Background: STD and HIV transmission occur among inmates within the California state prison system, the second largest in the U.S., housing over 120,000 inmates. In September 2014, California passed Assembly Bill 966, requiring the California Department of Corrections and Rehabilitation (CDCR) to provide condom access for inmates in all 35 state prisons. STDCB, OA, and CCHCS collaborated in a CDCR-led multi-disciplinary workgroup coordinating implementation of the law.
Methods: CDCR established workgroup priorities, including: engaging diverse stakeholders, developing standardized messaging, and phasing implementation of condom access. Our workgroup, representing public and correctional health, legal and legislative affairs, labor relations, and prison staff participated in four full-day planning meetings from May-September 2015. We surveyed frontline staff and inmates to determine feasible mechanisms to address potential challenges and facilitate access; conceptualized a tamper-resistant dispenser; developed educational materials for inmates, frequently-asked-questions for staff, fact sheets for the public; and conducted forums for custody and medical staff at each prison. Condom access was initiated at four prisons in July and three in November 2015. Disciplinary actions and number of condoms accessed are communicated to CDCR administration for report to the legislature.
Results: As of January 2016, seven prisons implemented the program reporting over 43,000 condoms accessed across all sites, an average of 418 condoms per 1,000 inmates per month (range 99-735). Survey feedback informed dispenser locations and messaging. While staff and inmates expressed concern that this legislation would condone sex between inmates and provide repositories for contraband, there have not been any serious adverse incidents involving condoms reported.
Conclusions: California has demonstrated that condom access is a safe, low-cost intervention with high uptake for a large correctional system and provided a replicable implementation model for other states. Prison condom programs have potential to decrease STD transmission among incarcerated individuals, their families, and the communities to which most will return.