (25% vs. 6%; OR=5.3, 95% CI=1.7-17.0, p=0.002). A similar pattern was observed for males in regard to non-consensual sex with CSA survivors more likely to report this activity in prison with those with no history of CSA (8% vs. 1%; OR=6.6, 95% CI=2.3-18.6, p=0.001). Too few females reported non-consensual sex to determine any associations. Indirect questioning was also used: 23 (17%) females and 195 (30%) males were aware of sexual assaults on other inmates in the previous 12 months. When asked, 49% of the male prisoners overall were opposed to the introduction of condoms into prisons. The most common reason (23%) for this opposition was the fear that it would lead to an increase in sexual assaults. Nevertheless, condoms were introduced into the NSW prison system after the survey was completed as a result of a NSW Supreme Court ruling in 1995. During 1999, approximately 30,000 condoms per month were distributed among the 7,250 male prisoners in NSW. If this is an index of sexual activity among male prisoners then the levels determined in this study are probably conservative. However, anecdotal evidence suggests that some condoms and gel are used for other purposes by prisoners. The impact of sexual assaults in prison can be particularly devastating with the victim having few options other than trying to escape the situation through self-harm, suicide or protective segregation; submitting to the assault; or fighting back (possibly resulting in serious physical injury or homicide). 7,8 A higher proportion of prisoners in this study who had been subject to non-consensual sex reported self-harm (47% vs. 15%; OR=5.1, 95% CI=1.9-13.6, p=0.001). The dynamics and consequences of sex in prison are undoubtedly complex and require further research. The aim should be to develop policies and procedures that reduce harm and provide a more humane custodial system.