Alternatives to abstinence: the practice of (un)safe sex in prison

Correctional rules and regulations requiring sexual abstinence for prison inmates, coupled with unsupported beliefs about the risks of condom provision, keep most inmates in a dangerous muddle of criminalized sexual expression, covert efforts at erroneous myth-based safe sex practices, and high risk of sexual disease contraction and transmission. With the vast majority of inmates eventually released to re-enter communities across the US, these health concerns are not quarantined to the correctional environment, but rather contribute to what has been described as the hidden epidemic in public health . Using inmate voice from a large-scale national examination of inmate sexual behavior, the current study explores inmates' attempts at 'safe sex' in an environment where sexual behavior, though prohibited, frequently occurs, and where no sex is the only accepted form of 'safe' sex. Inmates identify many approaches to safe sexual practice including barrier protection, partner selection, and risk reduction strategies. Unfortunately, many improvised, though innovative, inmate protection strategies reflect a very rudimentary understanding of safe sex for the purpose of reducing disease transmission and contraction, frequently exacerbating these risks. Policy implications include widespread condom provision and expanded inmate education and programming around sexual health and disease prevention.