Evaluation of a Prisoner Condom Access Pilot Program Conducted
in One California State Prison Facility
Prepared By:
Kimberley D. Lucas, M.P.H.
Jamie L. Miller, M.P.H.
Valorie Eckert, M.P.H.
Stacy Goldsby, B.A.
Megan C. Henry, M.P.H.
Michael C. Samuel, Dr.P.H.
Janet C. Mohle-Boetani, M.D., M.P.H.
Public Health Unit
California Correctional Health Care Services
Office of AIDS
Center for Infectious Diseases
California Department of Public Health
Sexually Transmitted Disease Control Branch
Division of Communicable Disease Control
Center for Infectious Diseases
California Department of Public Health
September 2011

KEY COLLABORATORS
EXECUTIVE SPONSOR
Richard Subia, *Associate Director, General Population II and III
California Department of Corrections and Rehabilitation
Division of Adult Institutions
IMPLEMENTATION AND EDUCATION
Mary Sylla, J.D., M.P.H., *Director of Policy and Research
Center for Health Justice
Vimal J. Singh, *Associate Warden, Level III Operations
California Department of Corrections and Rehabilitation, Solano State Prison
EVALUATION
Principal Investigators
Kimberley D. Lucas, M.P.H., Research Scientist
*California Department of Public Health, Office of AIDS
*California Correctional Health Care Services, Public Health Unit
Janet C. Mohle-Boetani, M.D., M.P.H., Deputy Medical Executive
California Correctional Health Care Services, Public Health Unit
Research Associates
Jamie L. Miller, M.P.H., *Manager
California Department of Public Health
Sexually Transmitted Disease (STD) Control Branch
Corrections, STD Specialty Clinics, and Substance Abuse Unit
Valorie Eckert, M.P.H., Research Scientist
California Department of Public Health, Office of AIDS
HIV Prevention Research and Evaluation Section
Stacy Goldsby, B.A., *Communicable Disease Manager
California Department of Public Health, STD Control Branch
Disease Intervention Section
Megan C. Henry, M.P.H., *Research Scientist
California Department of Public Health, Office of AIDS
HIV Prevention Research and Evaluation Section
Michael C. Samuel, Dr.P.H., Chief
Surveillance and Epidemiology Section
STD Control Branch
California Department of Public Health
*Title and affiliation during the pilot project
2

PREFACE
Assembly Bill 1334 (2007) would have required the California Department of
Corrections and Rehabilitation (CDCR) to allow non-profit and health agencies to enter
CDCR institutions to provide “sexual barrier protection devices” such as condoms to
state prisoners. In his October 14, 2007 veto message, Governor Arnold
Schwarzenegger noted that, although it is illegal to engage in sexual activity while
incarcerated, providing access to condoms is “consistent with the need to improve our
prison healthcare system and overall public health.” The veto message directed CDCR
to carry out a pilot program in one state prison to assess the “risk and viability” of
condom distribution. To accomplish the Governor’s directive, we assessed the pilot
program that was implemented in Solano State Prison, Facility II, for one year
(November 5, 2008 through November 4, 2009). Several agencies covered all costs
and volunteered their staff time and expertise. The Center for Health Justice, a nonprofit organization, purchased the condom dispensing machines and condoms,
monitored and re-filled the dispensers throughout the pilot period, and provided
education for staff and inmates. Researchers from the California Correctional Health
Care Services (CCHCS), Public Health Unit (PHU); the California Department of Public
Health (CDPH), Office of AIDS (OA), and the Sexually Transmitted Disease (STD)
Control Branch provided evaluation services.
This report describes: 1) a review of the research regarding guidelines for preventing
HIV/STDs in correctional settings and existing prisoner condom access programs in jails
and prisons internationally; 2) the implementation of the pilot project, including selection
of the CDCR facility and condom distribution method, staff and inmate education,
challenges, and lessons learned; and 3) the evaluation methods, results, conclusions,
and recommendations.

3

TABLE OF CONTENTS
Executive Summary

5

I.

Background

7

II.

Implementation

8

III.

Evaluation Methods
Aims
Detailed Methods

10
10
10

IV.

Results
Rule Violation Report Review
Monitoring Condom Dispensing Machines
Cost
Staff and Inmate Surveys
Meetings with Inmate Peer Educators and Men’s Advisory Council

12
12
13
14
14
15

V.

Discussion
Risk
Feasibility
Cost
Limitations

16
16
17
17
19

VI.

Conclusions

19

VII.

Recommendations

19

References

21

Tables and Figures

23

Appendices
Appendix A. Bill 1334 Veto Memo (October 14, 2007)
Appendix B. Institution Operations Plan
Appendix C. Inmate Educational Flyer and Rules for Accessing Condoms

25
25
26
32

4

EXECUTIVE SUMMARY
Background
In his October 14, 2007 Assembly Bill 1334 veto message, Governor Arnold
Schwarzenegger directed the California Department of Corrections and Rehabilitation
(CDCR) to determine the “risk and viability” of allowing non-profit or health care
agencies to distribute sexual barrier protection devices (e.g., condoms) to inmates in
one state prison facility, noting that, while sexual activity in prisons is against the law,
providing condoms to inmates is “consistent with the need to improve our prison
healthcare system and overall public health.”
Research Review
The World Health Organization and the United Nations Programs on HIV/AIDS
recommend that prisoners have access to condoms during their incarceration and prior
to release. Published evaluation studies found no security problems or serious
incidents involving a condom, no increase in sexual activity, and that when condoms are
available inmates use them during sex. Condoms are currently available in two prison
and five county jail systems in the United States and many prison systems worldwide.
Implementation
During December 2007 and January 2008, CDCR convened a task force of internal and
external stakeholders and selected Solano State Prison, Facility II, for the pilot project.
The Center for Health Justice (CHJ) provided the condom dispensing machines,
condoms, and staff and inmate education. Following implementation of an exception to
the contraband rule, CHJ made condoms available from wall-mounted dispensers
throughout the pilot facility from November 5, 2008 through November 4, 2009.
Evaluation
The California Correctional Health Care Services (CCHCS), Public Health Unit (PHU),
in collaboration with the California Department of Public Health, Office of AIDS (OA),
and Sexually Transmitted Diseases (STD) Control Branch, evaluated the risk, feasibility,
and cost of providing condoms. We reviewed Rule Violation Reports for the pre-pilot
and pilot periods and compared the numbers and rates of incidents. Program staff
routinely monitored the number of condoms dispensed and the operability of each
dispenser. We estimated the cost of condom distribution and the number of HIV
infections that would need to be prevented for a cost-neutral program.
Conclusions
We found no evidence that providing condoms posed an increased risk to safety and
security or resulted in injuries to staff or inmates in a general population prison setting.
Providing condoms from dispensing machines is feasible and of relatively low cost to
5

implement and maintain. Providing condoms would likely reduce the transmission of
HIV, STDs, and hepatitis in CDCR prisons, thereby reducing medical costs in both
CDCR and the community. Very few HIV infections (2.7 to 5.4) would need to be
prevented for a cost-neutral program.
Recommendations
A program to provide CDCR inmates access to condoms should be initiated and
incrementally expanded while continuing to monitor the safety and acceptability of the
program. Consider conducting similar pilot studies when expanding the program to
other prison populations (e.g, with a higher security level or in a mental health treatment
housing unit). Prisons should locate dispensers in discreet areas and consider
providing condoms confidentially through medical staff or in a medical clinic. Inmate
peer educators and Men’s and Women’s Advisory Counsels, and medical, public health,
and custody representatives should be involved at all stages of program planning and
implementation. Staff and inmates should receive information describing findings from
the current study demonstrating that safety and security were not impacted by the
distribution of condoms.

6

I.

BACKGROUND

Although prohibited in prisons, sexual activity occurs during incarceration (1-7).
Custody staff cannot be expected to prevent all sex among prisoners. Outbreaks of
sexually transmitted diseases (STDs) in correctional settings, including syphilis,
gonorrhea, and hepatitis B, and in-custody transmission of HIV are well documented
(2, 8-13). The use of condoms prevents the spread of STDs. Condoms are defined
internationally as the “single, most efficient, available technology to reduce the sexual
transmission of HIV and other sexually transmitted diseases” (14). In 1993, the World
Health Organization (WHO) and the United Nations Programs on HIV/AIDS (UNAIDS)
recommended that condoms be made available to prisoners throughout their
incarceration and prior to release (15). In 2007, the United Nations Office on Drugs and
Crime joined WHO and UNAIDS in recommending a range of risk-reduction measures,
including confidential condom access for all male and female prisoners (16).
Similar to most other correctional systems, both the California Penal Code, § 286(e) and
the California Code of Regulations, Title 15, § 3007 prohibit sexual activity in California
prisons and jails, and concerns about safety and security operations pose barriers to
initiating condom distribution programs. Based on the experiences of those advocating
for or implementing condom distribution in a variety of correctional settings, many
California Department of Corrections and Rehabilitation (CDCR) correctional officers
and other personnel are concerned that condoms could be used by inmates to conceal
and transport contraband or controlled substances or could be used as a weapon
(e.g., “gassing”) in assaults on staff or inmates. Staff and inmates also express concern
that improperly disposed used condoms may pose a health risk. Custody staff may also
view providing condoms as condoning or even promoting illegal sexual activity among
inmates and that it could lead to increased sexual activity among inmates.
Despite these concerns, condom program evaluation studies from jails and prison
systems have found that: 1) following implementation, condom distribution is accepted
by a majority of inmates (17, 18) and correctional officers (18); 2) inmates approve of
dispensing machines in discreetly accessible locations (17); 3) dispensing machines
increase access compared with distribution in group health education classes (19);
4) there were no serious incidents involving condoms (20-22); 5) inmates used
condoms for sex (17-21); and 6) self-reported sexual activity did not increase (19). The
New South Wales, Australia prison system condom program evaluation, with a
90 percent survey participation rate among inmates, found a statistically significant
decrease in self-reported sexual activity following the introduction of condoms, possibly
due to a newly introduced HIV/STD and hepatitis education program or increased
awareness and reinforcement of prevention messages due to the presence of the
condom dispensers (22).
In 2007, WHO/UNAIDS/UNODC reviewed condom programs internationally and
concluded that prison condom programs are feasible, accepted by a majority of
correctional staff and inmates, have resulted in no reported security problems or serious

7

incidents resulting in injury, and do not lead to increased sexual activity or drug use
(16).
The Centers for Disease Control and Prevention (CDC) has urged correctional systems
to evaluate existing condom programs, and, for systems without condom access, to
assess relevant laws, policies, and local circumstances and determine the risks and
benefits of condom distribution (2). WHO recommends focusing program evaluation on
determining: 1) whether condom access has unintended negative consequences for
safety or security operations, 2) the feasibility of implementing and expanding condom
access, and 3) conditions that facilitate acceptance among staff and inmates (16).
In response to the WHO recommendations, over 80 percent of European Union prison
systems, the Correctional Service of Canada, and prisons in Australia, South Africa,
Brazil, Indonesia, and Iran provide condoms for inmates (16-17, 24-25). In the United
States, condom distribution programs exist in the Los Angeles, California;
San Francisco, California; New York City, New York; Philadelphia, Pennsylvania; and
Washington, D.C. county jails; and in the Mississippi and Vermont state prison systems
(19). Condoms have been available to jail inmates in San Francisco since 1989, and to
inmates in the Los Angeles jails since 2001. However, the 165,000 state prisoners in
California have not had access to condoms, and a pilot program evaluating the risks, as
recommended by CDC, had not been conducted.
Consistent with CDC and WHO guidance, Governor Arnold Schwarzenegger, in his
October 14, 2007 veto message of Assembly Bill 1334 (Appendix A), directed CDCR to
determine the “risk and viability” of allowing non-profit or healthcare agencies to
distribute sexual barrier protection devices (e.g., condoms) to inmates in one state
prison facility, noting that, while sexual activity in prisons is against the law, providing
condoms to inmates is “consistent with the need to improve our prison healthcare
system and overall public health.”
II.

IMPLEMENTATION

In December 2007, the CDCR Special Projects Unit (SPU) convened a Sexual Barrier
Device Task Force comprising internal and external stakeholders, including CDCR
Legal Affairs, Risk Management, Regulations and Policy Management, and Research;
the California Correctional Health Care Services (CCHCS), Public Health Unit (PHU);
the California Department of Public Health (CDPH), Office of AIDS (OA), and Sexually
Transmitted Disease (STD) Control Branch; the Center for Health Justice (CHJ); and
other non-profit organizations. CDPH OA and the STD Control Branch reviewed
existing condom programs and proposed evaluation measures. Task Force members
conducted site visits to observe condom distribution methods and inmate education in
the Los Angeles and San Francisco county jails. CHJ implemented the condom pilot
program, and CCHCS/PHU directed the evaluation study in collaboration with OA and
the STD Control Branch.

8

CDCR selected Solano State Prison (SOL) Facility II for the pilot project based on its
Level III security status; housing general population inmates (including one mental
health unit) in four 270-degree-view celled buildings (housing inmates in two-person
cells); and one dormitory. CDCR chose dispensing machines for condom distribution
based on successful use in the San Francisco jail system and several other prison
systems, and because dispensers require minimal staff involvement. Because, in
practice, the California Code of Regulations (CCR) Title 15, §3006 (contraband)
prohibits inmates from possessing condoms, CDCR applied an exception to the
contraband rule for Facility II inmates. From November 5, 2008 through
November 4, 2009, Facility II inmates were permitted to access condoms from
wall-mounted dispensers located in common areas of the celled housing units, the
dormitory restroom area, the Education Building restroom, and the Medical Primary
Care waiting area restroom. Although the dispensers in the Education Building and
Medical Primary Care restrooms were accessible to inmates in other facilities, nonFacility II inmates were prohibited from using the dispensers or possessing condoms.
At the end of the pilot, CDCR removed the machines and reinstated the rule regarding
condoms as contraband.
SOL developed an Institutional Operations Plan (Appendix B) and completed labor
negotiations. The Operations Plan stated the public health purpose of the condom pilot
program, and provided a means to communicate with staff. To ensure professional
implementation, the Operations Plan stressed the importance of discreet access and
instructing officers to write up inmates only for the specific penal code violation when a
condom is used or misused and not additionally for possession of a condom as
contraband. CHJ gave presentations to staff during the Quarterly Warden’s Forum
meetings just prior to the pilot. Information was also shared with staff during staff
meetings and New Employee Orientation. CHJ, in collaboration with CDCR personnel
and the inmate peer educators, developed an inmate information flyer and produced a
video to be shown on inmate television throughout the pilot. The flyer and program
rules (Appendix C) were posted adjacent to each dispenser and distributed to all
existing and arriving Facility II inmates. Inmate education included a clear message that
sexual activity while incarcerated is still against the law. The SOL inmate Men’s
Advisory Council (MAC) was briefed throughout the pilot, and the SOL Peer Education
Coordinator and inmate peer educators provided information and counseling to inmates
about HIV/STD and hepatitis risks and the proper use and disposal of condoms.
Based on initial observations, custody staff had two main concerns: 1) reconciling the
illegality of sex in prison with providing condoms; and 2) the potential for harm and
misuse of condoms to conceal contraband. Inmates were concerned about:
1) the perception that provision of condoms condones sex among inmates; 2) being
portrayed by the media as homosexual and consequently negatively judged by family,
friends, and the community; 3) the potential impact on their daily routine (e.g., more
lockdowns); 4) the possibility of being written up for a rule violation; and 5) the
dispensers mounted in plain view in the housing units sending a mixed message. Key
factors ensuring effective implementation of the pilot project included collaboration
among the lead organizations and task force members, administrative buy-in,
9

engagement of custody staff, and clear communication to staff and inmates about the
project purpose, plan, and rationale. By the end of the pilot, both staff and inmate
concerns appeared to have diminished, from the perspective of MAC, inmate peer
educators, and SOL custody leads.
III.

EVALUATION METHODS

Aims
We conducted a one-year pilot study. To assess the potential impact of condom
distribution on safety and security (risk) we: 1) compared pre-pilot and pilot period rates
of documented rule violations involving contraband, controlled substances, assaults with
weapons, and sexual misconduct; and 2) surveyed staff and inmates about unintended
uses and negative consequences or serious incidents involving condoms.
To assess whether condoms were readily available and barriers to accessing condoms
(feasibility), program staff monitored the condition and operability of each dispenser and
the numbers of condoms dispensed on a regular basis. We surveyed staff and inmates
about their preferences for dispensing machine locations and type of distribution
method. To collect additional qualitative information about program acceptance and to
obtain feedback on education and condom distribution methods (including any problems
with the dispensers), we held several voluntary meetings with the SOL inmate peer
educators and inmate MAC members throughout the pilot.
To estimate the first year cost and subsequent annual cost of distributing condoms
using the pilot project model, CHJ staff provided us with information about the
dispensing machine and condom costs and the time required to check and stock the
dispensers. Factoring in salary expenses, we compared the cost of condom distribution
using the dispensers with the average annual cost of medications to treat one HIV case.
Detailed Methods
Rule Violation Report (RVR) Review
CCR, Title 15, sections 3006 (contraband), 3007 (sexual behavior), 3008 (obscenity),
3016 (controlled substances, drug paraphernalia and distribution), and 3005 (conduct:
force or violence, with a notation of severe bodily injury or involvement of a weapon)
were eligible for inclusion in the study. We reviewed the RVR database records and
corresponding hardcopy reports for these violations. We abstracted the penal code
violation, violation date, findings (found guilty or not guilty), and adjudication from the
RVR database, and the inmate housing assignment, contraband or act, and wrapping
used (e.g., cellophane, latex glove, condom) from the hardcopy records. We abstracted
adjudicated RVR database records and reports available at four months after the last
day of the pre-pilot and pilot intervals respectively, merged them into a Microsoft Excel

10

database, and imported them into Statistical Analysis System (SAS) for analysis.
Records were de-duplicated based on two or more reports describing a single incident.
To permit comparison of incident rates by the specific Penal Code violation and by the
type of housing unit, custody staff provided us with inmate average daily population
(ADP) estimates from on-site custody records. We calculated the number of incidents
per 100 ADP per year for all violation and housing type categories for the pre-pilot
period (November 5, 2007 through November 4, 2008) and pilot period
(November 5, 2008 through November 4, 2009). Since the dormitory was closed five
months into the pilot period, we compared violations during the last five months of the
pre-pilot period with the first five months of the pilot period. Finally, although the
administrative housing units were not included in the pilot program, we included
violations by inmates housed in these units, in case condoms were indirectly accessed.
To assess the comparability of the pre-pilot and pilot interval incident rates, we
calculated the percentage of RVR database records that were adjudicated and the
percentage of eligible incidents for which a report was available for abstraction.
Monitoring Condom Dispensing Machines
CHJ staff checked and stocked the condom dispensers weekly for the first nine months
and then every other week for the final three months of the pilot year. CHJ staff
reduced the frequency of checking the machines after monitoring had clearly
established that dispensers would not be emptied within two weeks. Each dispenser
was initially filled to capacity with 144 condoms. The number of condoms required to
refill each dispenser was recorded for each site visit by date and dispenser location.
We collected information on the time required to check and stock the dispensers,
dispenser operability, and damage due to tampering or vandalism.
Cost
CHJ purchased the condom dispensing machines from C&G Manufacturing
(Grand Junction, Colorado) for $200 each and the condoms for $.22 each. Based on
the ADP of 810 inmates in the pilot facility celled buildings and dormitory, the unit costs
of dispensers and condoms, the total number of condoms dispensed during the pilot
year, and the time required for CHJ to check and stock the dispensers, we estimated
the cost per inmate of providing condoms from three dispensers mounted in discreet
and accessible locations. We applied a salary of $50 per hour hto the time required to
check and stock three dispensers. The cost of treating one HIV-infected patient in the
United States is estimated to be between $2,100 per month if diagnosed early, and
$4,700 per month if diagnosed with progressed disease (26). We compared the cost of
condom distribution with the mid-range cost of treating one HIV patient per year, and
applied the condom distribution cost to cover the 147,861 male and female inmates in
CDCR in-state institutions and camps (27). We estimated the number of HIV infections
that would need to be prevented for condom distribution to be cost-neutral by dividing
the total program cost by the cost to treat one HIV patient for one year.
11

Staff and Inmate Surveys
Two months prior to the pilot start date and again at the conclusion of the one-year pilot,
CDCR attached an anonymous, self-administered, paper survey and postage-paid
CDPH return envelope to the pay warrants of all staff at SOL. Staff reporting at least
ten percent of their time spent in Facility II or working with Facility II inmates were
eligible for inclusion in the analysis. We also surveyed general population inmates from
Facility II through confidential interviews within two months prior to the pilot start and
within one month of the conclusion of the pilot period. Inmates who were housed in
Facility II for at least one year at the time of the pre-pilot survey and inmates housed in
Facility II for the duration of the pilot were eligible to participate in the
pre- and post-pilot surveys, respectively. We reviewed custody records for inmate work
and program hours for optimal scheduling of voluntary meetings with the CDPH
interviewers. Eligible inmates received a voluntary ducat allowing passage through
security checkpoints to meet in a designated confidential space with a trained CDPH
interviewer. After obtaining written informed consent, we administered a face-to-face
standardized questionnaire. The inmate and staff survey instruments included both
closed-ended and open-ended questions relevant to the study aims and objectives. We
grouped responses to open-ended questions, entered the survey data into a Microsoft
Access database, and analyzed the data using SAS.
Meetings with Inmate Peer Educators and Men’s Advisory Council (MAC)
We met with three MAC representatives and all eight of the SOL inmate peer educators
separately at three and six months into the pilot period. To facilitate group discussion,
we invited the inmates to ask questions about the pilot project and to voice their
opinions about whether condoms should be available, how best to distribute condoms,
and what should be included in education for inmates. We also asked them questions
based on their observations and conversations with other inmates about: 1) how
inmates were learning about the pilot program, 2) opinions expressed by other inmates
about condom access, and 3) whether they were aware of or had heard of any
problems regarding the condom dispensers.
IV.

RESULTS

Rule Violation Report Review
The RVR dataset included 1,214 pre-pilot and 782 pilot interval records. Exclusion of
records that were not from Facility II or that had an ineligible or missing violation date
resulted in 1,159 pre-pilot and 771 pilot period records. Of these, 494 pre-pilot and 316
pilot interval records, respectively, represented eligible violations. After
de-duplicating, excluding un-adjudicated records, and dropping incidents of violence
without a weapon, we included 398 and 258 eligible violations in the pre-pilot and pilot
period datasets, respectively.
12

Table 1 shows the number of eligible violations, unadjusted for inmate ADP, overall and
broken down by Penal Code violation and inmate housing type. Table 2 presents the
number of violations per 100 ADP. There were no increases in the unadjusted or
adjusted numbers for specific eligible violations for those in the general population
housing units (including the celled buildings and dormitory), for those with missing
housing information, and for those in Facility II overall. There also were no increases in
the total counts and rates per 100 ADP for eligible violations overall, including those in
the general population and administrative segregation housing units, and for those with
missing housing information.
We found very similar rates of adjudication when comparing the pre-pilot (89.5 percent)
and pilot (89.2 percent) intervals. Eighty-one (20.2 percent) of the pre-pilot and 23
(8.7 percent) of the pilot period incidents were missing the housing unit building number,
due to the hardcopy report not having been filed and available for abstraction by the
four-month cut-off date.
One incident occurred during the pre-pilot period, in which a “balloon” (a term used by
some custody staff to mean a condom) containing heroin was introduced into Facility II
by an inmate returning from a weekend family visit. We found no instances during the
pilot period of a condom being used to conceal or transport contraband, controlled
substances, drug paraphernalia, or weapons. The Associate Warden for the Level III
population and Facility II custody supervisors were also unaware of any reported or
reportable incidents involving condoms during the pilot period.
During the pre-pilot period, there were ten incidents of sexual misconduct, including one
described as “consensual” anal sex between cellmates. The remaining nine were for
inappropriate touching in the visiting area, masturbation, or indecent exposure. All of
the pre-pilot incidents, except touching in visiting area, involved inmates housed in
Administrative Segregation. During the pilot period there were six incidents of sexual
misconduct, including masturbation and indecent exposure, with no condom use
reported.
Monitoring Condom Dispensing Machines
A total of 2,383 condoms were dispensed from seven machines during the pilot period.
Of these, 263 condoms were left in the dispenser tray and 10 were reportedly taken
initially by staff, citing training purposes, resulting in a total of 2,110 condoms
dispensed. Of the 2,110 total, 817 were dispensed in the Education Building restroom,
395 in the Medical Primary Care restroom, 727 overall in the four celled housing units,
and 103 in the dormitory during the five months it was open. Four hundred and ninetynine condoms (24 percent) were dispensed during the first month. Excluding the first
month, greater numbers of condoms were dispensed in the Education Building restroom
(695) and the Medical Primary Care restroom (395), compared with each of the four
dispensers in the celled housing units (range: 89 to 156; total: 446). Figure 1 presents

13

the number of condoms dispensed by pilot month in the celled housing units combined,
the Education restroom, and the medical restroom.
Routine monitoring throughout the pilot showed that the dispensers in the Education,
medical, and dormitory restrooms were less frequently vandalized or found to be
inoperable, compared to the dispensers in plain view in the celled housing units.
Table 3 shows the percentage of CHJ staff site visits to check and stock the dispensers
during which the dispenser was found to be inoperable. Excluding the first month and
the weeks during which the dispenser was found inoperable or not mounted, or the
building was closed, the average number of condoms dispensed per week was 4 in the
celled housing units, 3 in the dormitory, 9 in the medical restroom, and 14 in the
Education restroom.
Cost
The cost, including the purchase of the dispensers and the condoms, was $1.39 per
inmate, for an ADP of 810 inmates during the pilot year. The cost of the condoms alone
was $.65 per inmate. CHJ staff reported spending an average of 38 minutes per visit to
check and stock all seven dispensers, or 5.4 minutes per dispenser. Given that, during
the pilot, 2,383 condoms were dispensed from dispensers holding 144 condoms each,
we estimated that three dispensers would need to be checked and stocked 6.6 times
per year (approximately every two months), taking 0.13 minutes of staff time per inmate
per year. (We based our cost projections on three, rather than seven, dispensers
because the four dispensers in the celled housing units were found to be inoperable at
least twice the rate of any other location, and the three other locations (Education
Building, Medical Primary Care, and dormitory restrooms) were the only discreet
locations available in Facility II, a typical Level III facility.) After adjusting for a salary of
$50 per hour, and calculating the total cost based on 147,861 male and female inmates
currently in-state in CDCR institutions and camps, we arrived at a total cost of
$221,368, or $1.49 per inmate, for the first year, including the one-time purchase of the
dispensers; and a total of $95,653, or $.76 per inmate, for subsequent years, to
maintain the program. Dividing the total program cost by the average annual cost of
antiretroviral medications to treat one HIV patient in the United States ($40,800), we
estimated that 5.4 HIV infections would need to be prevented in CDCR statewide for a
cost-neutral program in the first year. Similarly, 2.7 HIV infections would need to be
prevented statewide for a cost-neutral program in subsequent years.
Staff and Inmate Surveys
Pre-pilot, 114 of 1,342 staff and 26 of 242 inmates, and, at the conclusion of the pilot,
55 of 1,381 staff and 25 of 171 inmates, were eligible and participated in a survey.
The convenience sample of custody, medical, and other staff answered questions
regarding the impact of condoms on safety and security. The number of staff who
agreed that inmates would use condoms for something other than sex that would result
in serious negative consequences or injury to staff or inmates fell from 85 (76 percent)
14

pre-pilot to 5 (10 percent) after the pilot. Among custody staff, 52 (83 percent) agreed
pre-pilot and only 3 (13 percent) agreed after the pilot. Following the conclusion of the
pilot, five staff reported being aware of or hearing about condom use that resulted in
injury to staff or inmates. Of three staff who elaborated, two custody staff made general
statements that inmates may use the condoms to conceal drugs and cell phones, and
one medical staff person reported that a heroin overdose had occurred, but did not
provide specific information regarding how a condom had caused the overdose.
We asked staff respondents to rank their preferences regarding how condoms should
be distributed. Making condoms available confidentially during a medical visit or from
dispensing machines were more commonly preferred over allowing non-profit or health
agencies to distribute condoms during health education classes. The reasons given for
preferring distribution during a medical visit were the need for confidentiality, a
perception that condoms are a medical issue, and improved access. Prior to the pilot,
more staff preferred that condom dispensers be in view of custody posts. However,
following the pilot, more staff preferred that dispensers not be in view of custody posts.
The reasons for favoring dispensers not being in view of custody were confidentiality,
improved access, and less impact on staff. Staff preferring dispensers in view of
custody felt that inmates should be monitored in case they may be planning to engage
in illegal activity.
Among the convenience sample of inmates following the pilot, when asked to suggest
better ways to distribute condoms, five suggested placing dispensers in less
conspicuous areas for confidentiality and improved access, since dispensers in hidden
areas would be less likely to be vandalized. Seven inmates suggested making
condoms available in clinics or from medical staff.
Meetings with Inmate Peer Educators and Men’s Advisory Council (MAC)
At three months into the pilot period, the inmate peer educators and MAC
representatives were approached often by inmates throughout SOL requesting
information about the purpose of the program; wanting to know why SOL Facility II was
selected; and expressing concern that the program promoted homosexuality and that
condoms do not protect against HIV or hepatitis transmitted through sharing needles for
drugs and tattooing. Inmates were also concerned that, because only Facility II was
chosen for the pilot project, they were being portrayed as having more homosexual or
HIV-infected inmates in their facility compared with other facilities or prisons. Some
inmates also feared that inmates seen taking condoms would be written up for violations
more frequently and that disturbances around the condom dispensers would impact
non-participating inmates indirectly as a result of lock-downs.
During the meetings held six months into the pilot program, the inmate peer educators
and MAC inmates reported that the novelty of the program had significantly decreased.
In contrast to early in the pilot, when large numbers of inmates were voicing concern
about the stigma around homosexuality and HIV, the potential for more lock-downs and

15

write-ups involving condoms, and why Facility II had been selected, as the pilot
progressed, the dispensers were seldom mentioned and no one was aware of any
write-ups or disturbances around the dispensers. Inmates reportedly continued to
approach the peer educators and MAC representatives with questions about the pilot,
and some inmates shared their acceptance of the program privately, in contrast to the
negative opinions stated openly on the yard earlier. Some inmates from outside of
Facility II asked why they did not have access to condoms.
None of the peer educators or MAC representatives reported having observed inmates
accessing the dispensers in the housing units, noting that the lack of privacy and peer
pressure are barriers to using the machines, and that the dispensers had been
vandalized. They felt that the Education Building and Medical Primary Care restroom
dispensers provide sufficiently confidential access, but there should be additional ways
to obtain condoms including during a medical visit, from the medication dispensing
window, and with a brochure in the orientation kit given to entering inmates. They also
expressed a need to expand access to administratively segregated inmates who are
under constant and close custody supervision outside their cells.
The inmate peer educators and MAC representatives noted that the inmate peer
educator video played daily on inmate TV appeared to be the most effective means of
informing the inmate population. They stressed that education for inmates should
elaborate on the purpose of the program, include more information about HIV/STDs and
hepatitis in the prison setting, and include messaging that is public health rather than
life-style focused with a wide range of health issues. In addition, education and
prevention should include methods other than condoms since throughout the pilot
inmates expressed concern that condoms do not prevent non-sexual transmission of
HIV and hepatitis.
V.

DISCUSSION

Risk
We found no incidents involving a condom in our review of the RVR database records
and hardcopy reports. The incident numbers and rates did not increase from the prepilot to pilot years for each violation type and there were no incidents reported to us by
custody supervisors or managers. We found no evidence that misuse of a condom
resulted in injury to a staff person or inmate. Although several staff survey respondents
alleged that a condom had caused an injury, convincing details were not provided and
there were no such incidents reported through the RVR process.
The very similar rates of adjudication comparing the pre-pilot and pilot intervals
suggests that the timeliness of processing reports was consistent across the pre and
post-pilot intervals, resulting in comparable data across the intervals. Eighty-one (20.2
percent) of the pre-pilot period incidents were missing the housing unit building number
due to the hardcopy report not being filed and available for abstraction by the four
16

month cut off date. However, only 23 (8.7 percent) of the pilot period reports were
unavailable for abstraction. Had a greater proportion of pilot period reports been
unavailable, we would have found greater reductions rather than any increases in the
numbers and rates of incidents than we observed.
Feasibility
Condom distribution in the prison setting using dispensing machines appears to be a
feasible method provided there are multiple discreet locations. Since dispensers in
discreet locations were more acceptable, inmates who need condoms may be more
likely to access them from these locations. Our observation that dispensers in plain
view were frequently vandalized supports the need for discreet locations and is
consistent with open-ended comments made by staff and inmates who responded to the
survey, as well as the inmate peer educators and MAC representatives during meetings
with CDPH and CHJ staff throughout the pilot year. Dispensers in discreet locations are
expected to require repair or replacement less frequently compared to dispensers in
plain view.
Cost
Our best estimates indicate an average pharmacy cost-savings of $40,800 per year to
treat each HIV infection acquired while in custody. Just 2.7 to 5.4 HIV infections would
need to be averted to cover the costs of condom distribution using dispensing
machines. Condoms can be provided using this method at very low cost and minimal
time required to check and refill the dispensers.
The costs associated with treating one HIV patient are likely to be higher. The cost
included in our estimate is for antiretroviral medications only, accounting for 73 percent
of the total cost of HIV care. Other costs such as hospitalizations (13 percent) and outpatient care (9 percent) (26) may be significantly higher in correctional settings due to
custody supervision and housing policies. In addition, while it would be difficult to
estimate the percentage of those who are infected with HIV in CDCR who would
subsequently receive treatment in CDCR and the duration of their treatment, it is likely
that the majority will be treated in CDCR for at least one year, given the average time
served is 25 months and a recidivism rate of over 65 percent in California (28). In
addition, a majority of HIV-infected prisoners released to the community are likely to
receive publicly funded treatment and care.
As observed with other jail and prison condom programs, higher numbers of condoms
were distributed early on, likely due to the novelty of the program. There was also
increased uptake of condoms during the last couple months of the pilot, possibly due to
inmates or staff stocking up prior to the dispensers being taken down. Considering the
higher than average uptake early and late in the pilot year, the actual cost of condoms
and time to re-stock dispensers could be lower than we estimated once a program is
established.

17

In the Georgia state prison system, there were 41 HIV seroconversions between July
2003 and February 2005 (2). The most common HIV risk factor reported by the
seroconverters was male-to-male sexual contact, including 72 percent reported as
consensual with the remaining 28 percent including exchange sex (e.g., for money,
goods, or protection) and forced sex. Given the Georgia state prisons’ inmate
population in 2005 was 44,990, we estimate the in-custody HIV seroconversion rate
was 57 per 100,000 inmates per year. There may be a number of population and other
factors influencing HIV risk behaviors and transmission rates that differ between the
Georgia and California state prison systems. However, given prisoners as a group are
at higher risk for HIV, STDs, hepatitis, and co-morbid illnesses, it is reasonable to
assume that HIV transmission occurs frequently enough among CDCR prisoners to
avert the 2.7 to 5.5 infections per year for a cost-neutral or cost saving program if
condoms were made available. Several program evaluations found that when condoms
are available prisoners use them during sex and that sexual activity is not increased
(17-20, 22), indicating that the transmission of HIV/STDs would likely decrease. Since
sexual activity has been documented in California prisons, it is likely that the availability
of condoms would also prevent HIV/STDs in California prisons.
Limitations
The current study took place in a Level III, general population facility. The findings may
not be generalizable in different settings, ( e.g., with a higher level of security or in a
housing unit designated for a population requiring a high level of mental health
services).
Rule Violation Report Review
The cut-off date of four months following the end of the pre-pilot and pilot intervals for
inclusion of adjudicated RVR database records and associated hardcopy reports means
that we could not include some rule violations in the current analysis, either because the
violation had not yet been adjudicated or the hardcopy report had not yet been filed in
the RVR log book.
Overall, we found fewer incidents and lower incident rates per 100 ADP during the pilot
year compared with the pre-pilot year. A possible explanation is that between
December 2008 and May 2009 (during the pilot year) the celled housing units were
undergoing cell door retrofits during which inmates were moved to other buildings. The
cell moves may have temporarily disrupted or discouraged rule violations because of
the increased risk of being found in possession of contraband or controlled substances
during the move.
Monitoring Condom Dispensing Machines
Because the Education Building restroom dispenser was accessible to a subset of
inmates in Facilities I and II and the Medical Primary Care restroom dispenser was
accessible to a subset of inmates from all four Facilities, inmates from outside Facility II
18

may have taken condoms, even though they notified that they would be written up if
found in possession of a condom. While all Facility II general population inmates had
access to dispensers in their housing units, only a subset of Facility II inmates could
access the Education Building and Medical Primary Care restroom dispensers.
Although more condoms were taken from the Education Building and Medical Primary
Care restrooms than from the housing unit dispensers, we cannot conclude based on
uptake levels alone, that the Education Building and Medical Primary Care restroom
dispensers were more accessible to Facility II inmates. However, the far greater
percentage of time that the dispensers in the celled buildings were inoperable compared
to those in Education Building and Medical Primary Care locations and feedback
provided by the inmate peer educators and MAC representatives supports this
conclusion.
Inmate and Staff Surveys
The low survey response rate among staff and inmates introduces significant limitations
for estimating the impact of the pilot project and the results are not generalizable. Staff
and inmates who agreed to answer questions may have been more likely to either
oppose or be in favor of prisoner access to condoms. Because the staff survey was
anonymous, staff who were either strongly opposed or in favor of condom access may
have responded to both surveys. Due to the low response rates and the serious biases
that may have been introduced, we treated the survey responses as convenience
samples, and include only notable open-ended responses and anecdotal trends in the
results and discussion.
VI.
•
•
•
•

•

CONCLUSIONS
We found no evidence that the availability of condoms created an increased risk of
breaches of safety or security or resulted in injury to staff or inmates in a general
population prison facility setting.
The findings may not be generalizable to other settings, e.g., higher security or in a
setting dedicated to inmates with mental health problems. Additional pilot studies
similar to this one may be warranted in these settings..
Providing condoms from dispensing machines similar to those used in the pilot
program is feasible and of relatively low cost to implement and maintain.
We cannot demonstrate a reduction in disease transmission during the pilot study.
However, since several studies have provided evidence that when condoms are
made available to inmates they are used for protection during sex, and that sexual
activity did not increase, it is likely that providing condoms to CDCR inmates would
prevent transmission of HIV and STDs.
Estimates of the in-prison HIV and STD transmission rates are not available.
However, given the relatively low cost of providing condoms relative to the cost of
treating HIV, and that very few HIV infections would need to be prevented to cover
the costs of the program, it is likely that providing condoms could reduce CDCR
medical costs.
19

VII.
•
•
•

•
•
•

RECOMMENDATIONS

Initiate and incrementally expand a program to provide CDCR inmates access to
condoms while continuing to monitor the safety and acceptability of the program.
Consider additional pilot studies in settings that may pose a serious health or safety
risk, e.g., higher security facility or housing for inmates with mental health problems.
Mount dispensers in discreet locations to provide confidential access and increase
accessibility by minimizing inoperability due to vandalism. Dispensers with solid
steel construction and protected locks are available that are more tamper resistant
than those used in the pilot study.
Consider making condoms available confidentially upon request during a medical or
mental health visit, in addition to dispensing machines.
Provide information to staff and inmates describing findings from the current study
demonstrating that safety and security were not impacted by the distribution of
condoms.
Include inmate peer educators, inmate Men’s and Women’s Advisory Counsels,
medical, public health, and custody staff in local (institutional) condom program
planning and implementation.

20

REFERENCES
1. Abiona TC, Adefuye AS, Balogun JA, et al. Gender differences in HIV risk
behaviors of inmates. Journal of Women’s Health 2009; 18 (1): 65-71.
2. Centers for Disease Control and Prevention. HIV Transmission Among Male
Inmates in a State Prison System – Georgia, 1992–2005. MMWR 2006;55:4216.
3. Lucas KD, Horne RL, Bick JA. “Sexual and drug-using HIV risk behaviors among
incarcerated African American and white males.” 17th Meeting of the International
Society for Sexually Transmitted Disease Research, July 28 – August 1, 2007,
Seattle, WA.
4. Bellatty P, Grossnickle D. Survey of high-risk inmate behaviors in the Oregon
prison system. Oregon Department of Corrections, May 20, 2004.
5. Swartz JA, Lurigio AJ, Weiner DA. Correlates of HIV-risk behaviors among
prison inmates: Implications for tailored AIDS prevention programming. The
Prison Journal 2004;84(4):486-504.
6. Butler T, Milner L. The 2001 New South Wales Inmate Health Survey. 2003.
Corrections Health Service. Sydney. ISBN: 0 7347 3560 X.
7. Wohl AR, Johnson D, Jordan W, et al. High-risk behaviors during incarceration
in African-American men treated for HIV at three Los Angeles Public Medical
Centers. JAIDS 2000;24:386-392.
8. Sexually Transmitted Disease Control Branch, Division of Communicable
Disease Control, Center for Infectious Diseases, California Department of Public
Health. Report on a Syphilis Outbreak at California Men’s Colony State Prison in
San Luis Obispo, California, 2007-2008. April 2010.
9. Tucker JD, Chang SW, Tulsky JP. The catch 22 of condoms in U.S. correctional
facilities. BMC Public Health 2007;7:296. Available at:
http://www.biomedcentral.com/1471-2458/7296.
10. Krebs CP, Simmons M. Intraprison HIV transmission: an assessment of whether
it occurs, how it occurs, and who is at risk. AIDS Educ Prev 2002;14:53-64.
11. Dolan KA, Wodak A. HIV transmission in a prison system in an Australian State.
The Medical Journal of Australia. 1999;171(1):14-17.
12. Mutter RC, Grimes RM, Labarthe D. Evidence of intraprison spread of HIV
infection. Archives of Internal Medicine. 1994;154(7):793-795.
13. Brewer TF, Vlahov D, Taylor E, et al. Transmission of HIV-1 within a statewide
prison system. AIDS. 1988;2(5):363-367.
14. WHO, UNAIDS, UNFPA (2004). Position statement on condoms and HIV
prevention. Geneva.
15. WHO/UNAIDS. “Guidelines on HIV Infection and AIDS in Prisons.” Geneva:
World Health Organization 1993.
16. WHO/UNODC/UNAIDS. “Effectiveness of Interventions to Manage HIV in
Prisons – Provision of condoms and other measures to decrease sexual
transmission.” World Health Organization, Geneva, 2007.
17. Dolan K, Lowe D, Shearer J. Evaluation of the Condom Distribution Program in
New South Wales Prisons, Australia. Journal of Law, Medicine & Ethics, 32:
124-128, 2004.
21

18. May, John P and Earnest L. Williams. “Acceptability of Condom Availability in a
U.S. Jail.” AIDS Education and Prevention 2002;14(Supplement B):85-91.
19. Sylla M, Harawa N, Grinstead Reznick O. The first condom machine in a US jail:
the challenge of harm reduction in a law and order environment. American
Journal of Public Health 2010. Jun; 100(6):982-5.
20. Correctional Service of Canada, Performance Assurance Sector. “Evaluation of
HIV/AIDS Harm Reduction Measures in the Correctional Service of Canada”.
April 1999.
21. Yap, Lorraine et al. Do Condoms Cause Rape and Mayhem? The long-term
effects of condoms in New South Wales’s prisons. Sexually Transmitted
Infections, 83:219-222, 2007.
22. Scottish Prison Service. “Measures to reduce the risk of transmission of blood
borne viruses between prisoners: Pilot evaluation of provision of condoms and
dental dams made available to prisoners”. January 2007.
23. Sylla M. Prevention in practice: Prisoner access to condoms – the California
experience. IDCR 2007;9(20):2-3.
24. Jurgens R. “HIV/AIDS in prison: final report.” Canadian HIV/AIDS Legal Network
and Canadian AIDS Society 1996.
25. CNN. South Africa fights to quell spread of HIV in prisons. July 21, 1996.
Available at: http://www.cnn.com/WORLD/9607/22/south.africa.aids/.
26. Schackman BR, Gebo KA, Walensky RP, et al. The lifetime cost of current
human immunodeficiency virus care in the United States. Med Care. 2006
Nov;44(11):990-7.
27. California Department of Corrections and Rehabilitation, Offender Information
Services Branch, Data Analysis Unit. Weekly report of population as of midnight
November 10, 2010. Available at:
http://www.cdcr.ca.gov/Reports_Research/Offender_Information_Services_Branc
h/Population_Reports.html.
28. California Department of Corrections and Rehabilitation. Fourth Quarter 2008
Facts and Figures. Available at:
http://www.cdcr.ca.gov/Adult_Operations/docs/Fourth_Quarter_2009_Facts_and
_Figures.pdf.

22

Table 1. Number of eligible violations overall and by housing unit, unadjusted for inmate ADP.
Generall Population
G
P
l ti
(GP) Housing Units

Violation

Missing Building1

GP, Ad Seg,
GP
S
&
Missing Bldg

Pre-Pilot

Pilot

Pre-Pilot

Pilot

Pre-Pilot

Pilot

2

0

1

0

4

0

7

0
187

3005(d) / Conduct: force or
2
violence
3006 / Contraband

Administrative
Ad
i i t ti
Segregation (Ad
Seg)

Pre-Pilot Pilot

195

164

10

10

45

13

250

3007 / Sexual behavior

3

3

7

1

0

0

10

4

3008 / Obscenity

0

0

1

0

0

0

1

0

3016 / Controlled substances
Total

3

89

54

9

3

32

10

130

67

289

221

28

14

81

23

398

258

Table 2. Number of eligible violations per 100 inmate ADP, overall and by housing unit.
General Population
(GP) Housing Units

Violation

Administrative
Segregation (Ad
Seg)

Missing Building1

GP, Ad Seg, &
Missing Bldg

Pre-Pilot

Pilot

Pre-Pilot

Pilot

Pre-Pilot

Pilot

3005(d) / Conduct: force or
2
violence

0.2

0.0

0.3

0.0

0.3

0.0

0.6

0.0

3006 / Contraband

21.8

20.2

2.9

3.8

3.6

1.2

20.3

17.5

3007 / Sexual behavior

0.3

0.4

2.1

0.4

0.0

0.0

0.8

0.4

3008 / Obscenity

0.0

0.0

0.3

0.0

0.0

0.0

0.1

0.0

10.0

6.7

2.6

1.2

2.6

0.9

10.5

6.3

32.3

27.3

8.2

5.4

6.6

2.1

32.3

24.1

3016 / Controlled substances
Total

3

Pre-Pilot Pilot

1

Missing the building number due to hardcopy incident report unavailable for abstraction.

2

Includes only incidents involving a weapon.

3

Includes possession or distribution of controlled substances or paraphernalia.

Data compiled by California Prison Health Care Services, Public Health Unit from Solano State Prison, Facility II rule violation reports.

Figure 1
1. Number of condoms dispensed by location and pilot month
450
400

Number Dispen
nsed

350
300

All 4 Celled
g
Bldgs

250

Medical

200

Education
150
100
50
0
1

2

3

4

5

6

7

8

9

10

11

12

Pilot Month
Data compiled by California Prison Health Care Services, Public Health Unit, from Center for Health Justice program implementation records.

23

Table 3. Proportion of routine condom dispenser monitoring visits during which dispenser was found to be
inoperable
Dispenser Location

Description

% Visits Dispenser
Found Inoperable

95% Confidence
Interval

Celled Housing Units

Common area next to drinking fountain; in
direct view of half of building; not in direct
view of custody post

34.8

28.3 - 41.9

Medical Primary Care
Restroom

Inside closed single person restroom in
small inmate waiting area

17.3

9.2 - 30.0

Dormitory (converted
gymnasium)

Inside open multiple person restroom; in
direct view of one corner of building; not in
direct view of custody post

10.0

1.6 - 31.3

Education Building Restroom

Inside closed multiple person restroom; not
in direct view of custody post

3.8

0.3 - 13.7

Data compiled by California Prison Health Care Services, Public Health Unit, from Center for Health Justice program implementation records.

24

APPENDIX A
BILL NUMBER: AB 1334
VETOED
DATE: 10/14/2007

To the Members of the California State Assembly:
I am returning Assembly Bill 1334 without my signature.
This bill would enact the Inmate and Community Public Health and Safety
Act, which would allow any nonprofit or health care agency to
distribute sexual barrier protection devices to inmates in state
prisons.
As stated in my veto of AB 1677 last year, the provisions of this bill
conflict with Penal Code Sections 286 (e) and 288 (e), which make
sexual activity in prison unlawful. However, condom distribution in
prisons is not an unreasonable public policy and it is consistent with
the need to improve our prison healthcare system and overall public
health.
Local jail systems in both Los Angeles and San Francisco have already
implemented condom distribution programs. Therefore, I am directing
the California Department of Corrections and Rehabilitation to
determine the risk and viability of such a program by identifying one
state prison facility for the purpose of allowing non-profit and health
agencies to distribute sexual barrier devices.
Sincerely,

Arnold Schwarzenegger

http://leginfo.ca.gov/cgibin/postquery?bill_number=ab_1334&sess=0708&house=B&author=swanson

25

APPENDIX B

!INST;ITUT;IONAL OPERATlONS PLAN
CALIFORNIA DEPARTMENT OF CO RRECT IONS AND REHABI LI TATION
CALI FORNI A STATE PRIS ON-SOLANO
VACAVILLE, CALI FORNIA
PLAN TritE SEXUAL BARRIER DEVICE DISTRIBUTION (PILOT PROJECT)
PLAN NUMBER CSPS·L3·0B·117
0,1\ TED: September 2008
ADDENDUM T O OPERATIONS l'LAN
Th is addend um wil l be incorporated ll1to the next rev ision of O perations Plan C SPS-L3-0 8- J 17 , SEXlJAL
HARRIER DE VI CE DlSTRIBUTlON (l'ILO T PROJECT) in June 2008.
Add ed Lauguage

3. Sexual Barri er Dev ice (SBD) Dispe nsing Machines aud Inmate Access.
Seven di spensing machines will be II1sta lled: on e in each of the five Facility II General Popu lat ion
Housi ng Units, one in the Lev el III Education inmate restroom and one in the Primarv Cl mi c restroom
closes t to the breezewav. T hese machines will be mounted in locations wh ich are somewhat
inconsp icu ous: however. given the layout of the h OLlsing units by conectional design. th ese locations are
not discreet. T he machines are also placed such that staff will be able to periodi cally obser ve them for
the purpose of mamtaining security . The SBD dispensin g machines w ill be serviced b y personnel from
the Center for Health Justice at no cost to the State of Californ ia. Inmates will be made aware of the
availabiiI ty of condoms and how to obtain tb em fro m th e dispensing machi nes. T he basic pro cedures
for inmates 10 loll ow will be posted next to the mach ines and wili in clude:

CONDOM DISPENSING MA CHINE IWLES
**This ma chin e is for Fac ili tv Il inll1"te us e onl,,'''*
Inm ates ill FlIcilities 1. III. lind TV ill possession of
a condoll1 will be subject til CDCR 115

•
•
•
•
•

•

Hav ing sex in prison is illegal under California Penal Code § 286(e) and CCE Section 3007. Fai lure
to obey these rul es will result ill disciplmary a ctIon.
Facil ity Il inmatcs are allowed to carey one condom to all areas except the regular v isiti ng area as
lon g as the condo m is still in side the inner clear sealed pl astic wrapper.
Condoms enclosed ill the inner clear sealed plastic wrapp er are not contraband.
Condoms remainin g III the externa : orange box or rem ov ed fro 111 th e inn er clear sealed pl astic
wrapper are contraband and wi ll be confiscated .
To k,; only o n e condom at a titTle irorn the vending lna chinc
ImlTJedIately open condom pac kage and dIsca rd the ex te l'llal ce llophane wrapper and orange paper
box.
.
.
In mat.es a!'e responsib le for tbe proper disposal of used condoms - flusiling clown the toilets is
considered approp;'iate for th is pilot pen od .

HOV C3 2008
PAGE

26

J

of 2

JNSTJTUTJONAl 'OPERATJONS PLAN

'

CALI FORNIA DEP ARTMENT OF CORRECTION S AND REHABILITAT IO N
CALI FORNIA STATE PRISON-SOLANO
VACAV ILLE, CALI FORN IA
PLAN TI TLE SEXUAL BARRIER DEVICE DISTRIBUTION (PILOT PROJECT)
PLAN NUMB ER: CSPS-L3-0 8-1 17
DATED : September 2008
As al ways, staff!.!; acl vised to usc stali dard precautions, including latex gloves, whenever there is a
po ssibili ty of coming into contact with potentially mfectious or dangerous material s 11l the course or
co nductin g searches of pers ons, cel ls, or pro perty . Latex gl oves should be used if tb e neeci ever arises to
handl e condoms for the purpose o f ev idence co llection or d isposai.

4. Disciplin a ry Processes.
In giving the inmate population access to condoms, tbe CDCR is not implying acceptance or condon ing
of sexual behavior within CDCR facilities. However, CDeR acknowled ges the reality tbat sexual
activi ty may occur, although the prevalence of su ch activity is not known . Therefore, inmates assigned
to Fac il ity II may possess on their person, or in their cell or locker, one (1) SBD (condom). M ore than
one condom found in an inmate's possession shall be considered contraban d. The inner seakd condom
package sha ll be not opened or tampered with. If the condom package IS found by staff to be
compromised it will be considered contraband. The inmate mal' enter the Program Complex B,
E ducation B , Dining Hall 3 or 4 , Main K itchen, the Treatment and Triage Area (TTA) and their work
site (including C- Side) with one condom on their person.
In practice , the Caiifom ia C ode of Regulation s (e CR) Title 15 , Section 3006 (Contraband) has
prohib ited inmates hum being in possession of condoms. However, an exception to this practice wi ll be
made during th e one-year SBD pilot project for inmates housed in Facility n .

R!(UJ7W;

\(b. K

SISTO

r Warden

PAGE 20f2
27

CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILlTA,ION
CALI ::-ORN IA STATE PR ISON - SOL.ANO
VACAVIL.L.E , CALIFORNIA
P LAI~

FOe:;

PLAI~

NUIVlBER CSPS-L3-08-11(- "

SEXUAL.

BARI~I:::R

D:::VIC:: DIS,RIBUTION (PILO, PROJeCT)

DATED June 25 , 2008

J.

. t;

PLAI\' NUMBEH AND TIT LE:

O!'ER.iI. nONS PLAN Sexual Barr ier Device DistributIon Pi iot Project.
I I.

!'lJ RPOS f. AND OBJECTfVES
A,

]'URI)OSE

The purpose of the program 10 to provi de Sexual B alTieI' Devices (SBD) as a means of preventing the
spread of Euman Im111ulloti eiicicn cy VITUS (HTV) ane' other Sexually Transmitted D iseases (STD )
inside CDeR state prisons , CD CR recognizes that consensual and IlOll-consensuai sexuai activity
h etween nU11ates may OCCllI, in spite of regul ations prohi bitin g such condu ct, disciplinary actions, and
other cuslOdy practi ces designed to minimize or eiiminate sexual activity, Engaging in high-risk
sexual behavIOrs whiie inGarcerated constltutes a serious threat to the health and welfare of the inmate
populatiol1 and the commun ilies 10 which tbe majority will be relUrned, While the majority ofinll1ates
with EJV and STD, likely acq uired then mfectlO115 pn or to bem g Il1carcerated, some indlviclua1s
continue hig1, risk sexual and drug-using risk behav iors Wilik in orison, O utbreaks of HIV an d STD s
mc!uci ing syphilis, gonorrhea, and H epalltis B bave been docum ented in many state prison systems,
State and fed eral prison imnales are affected by rates of HJV infection that are three to iive times that
in the free population. Tins urogram alms to reduce th e risk of acquiring such diseases within the
CDCR facihties
- .' . - ... .-

B.

OF.JECTIV ES

The SED pilot proj ecl is ciesigned to assess .tbe n sk and viabi lity of dislributing .condoms within
Californi a p risons, T he SBD pi iot will be conducted in one Level III Facility at the California S tate
P;'isoll-Sol ano (SOL) containin g fiv e general population housing units, housing abo ut 1,025 inmates,

III,

REFE RENCES :
On Octoher 14, 2007 , Gov cmOl' Arnold Schwarzenegger vetoed A ssembly 3ill13 34, This bill w ould
have required CD CR to a llow nop-profi t and public bealth care agencies to dl slribute "sexual barrier
protecti on devi ces" (sLich as cond oms and dental dams) to California State prisons ilIDlates in an
efjo~ to reduce the transI11isSl 0n of~IJV , and oth er sexually tran slnitlecl c1i~eases.

lil his veto message, the Govel11or direcled CDCR to determine the "riSK and viability" of a con dom
distri bution program by i denH ying one state prison faci lity for the purpose of allowing non-pToiit and

heaJth agen~:ie.s to distri bute sexual ban-jer devices.
Th e regulati o11s r elevant tD th e pilot e,.'ai uatJOlj are:
CalifDrnia Code of Regul ations (CCR), Title ] 5, Secti ons 3005 (e), 3006, 3007, 3008 and 30 16
California Penal Cod e 286 (e) and 2888 (e)

28

CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
CALIFORNIA STATE PRISON - SOLANO
VACAVILLE , CALIFORNIA
PL A I~

cOR S::: XUAL BARRIEK DEVICE DISTRIBUTION (PI LOT PHOJECT)

PLAI~

NUMBER CSPS·L3-0B·117

D.ATED : June 25, 2008 '
.~ "

IV .

.

AI'PTW VALAND REVIEW:
This Operations Plan will be reviewed as needed during th e pilot period by the Associate Warden,
Levcl lll.. th e Chi ef Depu ty Warden, ane! signeci offby th t· Ward en

V.

RESPONSIBILITY:
The Warden designates ov erall responsibili ty to tbe Associate Warcien, Level Ill, at SOL. The
Facility IT Captain, Program Lieutenants, and Program Sergeants will be responsible for adherence to
the policies and procedures defined in this Operations Plan. All employe es are responsible to ensure
compiiance.

VI.

METHODS:
1.

Staff and Inmate Information and Education

The Center lor Health Justi ce 111 cooperation witb CDCR persolll1el will provide inf01111atlOn and
education for all SOL staff and the inmate popUlation at the selected pilot facility.lnfo1111ation wili be
provided to staff on site during tbe Quarterly Warden's Forum. Information provided to staff will
include the history, purpose, an d inmate and custody procedures to be fo ll owed during tbe on e~ye ar
SED piiot proj ect. During the Ill-persall lllfoDnationai sessions, staff will be given ample opportunity
to comment and ask questions. Addltional opportulllties fo r stafT to provlde input regardmg the
condom distribution program wil l in clude voluntary and an011)'111ouS staff surveys to be administered
prior to and after tbe pilot period. The inmate populati on will v iew a video presentation which
e):piains the purpose of th e pilot proJect an d th e procedures that must be followed with respect to
accessing, possessmg, an d disposing Dr condoms dunng the one-year pil ot period. Inmate education
wii1 include a clea:"message that sexual activJ ty while l11Cllrcerated is still against tll e law , pursuant to
the Californi'l Penal Co de [28G (eJ & 2 ~8a ( e)] , an d is a viol ati on ofCCR Section 3()07 .
Throughout the pil ot period, tbe SOL Peer Ed ucation Coord inator anrl the Peer Ed ucators will be
aVili lable to provide ed ucatIOn and counseling to 1Il111ates regardll'lg risks for HTV, STDs, ,md
HepatitIS, and on th e proper use and dispos al of cond oms.
2. SUD Pilot Site - Facili ty II
Facility Il is a Level lIJ Facili ty with five General Pop ulatior: housing Ul1lts. T here are fo ur 270 design
cel led housing units anri one Gymnasiu111 converted into a dOlTllltory. Tile iDm ate pop ulatIOn consists
of J ,025 Level lIJ Gen eral Popu lation inmates WIth vanOl": custod y lev els an d commitment terms.

29

CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
CALIFORNIA STATE PRISON - SOLANO
VACAVILLE, CALIFORNIA
?L:A I~

FOR SEXUAL BARR ieR DEVICE DISTRIBUTION (PILOT PROJECT)

PLA I~

NUIv1B:: R: CSPS-L3-0 8-117

D,ll,T:: D: .Jun e 25 , 2008

~~~~="====~=~================~="=="===~=~.' "" "

:;, SexlI,,1 Barrier Device (S HD ) Dispensing Machin es and InITIa te Access,

Ten dis pcnsin g machine" will bt instalied in th e fiv e housing Uni ts (t wo pCI' housin g unit), These
Jllach in ~s will be mounted in locations wh ich arc inconspicu ous and all ow inm ates di screet access
given the layout of th e housing un its . The mach ines are als(I pl <lced ~:ucb that slaff will bc abl e to
pC]"IociJcall y observe them ior th e purpose of ma llltalll lll g ,CCUrl (y, Til t SIlL! dlsp ensin g nmchines
wili be serviceci by persOlmel Trom the Ccnter for Health .iustIce a: no cust to the State of CalIfornia.
b1l11al ~ s wili he made aware of the availability of GOnQOIm, and 110W to obtain them fro m tbe
dispensing machi nes, The basic procedures for inmates to follow will be posted n cx! to til e machines
and wi ll include :
•
•
•
•
•
•
•

Take only onE· condom at a t ime from the vending machine
Imm ediately open condom package and discard the extemai cell ophane wrapper and orange
paper DOX ,
Condoms enclosed in the inller clear sealed plastiC wrapper are not contraband,
Condoms remaining in ti-Ie externa; orange box or removed from the inner cleaT sealed plastic
wrappe;' are contraband and will be confis cated.
Having sex in prison is illegal under Califomi2 Penal Code § 28()(e) and CCR Section 3007,
FailmE to obey these rules will result in disciplinary action ,
lrmlates are responsible for the proper dIsposal of lIseo condoms - flushing down the toilets is
considered appropriate.for tins pilot period,

As always , staff are advised to use standard precautions, inc luding latex gloves, whenever therc is a
possibility of coming illtO GOntact with potentiall y infectious or dangerolls material s in th e course of
conciu cting searches of p crsons, cells, or prop erty, Latex gloves should be llseo ifthe n eed ever arises
to handle cllndclll1S for the purpose of evidence coll ecti on or disp osal.

4, Disciplinary Processes,
Dl 'giving the inmate population access to condoms, tbe CDCR is not implying acceptance or
condoning of sexual behavior withir' CDCR lfIcilities, However, CDCR aclUlowlcdges the reality that
sexual actiVity lTi8Y occm, although the preval ence of SllCb activity is not k nown. Therefore, IlllTJates
assigned to Facility n rna)' po sses s on their p erson, ur in their cell or lockeT, one (1 ) SBD (condom).
More than on e condom founci in an 111ma!e's possession shall be considered contraband, The condom
package shaJl be not opened or tampered with, if the cond om package is founel by staff to be
compromised it wi ll be conside:'ed contraband, The inmate may enter th e Program Complex B,
Educati on B, Dining Hall 3 0 ; 4, M.ain K itchen, the Treatment and Triage Area (IT A) and their work
site (including C- Side) with one condom on th eIr person.
III pr'actice, the Califomia Code of Regulati ons (eCR) Titl e 15 , Section 3006 (Contraband) has
prohibJ\.eci inm ates fro m heing ill possession of condoms . }-1ov,'ever, all eXGeption to this practice will
30
be made during the one-year SED pi lot project for inmates housed in Facil ity 11,
r"">".

,-..r- . ..., ,..."r JI

- - - - - - ----- - - - - - - - - - - - - - - - - - -- - - - -- - - - - -- - - - -- - - - - -

CALIFORNIA DEPARTM::NT 0;: CORRECTIONS AND REHABILITATION
CALIFORNIA STATE PRISON - SOLANO
VACAVILLE, CALIFORNIA
"'LAN FOR SE)(UAL BAR i,:IER DEVICE DISTRI BUTION (P ILOT PROJ EC T)
PLA I~

NUMBER: CSPS-L3-08-117

OP.TED : June 25 , 2008

.

R ule Viol ation Reports (RVR) written to docum ent lI nau th o riz~c1 possession of conclom(s) or fai lure
to fo liow the r ll le~; regarding the external and inner packaging posted beside tlle dispensing mach ines
sha ll be charged With CCR, Secti on 3006 . Possession of Con traband. Shou ld a condom be usee:
ciuring tim pilo[ program for anI' purp ose other thal l [10: IIllenci cci usc_ the EVP shan be cOlllpJelecl to
reflect the specific act and CCE section. For inc idents wilere an J{ VR reflecting a speci fIC non contraband act is comp ieteci , an additJOnal PVR charging the irunate With p ossession of Contraband
shall not be completed.
Inmates transfemng from Faciiity II to other fac ilities withll1 SOL will not be allowed to take
condoms wi th them. Inmates who are housed on Facili ties I, ill, and TV, found in possession of a
condom, regardl ess of its source, wil l be subject to the di sciplinary actions noted above. For incidents
in all FacilJties (I through JV), staff shall do cllment their find ings 011 an RVR When documentmg
Rules ViolatlOns, the RVR specific act will l11clude m parenthesis any Item used 111 conmlittmg the
act, including a condom, balloon, latex glove, or cellophane for storing or conveying contraband, or a
condom or other improvised weapon used in an assault (e_g., Possession of Contraband (SBD),
Possession of Contl-aband (Tobacco wrapped in celiophane), Gassmg (S BD), Gassing (latex glove),
Possession of a Siing Shot Weapon (SBD), PossessiOll of a Slmg Shot Weapon (rubber band). The
designation in parentheses of the specific vessel or tool used must be included on all RVRs and
disciplinary or infonnative documentation utilized by staff far tracking ,md repoliing_purposes.
5. Tracking of EVR Violations.
For the duration 01 the pilot project, on a quarterly basis, the ASSOCiate Warden s of Level Il und ill
Operations will ensure that the completed Rules Violations Repor! Log (Attachmen t 1-1.) with attacbec
-1:opies of relevant RVRs (pel1inent to the SBD pilo: project) are and forwarded to the Chief Deputy
Warden for his rcvl ew via the SOL Compliance Offi ce. Thi~; report will then be forwarded to the pilot
program cvaluatlon team members at th e CDCR; Ad ult Res earch Branch and the Depar1menl of
Pub li c Health, Office of AIDS .
Ongoing comlllunicati on 11etwee11 all stakeholders will be lmpemlivc. At the end of the ] 2-l1lontb
SBD Pilot ProJect, the data co llected during thi s tim e perloci wi ll be lIseo to evaluate the ris\: and
viability of SBD distribution in Californi a Slate PllSOll S_

APPROVED:

31

~ ':.-,

APPENDIX C

PRISONER INFORMATION SHEET
Condom Access Pilot Program

What is the history of this program?
• If Assembly Bill (AB) 1334 passed, it would have required CDCR to allow any non-profit
or health agency to provide condoms inside CDCR prisons.
• In his Veto Memo, the Governor of California directed CDCR to carry out a one-year pilot
program to provide prisoners access to condoms in one prison only.
• The purpose of pilot testing this program in one prison is to see if condoms can help
prevent the spread of HIV and other sexually transmitted diseases (STD).
• The pilot program will run for one year: from November 5, 2008 to November 4, 2009.
Why CSP Solano, Facility II?
• CDCR chose CSP Solano and Facility II for a few reasons:
• CSP Solano houses General Population prisoners in both cell and dormitory style
housing units.
• CSP Solano is close to California Department of Public Health staff who will be
evaluating this program.
• Facilities III and IV are already participating in other pilot projects and Facility I has
celled housing only.
Why provide prisoners access to condoms?
• As a group, prisoners have higher rates of HIV, STDs, and Hepatitis B and C than the free
population.
• This is part of a public health effort to reduce the spread of HIV and other STDs both
within prisons and to the community.
• Condoms are highly effective at preventing these diseases.
• CDCR is not condoning sexual activity. It is still illegal to have sex in prison. It’s not
always possible to stop sex from happening in prisons. In this case, being able to use a
condom may help stop the spread of HIV, STDs and Hepatitis.
What agencies are involved in this project and why?
Center for Health Justice
• Community-based organization that works on HIV prevention and treatment for prisoners
• Will provide the condoms and condom dispensing machines during the project.
California Department of Public Health: Office of AIDS & STD Control Branch
• The Office of AIDS and the STD Control Branch are agencies of the Department of Public
Health. They work on HIV and STD prevention and treatment in California.
• Public Health staff are interviewing prisoners to ask them to take a voluntary confidential
survey. The survey is part of the evaluation of the pilot project. The surveys will be done
before and after the pilot project.
• At the end of the project, findings from the surveys will be reported to the Governor to help
him decide if inmates in other prisons will be allowed to have condoms.
California Department of Corrections and Rehabilitation
• Is working with an advisory group to plan the pilot project, including various options for
placing the machines and the rules for inmates to follow.
• Will enforce existing rules about sexual activity and allow exceptions to condoms as
contraband.
• Will provide a confidential interview space for the CDPH staff to conduct surveys with
prisoners, and a custody staff person to escort the outside researchers and to maintain
security of the area. The custody staff will not be able to hear the interviews in progress or
32
have access to any survey materials.

1

2

PRISONER INFORMATION SHEET
Condom Access Pilot Program
Where will condoms be allowed? Who can carry condoms?
• The rules for the pilot program are given in the box below. These rules will also be posted
beside each condom machine.
• There will be exceptions to the contraband rule in order to allow prisoners access to
condoms for the one-year pilot program.
• Facility II inmates will be allowed to carry one condom to all areas except the regular
visiting area as long as the condom is still inside the inner clear sealed plastic wrapper.
Got something to say about it?
• Staff from the California Department of Public Health are doing a survey with prisoners
• If you are ducated for an interview, you are encouraged to participate to say your opinion. It
is very important that all opinions and experiences with the project are heard. It doesn’t
matter if you are for or against prisoners having condoms or whether you personally have
any need of this program.
• Participation in the survey is completely voluntary and confidential. Your name and
individual survey answers will not be used in any report.

CONDOM DISPENSING MACHINE RULES
**This machine is for Facility II inmate use only**
Inmates in Facilities I, III, and IV in possession of
a condom will be subject to CDCR 115

• Having sex in prison is illegal under California
Penal Code § 286(e) and CCR Section 3007.
Failure to obey these rules will result in
disciplinary action.
• Facility II inmates are allowed to carry one
condom to all areas except the regular visiting
area as long as the condom is still inside the
inner clear sealed plastic wrapper.
• Condoms enclosed in the inner clear sealed
plastic wrapper are not contraband.
• Condoms remaining in the external orange box
or removed from the inner clear sealed plastic
wrapper are contraband and will be
confiscated.
• Take only one condom at a time from the
vending machine
• Immediately open condom package and
discard the external cellophane wrapper and
orange paper box.
• Inmates are responsible for the proper disposal
of used condoms – flushing down the toilets is
considered appropriate for this pilot period.
33