HIV/AIDS and HCV in Prisons
A Select Annotated Bibliography
Education
Education has long been a key component of HIV (and more recently, HCV) prevention programming in prison settings. It is the most widely employed method of prevention due, in large part, to the fact that it is regarded as the least controversial approach among prison officials.
Antonius C (1994). HIV/AIDS and STD prevention in Surinamese prisons. AIDS Health Promotion Exchange, (4): 3-5.
The Suriname National AIDS Program (NAP) developed an education and support program involving activities for prisoners, staff, and non-prison personnel and organizations. Male prisoners and prison warders were selected for training as peer educators. Male prisoners formalized their status by forming the Boma AIDS Education Collective (BAEC). Female prisoners were not included in the training because most of them served short sentences and were instead involved in educational sessions which focused on sexual and mother-child transmission of STDs. BAEC produced AIDS education leaflets in three languages (Dutch, English, and Sranan Tongo) for new and discharged prisoners at the prison and also for all prisoners in Suriname. The leaflets were then pre-tested and modified based on comments from 17 prisoners. The Program was officially introduced in April 1992 when BAEC organized an AIDS/STD week. The week's activities included AIDS educational sessions, video shows, discussions, and HIV testing. A permanent HIV counseling system, which specifies that among other things HIV testing must be done on a voluntary basis, was implemented at Santo Boma prison for both male and female prisoners. A manual was produced for peer educators, and AIDS/STD education has since been included in the prison warder training curriculum. A number of collaborative activities with non-prison organizations were organized to demonstrate that prisoners are part of a wider community concerned about HIV/AIDS. However, some prisoners are against condom distribution in the prisons, because they feel that it would encourage homosexual contacts. Prison authorities have not yet approved official condom distribution.
Baster S (1994). AIDS education in the jail setting. Crime and Delinquency, 37: 48-63.
Boudin K et al. (1999). ACE: a peer education and counseling program meets the needs of incarcerated women with HIV/AIDS issues. Journal of the Association of Nurses in AIDS Care, 10(6): 90.
In this article, female prisoners who are peer educators and counsellors in an HIV/AIDS program at Bedford Hills Correctional Facility, New York State's only maximum security prison for women, describe the positive role of a peer support program. Using examples from their own experiences, the women discuss the strengths of the AIDS Counselling and Education Program (ACE) in meeting the medical and psychosocial needs of the prison population concerning HIV/AIDS.
Comfort M et al. (2000). Reducing HIV risk among women visiting their incarcerated male partners. Criminal Justice and Behavior, 21: 57-71.
Describes the development, implementation, and preliminary evaluation of a pilot project aimed at reducing HIV risk among women visiting their incarcerated male partners. 30 women visiting their incarcerated partners at a large state prison in California participated in focus groups that led to the development of a peer-led HIV education intervention. 86 women completed baseline surveys, 81 completed post intervention surveys, and 67 were followed 1 month after the intervention. Although women visiting their incarcerated partners are generally well-informed about HIV transmission and prevention, interventions addressing their specific emotional and informational needs are necessary to motivate and to assist them in reducing their risk of HIV infection, the authors note.
Connolly L (1989). Evaluation of the AIDS Education Programme for Prisoners in the NSW Department of Corrective Services: March, 1987 to March 1989. Sydney: NSW Department of Corrective Services (Research Publication No. 20).
Available via http://www.dcs.nsw.gov.au/information/research_and_statistics/research_publication/rp020.pdf.
Highlights that it is very difficult for AIDS educators to deliver clear and credible messages to prisoners while AIDS policy in prisons denies access to HIV prevention measures.
Connolly L, Potter F (1990). AIDS education in NSW prisons. Australian and New Zealand Journal of Criminology, 23: 158-164.
Correctional Service Canada. Peer Eduction Manual. Ottawa: CSC.
Dolan K, Rouen D (2003). Evaluation of an educational comic on harm reduction for prison inmates in New South Wales.  International Journal of Forensic Psychology, 1(1): 138-141.
Available via http://ijfp.psyc.uow.edu.au/index2.html.
The aim of this study was to educate inmates about harm reduction measures as a first step towards the reduction of HCV transmission in prison. An educational comic was developed and covered a range of relevant topics. A survey was included in the comic to assess inmates' knowledge. There was a very high level of knowledge among inmates who took part in the survey, but the response rate was very low. It appears that comics are a useful medium for the education of inmates about harm reduction measures, but education alone is insufficient. The study concluded that inmates need to be provided with the means for prevention.
Dolan K, Bijl M, White B (2004). HIV education in a Siberian prison colony for drug dependent males. International Journal of Equity in Health, 3: 7.
The study aimed to evaluate the effectiveness of an HIV peer training program conducted in a colony for drug dependent male prisoners in Siberia, Russia. Questionnaires were used to collect data pre and post peer training sessions. Three peer training sessions were conducted between questionnaires. Fifteen to twenty inmates were trained as peer educators at each week-long health education training session. In 2000 and 2001, 153 and 124 inmates completed a questionnaire respectively. Respondents in both years reported similar health and injecting histories and comparable levels of sexual activity. Respondents in 2001 were significantly more likely to correctly identify both how HIV can and cannot be transmitted compared to respondents in 2000. The prevalence of tattooing in prison decreased significantly between questionnaires. However, there was virtually no reported use of bleach to clean tattooing or injecting equipment in either 2000 or 2001. Access to condoms increased significantly between questionnaires. The study concluded that while this training program was associated with improved HIV knowledge, the Ministry of Justice should consider improved and additional harm reduction strategies. These include increased availability of bleach and condoms and the introduction of methadone treatment and syringe exchange in prison.
Ehrmann T (2002). Community-based organizations and HIV prevention for incarcerated populations: Three HIV prevention programs. AIDS Education and Prevention, 14(5 Suppl: HIV/AIDS in Correctional Settings): 75-84.
This article focuses on successful intervention practices such as peer-led education and discharge planning services that have been essential components of HIV prevention and provides a context for operating such programs within correctional facilities. It highlights the challenges community-based organizations encounter in providing HIV prevention in correctional institutions throughout the United States.
Grinstead O, Faigeles B, Zack B (1997). The effectiveness of peer HIV education for male inmates entering state prison. Journal of Health Education, 28: S31-S37.
Grinstead OA, Zack B, Faigeles B (1999). Collaborative research to prevent HIV among male prison inmates and their female partners. Health Education & Behaviour, 26(2): 225-238.
The authors have developed and evaluated a series of HIV prevention interventions for prisoners and for women who visit prisoners. They say that results of these studies support the feasibility and effectiveness of HIV prevention programs for prisoners and their partners both in prison and in the community.
Hogan N (1994). HIV education for inmates: uncovering strategies for program selection. The Prison Journal, 74: 220-243.
Keeton, Kato B, Swanson C (1998). HIV/AIDS education needs assessment: a comparative study of jail and prison inmates in Northwest Florida. Prison Journal, 78: 119-133.
Martin R, Zimmerman S, Long B (1993). AIDS education in U.S. prisons: a survey of inmate programs. Prison Journal, 3: 103-129.
Martin R et al. (1995). A content assessment and comparative analysis of prison-based AIDS education programs for inmates. Prison Journal, 75: 5-48.
Polonsky S et al. (1994). HIV prevention in prisons and jails: obstacles and opportunities. Public Health Rep, 109: 615-625.
States that education and risk-reduction counseling are the least controversial and most widely employed modes of prevention in prison, but that the effectiveness of current prevention efforts in reducing HIV transmission in this high-risk population is largely undetermined.
Rotily et al. (2001). Knowledge and attitudes of prison staff towards HIV/AIDS: a European study. Santé Publique, 13(4): 325-338. (French)
The goal of this European pilot study was to evaluate the knowledge, attitudes and beliefs of prison staff from five countries towards HIV infection and to identify factors related to the potential discrimination of HIV-positive inmates. The survey revealed that the levels of knowledge with regard to HIV transmission and the degrees of tolerance varied significantly between prisons. A large proportion of staff overestimated the prevalence of HIV in their prison and feared being infected. The study emphasized the necessity to improve HIV prevention policy for prison staff in order to strengthen good practice in terms of managing the risk of contamination and hindering discrimination.
Simooya O, Sanjobo N (2001). 'In But Free' - an HIV/AIDS intervention in an African prison. Culture, Health & Sexuality, 3(2): 241-251.
Reports about a project called 'In But Free' led by prisoners trained as peer educators implemented at Kamfinsa Prison in Zambia. Activities include face-to-face information giving, provision of HIV/AIDS educational materials, voluntary HIV counseling and testing and the promotion of better standards of hygiene. The project has been well received by prisoners and staff. Reports from them indicate a reduction in tattooing and injection drug use, but male-to-male sex and sharing of razor blades continues. The authors conclude that the risk of HIV transmission continues to be high and that "condom distribution in prisons must now be considered as well as steps to improve the poor living conditions in most Zambian prisons."
Swarr D (no date). AIDS, prison, and preventive medicine: society's debt to its debtors. Unpublished paper available at http://ww2.lafayette.edu/~vast/swarr.html
States that the "massive failure of current HIV/AIDS education and prevention programs are due to a variety of causes, which can be grouped into three major categories: failure to provide prisoners with the necessary resources to protect and/or help themselves; failure to provide appropriate and/or racially, culturally, and gender-specific education to prisoners; and finally, failure to provide prisoners with opportunities to learn and practice implementing skills that they may actively use to protect themselves from HIV, both inside and outside the prison."
Taylor S (1994). NSW Prison HIV Peer Education Program. Sydney: NWS Department of Corrective Services (Research Publication No. 30).
Available via http://www.dcs.nsw.gov.au/information/research_and_statistics/research_publication/rp020.pdf.
The Prison HIV Peer Education Program (PPEP) was established in 1991 and this evaluation was instigated in order to assess the effectiveness of the program in meeting its objectives. It found that the PPEP is "an effective tool in educating inmates on HIV and AIDS as it increased their knowledge and understanding of HIV"; attracts a relatively large number of prisoners who had not undertaken any educational courses while in the correctional centre and that this was mainly attributable to the program being well respected by prisoners; significantly contributes to change in attitudes and a reduction in prejudice that prisoners may have towards HIV and people affected by it.
Toepell AR (1993). AIDS knowledge among prisoners. Forum on Corrections Research, 5(1): 31-33.
Vaz RG, Gloyd S, Trindade R (1996). The effects of peer education on STD and AIDS knowledge among prisoners in Mozambique. Int J STD AIDS, 7: 51-4.
The study was designed to evaluate the impact of education on AIDS knowledge among prisoners in Maputo, Mozambique. A 6-month follow-up study was carried out in 1993 among 300 prisoners. A knowledge, attitudes, and practices questionnaire regarding AIDS and STD was administered to each subject as part of the intake medical examination and after an educational intervention provided by 30 prisoner 'activists'. A large proportion of prisoners had high risk behaviours (65% had 2 or more sexual partners per month and 39% had a history of STD) and low AIDS knowledge at incarceration. Statistically significant increases in knowledge occurred after the intervention. Prisoners with less formal education had a poorer performance on the initial questionnaire (43% vs 69% P < 0.00001) and had a greater improvement after the intervention (41% vs 24%, P < 0.00001). The results demonstrate that educational interventions involving peer health educators contribute positively to the acquisition of knowledge among prisoners.
Wexler H et al. (1994). ARIVE: an AIDS education/relapse prevention model for high-risk parolees. International Journal of Addiction, 29(3): 361-386.
An AIDS prevention training programme for parolees recently released from prison with histories of drug injection was developed and evaluated. One year follow-up results showed that ARIVE participation significantly decreased certain sexual and drug-related risk behaviours
and improved parolees' community adjustment.
Wykes R (1997). The failure of peer support groups in women's prison in Western Australia. Unpublished paper available at http://www.drugtext.org/library/articles/wykes.htm
The paper describes the reasons why, in the author's view, peer support has failed in the prison environment, and puts forward "the only alternative solution that will work to reduce the transmission of blood-borne viruses in the prison setting."
 Condoms, Lubricants, and Combatting Sexual Violence
Recognizing the fact that sexual activity occurs in penal institutions and given the risk of disease transmission that it carries, many prison systems - in Europe, Canada, and Australia, but also in parts of the former Soviet Union and in countries like Brazil, South Africa, Iran and Indonesia, make condoms, together with lubricants, available to prisoners. This section contains documents that discuss the issues related to making condoms and lubricants available in prison, as well the documents that deal with the equally important issue of preventing non-consensual sexual activity.
Essential Resources
Correctional Service Canada (1999). Evaluation of HIV/AIDS Harm Reduction Measures in the Correctional Service of Canada. Ottawa: CSC.
The evaluation of the HIV/AIDS harm reduction measures in the Canadian federal prison system examined whether there were any perceptual or behavioural barriers which influence the prisoners' utilization of condoms and dental dams; what the prison system's implementation experience was with the condom and dental dam distribution program; and whether there were any unintended consequences related to the distribution of condoms and dental dams. Because a research and evaluation component was not built in at the time of the development of the program, no systematic data was collected on behaviour changes as a result of the program. The evaluation found that, in general, prisoners had easy and discreet access to both condoms and lubricant; and that although some unintended usage has been identified for condoms, there is no evidence that condoms have been used as weapons. Management and line staff interviewed at 18 prisons could not recall any incident where condoms had been used as weapons. A search of the federal prison system's incident database found 20 incidents involving the unintended uses of condoms. All incidents relating to condoms were associated with smuggling drugs. The evaluation concluded: "It has been ... six years since condoms were [first] distributed. To date, there is no hard evidence that significant incidents involving [condoms] have resulted in injury to CSC staff."
Dolan K, D Lowe, J Shearer (2004). Evaluation of the condom distribution program in New South Wales prisons, Australia. Journal of Law, Medicine & Ethics, 32: 124-128.
This evaluation of a prison condom distribution program concluded that is was feasible to distribute condoms to prisoners. There were several indicators for this: 1) the majority of prisoners supported the provision of condoms; 2) most prisoners were of the opinion that the condom vending machines were in accessible locations; 3) the reported level of harassment of prisoners using the machines was relatively low; 4) most importantly, prisoners were using condoms when having anal sex. From October 1997 to September 1998, 294,853 condoms were dispensed in New South Wales prisons. These figures are the equivalent of each prisoner obtaining one condom a week. Overall, there were no indicators of negative consequences as a result of the condom distribution program. Most senior correctional staff agreed with the distribution of the condoms, while views were evenly divided among correctional officers. Minor incidents of misuse such as water balloons, water fights and littering were recorded but these did not compromise prison safety or security. The only serious incident during the evaluation period involved the throwing of an apparently used condom at an officer. The condom was found to contain hair shampoo, however, the incident was distressing to the officer involved. No incidents of drug concealment were recorded
May JP, EL Williams (2002). Acceptability of condom availability in a US jail. AIDS Education and Prevention, 14(5 Suppl: HIV/AIDS in Correctional Settings): 85-91.
Studies have documented the transmission of HIV in incarcerated populations resulting from injection drug use or sexual activity. Less than 1% of the jails and prisons in the United States allow inmates access to condoms, and none allows access to needles. Results of a survey to measure the acceptability of a condom distribution program at the Washington, DC. Central Detention Facility, where condoms are available to inmates, are presented here. 307 inmates and 100 correctional officers were surveyed from October 2000 through October 2001. The surveys found condom access to be unobtrusive to the jail routine, no threat to security or operations, no increase in sexual activity, and accepted by most prisoners and correctional officers. Whether infections have been prevented has not been determined, but it was considered likely. The survey concluded that the model would be easily replicable in other institutions.
Other Resources
Anonymous (1997). Should condoms be available in prisons? SAfAIDS News, 5(3): 11.
The article notes that, worldwide, it is increasingly recognized that sex occurs in prisons and that this can lead to HIV transmission in prisons and will also impact widely on the community when prisoners are released. According to the article, "a multi-pronged strategy is needed. Several initiatives addressing the issue are being reviewed or implemented in various countries. In Zimbabwe, among the listed options under consideration in the draft National Policy on HIV/AIDS, the most debated policy issue is the dissemination of condoms in prison. Much public dissent has been noted, in which the fear is that this would be seen as condoning homosexuality. However, it is emphasized that the issue in prisons is not one of homosexuality, but of recognizing that many heterosexual men in prison will take the only sexual outlet available to them (in addition to masturbation). In doing so, they are at great risk of HIV infection, hence encouraging mutual or self masturbation and actively promoting condom use must be part of the response to the epidemic issue."
Anonymous (1998) AIDS in prisons - good intentions, harsh realities in Africa's penitentiaries. AIDS Analysis Africa, 8(3): 12.
Reports that there is strong cultural opposition to making condoms available in Africa's prisons, and that South Africa is the only country to distribute condoms in prisons. In Togo and Guinea, condoms are sold in prison hospitals. Indicative of the prevailing attitude was a comment made by the head of the detention center in Dakar: "If we introduce condoms into prisons, we are inviting prisoners to do what we otherwise forbid them to do."
Anonymous (2003). South African wins payout after prison HIV infection. AIDS Policy & Law, 18(4): 6.
The potential liability of correctional authorities to civil action was illustrated by an out-of-court financial settlement achieved by a South African former prisoner. The former prisoner claimed he contracted HIV through sex while in prison between 1993 and 1994. Condoms were introduced in South African prisons in 1996. He contended that the authorities did not warn prisoners about the risks of unprotected sex or supply condoms. The South African Department of Correctional Services denied any liability under the settlement.
BMA Foundation for AIDS (1997). Prescribing of condoms in prisons: survey report. London: The Foundation.
Available via www.medfash.org.uk/publications/archive.html
A report of a study that investigated the availability of condoms in prisons in England and Wales. The survey was conducted to monitor the implementation of advice to prison medical officers that they can (and should) prescribe condoms to prisoners where necessary to avoid a risk of HIV infection.
Braithwaite R, Stephens T (2005). Use of protective barriers and unprotected sex among adult male prison inmates prior to incarceration. International Journal of STD & AIDS, 16: 224-226.
Describes the predictors of protective barrier use and unprotected sexual intercourse among a sample of adult male prisoners.
Canadian HIV/AIDS Legal Network (2004). Prevention: Condoms (Info sheet 4 in the series of info sheets on HIV/AIDS in prisons). Montreal: The Network, third revised and updated version.
A 2-page info sheet about condoms in prisons. Available in English and French via www.aidslaw.ca/Maincontent/issues/prisons.htm. A Russian version will become available in 2006.
Community Agency for Social Enquiry (1997). Research to Explore the Implications for the Development of Policy on Condom Distribution in Prison. Braamfontein: South Africa.
The Community Agency for Social Enquiry (CASE) was commissioned by the AIDS Law Project (South Africa) to conduct research in a Johannesburg prison on the implications of introducing condoms as a key strategy for the prevention of HIV. Five focus groups were conducted, three with prisoners and two with warders. Based on their research, CASE made a number of recommendations to the South African Minister of Correctional Services, including, but not limited to the following: (i) take action to deal with the corrupt prison system; (ii) make prisoners aware of their rights in prison; (iii) conduct sexual education programs and life skills programs for all prisoners and warders; (iv) distribute needles; and (v) consider how condoms might best be distributed.
Correctional Service Canada (1994). HIV/AIDS in Prisons: Final Report of the Expert Committee on AIDS and Prisons. Ottawa: Minister of Supply and Services Canada.
Recommends easy access to condoms and that consensual sexual activity "be removed from the category of institutional offences"; and deals with prevention of non-consensual sexual activity.
Cregan J, Kippax S, Crawford J (1996). Sex, contagion, control: prison officers vs condoms in New South Wales Gaols. The Australian and New Zealand Journal of Criminology, 29(3): 227-246.
The paper examines expert and community opinions, HIV/AIDS and prison policies, public and correctional discourse, and statements made by prison officers' union representatives with regard to provision of condoms in prison. It offers an account of the prison officers' initial success in blocking condom distribution in prisons in New South Wales.
Davis AJ (1982). Sexual assault in the Philadelphia prison system and sheriff's vans. In AM Scacco, Jr (ed), Male Rape: A Casebook of Sexual Aggressions. New York: AMS Press, at 107-120.
Great Victory for South African Prisoners with HIV: Supreme Court Affirms Non-discrimination Protections on Basis of HIV Status and Sexual Orientation. IGLHRC Action Alert 1996; 5(5): 2-3.
The author reports that on 20 June 1996, the Supreme Court of South Africa ordered country-wide compliance with a new Department of Correctional Services HIV/AIDS policy securing the provision of condoms to all prisoners, medical attention and treatment for HIV+ prisoners, and protection from discrimination on the basis of HIV status or sexual orientation.
Heilpern D (1994). Sexual assault of New South Wales prisoners. Current Issues on Criminal Justice, 6(3): 327- 334.
Human Rights Watch (2001). No Escape: Male Rape in U.S. Prisons. New York: Human Rights Watch.
Available via http://www.hrw.org/reports/2001/prison/
Human Rights Watch undertook three years of research to expose the problem of male rape in US prisons. The resulting 378-page report is based on information from over 200 prisoners spread among thirty-four states, some of whom were interviewed personally, as well as an exhaustive survey of state prison authorities.
Jürgens R (1994). Prisoners Sue for the Right to Condoms. Canadian HIV/AIDS Policy & Law Newsletter, 1(1): 5.
Available at www.aidslaw.ca/Maincontent/otherdocs/Newsletter/Fall1994/104.htm.
Reports about a case in which prisoners from two prisons in Australia took civil action against the state of New South Wales over its refusal to permit prisoners to have access to condoms.
Jürgens R (1994). Results of the Staff Questionnaire. In: Correctional Service of Canada. HIV/AIDS in Prisons: Background Materials. Minister of Supply and Services Canada, at 85-109.
An overwhelming majority of 462 prison staff responding to a questionnaire said that making condoms available in Canadian federal prisons had created no problems.
Jürgens R (1995). Australia: Update on Prison Condom Case. Canadian HIV/AIDS Policy & Law Newsletter, 1(3): 3.
Available at www.aidslaw.ca/Maincontent/otherdocs/Newsletter/April1995/305.htm.
An update on the Australian prison condom case (see supra).
Kennedy M. (1995) Prison Discrimination Case Continues. [Australian] HIV/AIDS Legal Link, 6(2), 12.
Lockwood D (1994). Issues in prison sexual violence. In: MC Braswell, RH Montgomery Jr, LX Lombardo (eds). Prison Violence in America (2nd ed). Cincinnati, OH: Henderson, 97-102.
Moss C, Hosford R, Anderson W (1979). Sexual assault in prison. Psychol Rep, 44: 823-828.
Nacci P, Kane T (1982). Sex and sexual aggression in federal prisons. Washington: Federal Bureau of Prisons.
Potter RH, Tewksbury R (2005). Sex and prisoners: Criminal justice contributions to a public health issue. Journal of Correctional Health Care, 11(2).
Research into sexual behaviors in correctional institutions has existed in the criminological/criminal justice literature for more than 60 years, yet little of that literature appears to be known in the public health discourse on this topic. The objective of this study was to canvass this criminological research for a public health audience. The goal was to integrate criminal justice research into public health to develop a clearer picture of the current state of empirical knowledge about sexual behavior in correctional settings. The study design took a public health approach to assess the extent of sex in correctional settings through critical review of the criminological literature. The relationships among sexual behavior, disease transmission, sexual violence, and correctional operations issues were explored with an eye toward hypothesis generation and testing. The conclusion: Partnerships between public health and criminal justice can better address issues associated with inmates' sexual behavior in correctional settings in both research and operations.
Reyes H (2000). Condoms for prisoners: will they be used? [Rapid response e-letter] British Medical Journal.
Available at http://bmj.bmjjournals.com/cgi/eletters/320/7248/1493/a#8248
Points out that in African prisons, it would be counter-productive not to realize that HIV prevention depends more on prison and penal reform, than on condoms (and syringe exchange) programs. Argues that prison and penal reform need to "greatly reduce the prison populations, so that the few and underpaid guards be able to protect the vulnerable prisoners from violence - and sexual coercion." Says: "The many power struggles and internal conflicts that are common in the overcrowded and promiscuous prisons of Africa are hardly the setting for converting inmates to 'convinced condom users'."
Saum CA, Surratt HL et al. (1995). Sex in prisons: Exploring the myths and realities. The Prison Journal, 75(4): 413-430.
Simooya O (2000). Acceptability of condoms for HIV/AIDS prevention in an African jail [Rapid Response e-letter] British Medical Journal.
Available at http://bmj.bmjjournals.com/cgi/eletters/320/7248/1493/a#8213
Prisoners interviewed about their views on condom provision in prisons in Zambia suggested that more staff to supervise offenders, rather than condoms, would protect against HIV acquired through same-sex activity. A majority (68%) were opposed to making condoms available in prison and "found the idea of distributing condoms amongst men socially unacceptable." Simooya concluded that "in this situation, and given the gravity of the AIDS problem in Zambia, where up to one in five adults carry the AIDS virus, alternative forms of punishing offenders may need to be considered."
Spaulding A, Lubelczyk R, Flanagan T (2001). Can unsafe sex behind bars be barred? American Journal of Public Health, 91(8): 1176-1177.
Struckman-Johnson C, Struckman-Johnson D (2000). Sexual coercion rates in seven mid-western prison facilities for men. The Prison Journal, 80(4): 379-390.
Struckman-Johnson C et al. (1996) Sexual coercion reported by men and women in prison. The Journal of Sex Research, 33(1): 67-76.
Tewksbury R (1989). Measure of sexual behaviour in an Ohio prison. Sociol Soc Res, 74: 34-39.
Wooden W, Parker J (1982). Men behind bars: Sexual exploitation in prison. New York: Plenum Press.
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