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Sexual practices and dental dam use among women prisoners - A mixed methods study



Dental dams have been distributed to women prisoners for protection against HIV and other sexually transmissible infections (STIs) in some Canadian and Australian prisons for over a decade. However, we do not know whether they serve any useful public health purpose. To determine how dental dams are used in women's prisons in New South Wales (NSW), Australia. Using quantitative and qualitative methods, we investigated women's sexual practices with a focus on how dental dams are used in NSW prisons. Although 71 of the 199 (36%) women reported having had sex with another inmate, with oral sex involved in most encounters, only eight (4%) had ever used a dental dam. The main sources of STI transmission risk among women prisoners were oral sex, manual sex and sharing dildos. Furthermore, sharing razors could also allow the transmission of blood-borne viruses, which could occur during sex in the presence of cuts or menstrual fluid. The high rates of hepatitis B and C among incarcerated women compound this risk. Dental dams are not widely used by women prisoners and we question their utility in women's prisons. Oral sex is an important risk factor for acquisition of herpes simplex virus type 1, but most women in NSW prisons (89%) are already infected. Condoms and latex gloves may have more use. Condoms could be used as a barrier on shared dildos and sex toys, while latex gloves could be used to protect cut and grazed hands from vaginal and menstrual fluids.
Sexual practices and dental dam use among women
prisoners a mixed methods study
Lorraine Yap
, Juliet Richters
, Tony Butler
, Karen Schneider
, Kristie Kirkwood
and Basil Donovan
School of Public Health and Community Medicine, University of New South Wales, Sydney,
NSW 2052, Australia.
National Drug Research Institute, Shelby Street, Shenton Park, WA 6008, Australia.
Centre for Health Research in Criminal Justice, Justice Health, Matraville, NSW 2036, Australia.
Sydney Sexual Health Centre, Sydney Hospital, and National Centre in HIV Epidemiology and Clinical Research,
University of New South Wales, Sydney, NSW 2001, Australia.
Corresponding author. Email:
Abstract. Background:Dental dams have been distributed to women prisoners for protection against HIV and other
sexually transmissible infections (STIs) in some Canadian and Australian prisons for over a decade. However, we do not
know whether they serve any useful public health purpose. Objective:To determine how dental dams are used in womens
prisons in New South Wales (NSW), Australia. Method:Using quantitative and qualitative methods, we investigated
womens sexual practices with a focus on how dental dams are used in NSW prisons. Results:Although 71 of the 199
(36%) women reported having had sex with another inmate, with oral sex involved in most encounters, only eight (4%) had
ever used a dental dam. The main sources of STI transmission risk among women prisoners were oral sex, manual sex and
sharing dildos. Furthermore, sharing razors could also allow the transmission of blood-borne viruses, which could occur
during sex in the presence of cuts or menstrual uid. The high rates of hepatitis B and C among incarcerated women
compound this risk. Conclusion:Dental dams are not widely used by women prisoners and we question their utility in
womens prisons. Oral sex is an important risk factor for acquisition of herpes simplex virus type 1, but most women in
NSW prisons (89%) are already infected. Condoms and latex gloves may have more use. Condoms could be used as a
barrier on shared dildos and sex toys, while latex gloves could be used to protect cut and grazed hands from vaginal and
menstrual uids.
Additional keywords: Australia, cunnilingus, oral sex, prisons.
A World Health Organization report on interventions to address
HIV in prison recommends that female prisoners should have
access to dental dams and condoms
even though there is no
research evidence supporting the use of dental dams or their
effectiveness in preventing HIV transmission.
Despite more
than 10 years of dental dam provision in Canadian and
Australian prisons, we still do not know whether dental dams
serve any useful public health purpose. Anecdotal evidence
suggests that HIV can be transmitted during oralvaginal and
oralanal sex between women but such transmission is rare.
Canada and some Australian states and territories (New
South Wales (NSW), Australian Capital Territory, Western
Australia and South Australia) provide dental dams for
women prisoners. In Canada, women prisoners also have
access to condoms and water-based lubricants.
introduced dental dams in 1992
and NSW in 1996, on the
basis of parallel equity with the introduction of condoms in
mens prisons. A Canadian study briey reported on dental dam
dispensers not regularly being relled, the lack of anonymity for
users and prisoners nding the dental dams too thick.
present, free vending machines in womens prisons in NSW
dispense a small cardboard box containing one dental dam and a
plastic zip-lock disposal bag. Each year ~30 000 dental dams
are distributed in NSW prisons for a population of ~700 female
inmates (pers. comm.; S. Henry-Edwards, Principal Advisor,
Alcohol and other Drugs/HIV and Health Promotion, NSW
Department of Corrective Services).
Using both quantitative and qualitative methods, we
investigated womens consensual sexual practices in NSW
prisons with a particular focus on determining whether and
how dental dams were used, and whether they were appropriate
as barrier protection for women during sexual activities.
Telephone survey
Between August 2006 and June 2007, we conducted a computer-
assisted telephone interview (CATI) survey of a randomised
cross-sectional sample of 199 female prisoners as part of a
CSIRO PUBLISHING Research Paper Sexual Health, 2010, 7, 170176
CSIRO 2010 10.1071/SH09138 1448-5028/10/020170
larger survey of male and female prisonerssexual health
and behaviours. The sample of women prisoners represented
~28% of the total population of female prisoners in NSW. The
women were randomly selected using their prison numbers
from all four womens prisons in NSW. Those selected were
invited to participate in the survey. Women were excluded due
to insufcient English, mental illness, acute crisis, intellectual
disability, medical reasons or previous selection at another
prison. A few prisoners were not recruited because they had
been released or had died in the few days between sample
selection and recruitment.
During the survey, women were asked a series of questions
on their sexual experiences inside and outside prison,
masturbation, and use of barrier protection for sex in prison.
Full details are published elsewhere.
The women received $10
for completing the interview to compensate for time lost at work.
Data analyses were conducted using SPSS 15.0 (2006; SPSS,
Chicago, IL, USA) and c
-test analyses were used to generate
P-values to identify signicant differences between men and
women or other subgroups.
One of the limitations of the quantitative study was that
xed-response CATIs are not good for nding out peoples
understandings or why they do things. Thus we complemented
the study with a qualitative research component. Results from
the debrieng process of respondents after the survey revealed
that most prisoners accepted the telephone interview method to
elicit answers to sensitive sexual related questions. About 94%
of the men and 92.5% of the women interviewed said they would
be prepared to do another telephone interview. Only a few men
(n= 18) and no women preferred male interviewers. Many did
not mind either face-to-face interviews or telephone, and only a
minority would have preferred to do the survey with a face-to-
face interviewer, 123 (11.5%) men and 13 (6.5%) women. From
the debrieng, it appeared that the interviews made respondents
aware of the risks they had taken in the past, which prompted
them to seek health care with a public or sexual health nurse in
In-depth interviews
To complement the quantitative information, 19 in-depth
interviews were conducted, with 10 current and 9 former
female prisoners. The women were aged between 19 and
50 years with most (n= 14) born in Australia. Five were
Aboriginal, most (n= 12) had been in prison three or more
times and most had had sex while in prison (n= 14). Seven
identied as heterosexual, four as lesbian and eight as bisexual.
We purposively selected women with different sexual
orientations and sexual experiences in prison, and of various
age groups and ethnicities to ensure that a wide cross-section of
women who had been or were currently serving time in NSW
correctional centres had been included.
The interviews explored, in detail, sexual behaviours
inside and outside prison, sexual coercion and assault, and
protective sexual practices. The information from the
interviews is not intended to be representative of all women
prisoners but describes the diversity and range of sexual attitudes
and behaviours of women prisoners with different sexual
orientations and backgrounds. An interview guide was used
but the questions were not pre-scripted. The questions were
topical and open-ended, and encouraged women to open up
about their sexuality in prison in a conversational manner. Not
all topics were explored as each respondent was different
and brought up new information and experiences that the
researcher needed to investigate further, and time was limited.
The interviews with inmates were sometimes interrupted by
lockdowns, muster and security issues, which were all part
of prison life. Most of the interviews lasted about 2 h, and
were held in private ofces or interview and counselling
rooms, and were heavily monitored by security cameras and
prison ofcers looking in from the outside through glass
partitions or windows.
A snowball sampling strategy was used in prison. Prison
staff referred researchers to inmates whom they thought would
be comfortable talking about sex in prison. Referrals then
snowballed with other prisoner respondents referring their
inmate friends. Outside prison, ex-prisoners were recruited
through community organisations and through advertising
yers in methadone clinics and prisoner outreach organisations.
Prisoners received $10 (the maximum allowed in prison) and
ex-prisoners $30 for participating in the study. Community
participants received a higher rate of remuneration to
compensate for travel costs.
We completed data collection when data saturation had
been reached. Data saturation occurs when the researcher is
no longer hearing or seeing no new categories, themes or
explanations emerging from the data. The qualitative researcher
analysed the data throughout the study using NVIVO 7.0
(QSR International, Melbourne, Australia) to manage the
datasets into thematic codes. The thematic coding structure was
continuously revised as each interview was analysed. Some of
the themes were based on previous research in the quantitative
and qualitative prison sexual health literature, while new and
original themes were categorised on their own to be explored
further in future interviews.
Ethical approval
Ethics approval was provided by the NSW Justice Health
Human Research Ethics Committee and ratied by the
University of New South Wales Research Ethics Committee.
The NSW Department of Corrective Services Ethics Committee
recommended approval of the study, which was approved by the
Commissioner of Corrective services as required by the Crimes
(Administration of Sentences)Act for all research conducted
with inmates.
Researchers followed NSW Corrective Services safety
procedures for both the quantitative and qualitative
components of the study. Inmates were placed in secure
interview and counselling ofces and meeting rooms for their
interviews. No prison staff were physically present during the
survey and in-depth interviews, thus maintaining condentiality
between the interviewer and the respondent. Surveillance
cameras (visual only and no sound) and prison ofcers were
stationed outside the interview rooms but this had no impact on
the conversations, inmates were already familiar with the
procedures as it was integrated within their everyday living
Dental dam use among women prisoners Sexual Health 171
Telephone survey
Of the 238 eligible women approached, 199 women consented to
the survey. The response rate was 84%. Of the respondents, 63%
identied as heterosexual, 29% as bisexual, 7% as lesbian and
1% as other. More than a third (36%, n= 71) said they had had
sexual contact with another inmate at some time during either
the current or a previous episode of incarceration. The median
length of time in prison was just under 2 years. A third of these
women (n= 23) reported having their rst sexual experience
with another female while in prison. During the last occasion of
sex with another inmate, most had manual sex (i.e. stimulation
of the genital area with ngers or hand) and more than half
had cunnilingus (Table 1). Only 66 women (33%) disclosed
masturbating (self-stimulation) in prison; 13 women had done so
while someone else was in the same room or cell. Only eight
women (4%) reported having ever used a dental dam for sex in
prison and four (2%) had used condoms (despite their non-
availability) or gloves.
In-depth interviews
Sexual practices
Women discussed their sexual lives in relation to their long-
term and casual sex partners in prison. Womens sexual
behaviours included both non-penetrative and penetrative
vaginal and anal sex, practised alone or with one or more
female partners, in prison cells, residences and showers, and
during prison visits. The list is by no means exhaustive of
womens sexual activities since women are moved by their
limited circumstances into new and creative ways of nding
Participants repeatedly spoke of oral sex, kissing, touching,
cuddling, manual stimulation and digital vaginal stimulation
with their partner. One inmate referred to this suite of practices
as lesbians intercourse, sometimes practised when one or both
partners were menstruating.
In particular, the practice of shaving pubic hair by inmates
was brought to our attention by two female custodial ofcers
who had observed this feature during strip searches of women.
This was mentioned in one interview by an inmate who revealed
that she shaved her pubic region for hygieneand for a better
oral sex experiencewhile her sexual partner shaved because it
was fashionable.
They shave their pubic hair?
Yeah, a lot of women [prisoners] do. Like, my
girlfriend, she leaves a bit but she shaves most
of it.
Like a Brazilian wax?
Yeah, like a GT strip [three strips of unshaven
pubic hair]. A lot of women shave like that here.
I dont know why must be the thing.
You dont?
Actually, I shave all mine, pretty much. I prefer
it, yeah, bald, because its a lot smoother. And
its also more hygienic ...I dont get my periods
anymore because Ive had a hysterectomy, but
when its that time of the month, you know, its
more hygienic for that time of the month; you
dont have to worry about getting blood
everywhere through it and things like that.
Yeah, you dont have to worry about moving
all your hair out of the way while your
girlfriends trying to go down on you and
instead getting a mouthful of hair.(Female
prisoner, 35 years)
Women inmates also spoke about masturbation and how it
was sometimes difcult to accomplish privately if they shared a
room with another inmate.
A few inmates reported sometimes being involved in group
sex in prison. Two women, in separate interviews, recalled
sexual encounters involving between 3 and 10 women. The
younger woman reported the possible transmission of sexually
transmissible infections (STIs) between women involved in
group sex; she herself was later diagnosed with and treated
for gonorrhoea (Neisseria gonorrhoeae). However, this
transmission event was not conrmed.
Four of the girls that were involved in the group
sex, I found out that the four of them had
chlamydia. Is it VD or something?
Venereal disease?
Syphilis or something like that. Yeah, that. And
one of them had herpes. The warts or whatever
they are.
Genital warts?
Yeah, them things, yeah. And Ive heard of
other girls whove just had one-on-one sex,
theyve got chlamydia. That was the main STI
I heard of girls getting in jail, was chlamydia.
But I ended up catching gonorrhoea; I found
out when I got out of jail.(Female ex-prisoner,
19 years)
Sex toys
Sex toys, mainly dildos, featured in womens sexual
activities. Most women interviewed either had home-made
dildos or strap-ons in their possession in prison, or they knew
of another inmate who did. Women described dildos made in
prison from different materials including vegetables, frozen
meat, deodorant bottles, gloves, clay, sanitary pads, milk
cartons and headphone muffs.
Table 1. Sexual practices of women inmates at last sexual encounter
with another inmate (n= 71 of 199 women sampled)
No. %
Manual sex (respondents vaginal area) 60 84.5
Manual sex (respondents hand) 60 84.5
Cunnilingus (respondents vaginal area) 44 62.0
Cunnilingus (respondents mouth) 40 56.3
172 Sexual Health L. Yap et al.
...say youve got, like, the sanitary pads, like
theyll roll them up to the shape of a thing
[penis] or whatever and then put, say, either
something hard in the middle, you know, and
then wrap them up in the dental dams. Ive seen
double-enders and single ones [dildos].
(Female prisoner, 28 years)
Dildos were sometimes often discovered during cell searches
by prison ofcers, to the inmatesembarrassment. Others had
successfully smuggled vibrators into prison. One inmate had lent
her vibrator to other women.
One enterprising prisoner made and sold reusable strap-on
dildos for other inmates.
I had a couple of girls actually ask me if I could
make them one. And Ive gone, Its easy; just
get yourself a set of straps off the overalls.
I said, Stitch them on to the end of the bottle.
I said, Put a bit of padding there.I said, You
need padding because its going to hurt you as
well.I prefer to make one thats reusable, that
you can wash and use it anytime, anywhere,
whatever. And yeah, not have to keep tearing it
apart and remaking it every time you use it. With
mine, you just tie it on, and then you just untie it,
wash it and its ready to go again.(Female
prisoner, 35 years)
Other respondents indicated that dildos (single or double-
ended) were used both for masturbation and to sexually
stimulate one or more partners. Without being covered with a
fresh condom or washed, dildos were shared between women in
group sexual encounters. On one occasion, an unred clay dildo
had disintegrated while being used by an inmate and required a
hospital attendance.
Dental dams
While dental dams are the only routinely available means of
sexual barrier protection available inside womens prisons in
NSW, several women interviewed also mentioned the use of
condoms or gloves (n= 2) or said they had encouraged their
partner to use the prison clinic sexual health screening services
(n= 1).
Two women interviewed who had had same-sex encounters
in prison had used dental dams, either as a one-off or as a regular
practice with casual partners.
But Ive always used dams, especially on, as
I was saying, women that Ive only known for a
couple of weeks; or on the two or three
occasions where I have slept with someone on
the rst time of seeing and meeting them, Ive
used them as well.(Female prisoner, 35 years)
Others preferred to have sex without dental dams since they
saw it as more naturalor they perceived their partners not to be
at risk. As one prisoner illustrated to the interviewer,
Have you ever used the dental dams?
Is there a reason why?
No, because I havent really, like I said, only the
one person [her current partner] that Id ever
[sleep with], you know. And I was comfortable
enough with her to [not use dental dams], you
know, shes anally clean [not promiscuous], you
know.(Female prisoner, 25 years)
Apart from sex and dildo manufacture, dental dams were also
used in prison to manufacture hair ties, shoelaces or placemats.
Availability of dental dams
Most women interviewed said that dental dams were
available to them in prison, although two women reported
that they had heard of but had never seen a dental dam while
incarcerated. One said, Oh yeah, I know what they are. No,
never took one,(ex-prisoner, 24 years). Another woman
reported that dispensing machines had not been lled in a
long time or were quickly emptied (ex-prisoner, 38 years).
Our observations in one prison found that one dispensing
machine was lled with dental dam kits but the box had
become wet from the rainy weather as the vending machine
was located outside a residential prison block. Another vending
machine in a segregated unit of a womens prison was empty.
Perceptions of dental dams
Women, even the few regular users of dental dams, reported
that they did not like the taste or feel of the dental dams from the
vending machines. They found that they tasted powdery, plastic
or rubbery; were not avoured; and were too thick or dry,
reducing sexual sensations during oral sex.
They taste terrible. Ive put it up in my mouth,
and sucked it in and fucked around with it. It
tastes funny. Powdery plastic shit. Theyre not
avoured.(Female prisoner, 26 years)
No, generally people just gig the dental dams,
because theyre plastic, and, you know, if youre
going down on someone, you know, your
tongues [on her], theyll feel the pressure of
your tongue but theres no wetness there, and it
sort of kills the whole thing.(Female prisoner,
28 years)
But a couple of the girls that Ive shown have
used them, and it was also them that said,
Theyre too thick; you cant feel anything
through them,you know. I agree with them;
they are thick, these ones. Its like theres about
ve of them together, because theyre that thick.
(Female prisoner, 35 years)
Knowledge of how to use dental dams
In addition, women commented on the lack of information
sheets on how to use dental dams. Without this information, they
pointed out, inexperienced women would not be able to use the
dams even if they wanted to.
Dental dam use among women prisoners Sexual Health 173
Ive had a lot of girls say to me, How the fuck
do you use one of these?Thats like, Oh,
youre kidding me.Well, how do you think
youd use one? Its not something that you
just roll on and slip over, you know. Were
girls. Its, like, exactly Well, how would you
use it?Its, like, Youre kidding?Its, like,
Why?”“Well, just in case.Its, like, Dont
give me just in casejust because you want me
to show you how to use them. If youre seriously
going to use one, Ill show you roughly how to
use them, but if not, Im not even going to
bother.”’(Female ex-prisoner, 45 years)
It was women experienced in woman-to-woman sex who
often taught their new partners how to use dental dams. A
respondent suggested that dental dam kits may need to
display instructions on the plastic bag or include an
instruction pamphlet.
Condoms were not routinely available in womens prisons
but one inmate was able to obtain condoms from a prison ofcer.
She used them when digitally stimulating her sexual partner.
Gloves were also used during sex. Latex examination gloves
and thick rubber kitchen gloves were available throughout the
prison industrial complex. They were available in prison clinics
and prisoner work areas, and were used by prison ofcers during
clothing, cell and body searches.
One woman prisoner, a former sex worker who had regularly
visited the Sydney Sexual Health Centre and was well informed
about STI and HIV transmission, said she used gloves to protect
herself and her sexual partner from infection through cuts on her
hands from prison work.
I was doing the recycling, so I was tearing the
headsets apart, so tearing them apart, I was
getting like bits of wire and plastic stuck into me
cuts everywhere. So, yeah, I had to look after
my own [sexual] safety, so I used to wear rubber
gloves. When Im using my ngers [for sex] and
things like that, if I dont know them, Ill use a
rubber glove.(Female prisoner, 35 years)
Women inmates sometimes experienced cuts and abrasions
from cleaning, kitchen work, ground maintenance, farming and
other tasks. This woman said she could not get rubber gloves at
her prison residence but could obtain them at work or from
prison staff, making up excuses about dyeing her hair or
bleaching the bathrooms.
Prison health clinic access
Other inmates used the free prison clinic blood and sexual
health screening services as a protective measure. Prison
clinic staff meet prisoners on entry, offering voluntary
screening for syphilis, HIV, hepatitis B (HBV), hepatitis C
(HCV), chlamydia (Chlamydia trachomatis) and gonorrhoea.
One inmate, who expressed concern about disease transmission
through sex, asked her sexual partner to visit the prison clinic
and to undergo blood-borne virus and STI testing before they
continued their sexual relationship.
I tell her. I say, This is accident the rst time
[sex]. Could you please, can you go and ask the
doctor to go into the clinic to ask do you do
blood test before [on entry]....I say, You sure
you dont have any sickness or anything that you
can given to me?She say, Why you make a
thing like that?I say, Because I heard that
they say that when you using drug that you can
get the no good blood....She say, No. If
you share the needle, yeah. But I dont use
needle. I only smoke.And I say, Im scared
that maybe you sleep with the other woman
before. Maybe she got a germ.And she
saying to me she was very upset. I say,
Dont be upset because at least Im honest.
Because I say that Im horny to her, Im horny
but Im not that horny to get sick from you and
when I get out I gonna give to my kid.I say, At
least Im being honest with you. That you know
me that Im not a slut to go around
know.(Female prisoner, 28 years)
More than one-third of women reported having sex with another
inmate while in prison, with manual sex being the most common
type of sexual activity. Around 60% of those engaging in sex
reported oralgenital contact at their last encounter. Despite
dental dams being freely available in NSW prisons for over a
decade, only 4% of the women surveyed had ever used one in
prison for sex.
The low uptake of dental dams during oral sex could be due
to one or more of the following reasons: (1) a low perception of
disease transmission risk, (2) a lack of knowledge of how to use
dental dams, (3) a lack of availability, (4) a lack of access,
(5) dislike of dams reducing pleasure during cunnilingus and
(6) dislike of the taste. Without quantitative data, it is difcult to
generalise which are the most likely reasons for the low uptake
of dental dams. However, we previously documented that dental
dams were diverted for purposes other than sex in prisons,
although there were no signicant adverse consequences
linked to their free distribution.
Several studies in a variety of populations have found dental
dams to be almost universally disliked except in commercial sex
Oral sex is an important risk factor for genital
acquisition of herpes simplex virus type 1 (HSV-1), but most
women in NSW prisons (89%) are already infected.
In the
absence of any efcacy data on dental dams preventing the
transmission of STIs attributable to the rarity of such
transmission during oralgenital sex between women,
to the difculty of designing and executing a population-based
study capable of detecting such transmission
we suggest that
good quality dental dams be available upon request from the
prison clinics and that prison health workers promote the use
174 Sexual Health L. Yap et al.
of improvised dams by cutting up latex condoms or gloves
(if available) or perhaps by using cling wrap, made of
polythene lm. Cling wrap is known elsewhere as clinglm
or plastic wrap, or by brand names such as Glad Wrap or Saran
Wrap. The product would be a cheaper and more acceptable
option than dental dams, as it is clear, thinner and tasteless, and
has heat-transferring properties which make it more sensitive
than latex dental dams. Cling wrap is already available in
kitchens in some low-security settings and could be made
available in clinics. However, cling wrap is not a registered
therapeutic device and, unlike condoms,
no studies have been
done on its impermeability to STI pathogens. Hence authorities
are reluctant to formally recommend its use. Nonetheless, as the
operation of any barrier for cunnilingus is primarily through its
being watertight, it is possible that cling wrap would be at least
as effective in practice as the (rarely used) dental dams currently
provided. Unfortunately, although the acceptability of cling
wrap could be investigated, and its in vitro permeability to
STI pathogens could be studied, its in vivo effectiveness for
STI prevention in oral sex between women cannot be established
for the reasons discussed above.
Although we have no quantitative data on the extent of dildo
sharing among women prisoners, this provides a more plausible
risk of STI and blood-borne virus transmission. Similarly,
blood-to-blood contact from razor sharing could also pose a
risk of blood-borne virus transmission. The same is true of
injecting drug use, which was not explored in this study. The
high rates of HBV (31%) and HCV (64%) among incarcerated
women compound this risk.
Sexual transmission of blood-
borne viruses could occur in the presence of menstrual blood or
of open wounds such as cuts and grazes on hands and ngers
during manual sex.
In conclusion, we recommend that sexual health education in
womens prisons discourage the sharing of razors (and injecting
and tattoo equipment) and educate women on STIs, HBV and
HCV, and different types of barrier protection used in woman-
to-woman sex, even if mutual trust exists between sexual
partners. Apart from HIV/AIDS programs, there are no
sexual health education programs targeting woman-to-woman
sex in NSW prisons. As women prisoners are entitled to
protection from STIs and blood-borne infections, in addition
to better quality dental dams, this study shows that condoms and
latex gloves are useful in woman-to-woman sex in combination
with sexual health education. Condoms could be used as a
barrier on shared sex toys, while latex gloves could be used
to protect cut and grazed hands from vaginal uids.
Conicts of interest
None declared.
The Sexual Health and Attitudes of Australian Prisoners study was funded by
NHMRC Project Grant No. 350860. Additional funding was provided by the
NSW Department of Health and the Faculty of Medicine, University of New
South Wales. Tony Butler was supported by the Centre for Health Research
in Criminal Justice during much of the project, and Juliet Richters
and Lorraine Yap were at the National Centre in HIV Social Research,
University of New South Wales until mid-2007. Tony Butler is supported by
an NHMRC Career Award (ID No. 350992) and Basil Donovan is supported
by a NHMRC Practitioner Fellowship (ID No. 568613). We also would like
to thank Luke Grant, Assistant Commissioner for Offender Services and
Programs, NSW Department of Corrective Services, for additional
information and insightful comments on this paper and Max Saxby,
NSW Department of Corrective Services, for his assistance in facilitating
access to each prison. We are grateful to all prison staff, current and former
prisoners, and prisoner community organisations who contributed to this
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176 Sexual Health L. Yap et al.
... 3 Additionally, some report decreased pleasure and sensation with a dental dam in place 4 and a dislike of the taste. 8 The Ronald O. Perelman Department of Dermatology at New York University School of Medicine operates a STI clinic as part of the dermatology services offered at Bellevue Hospital Center. By rotating at this clinic, dermatology residents are able to gain insight into the diverse mucocutaneous manifestations of STIs and learn how to manage conditions, such as anogenital warts, gonorrhea, chlamydia, herpes simplex virus, and syphilis. ...
Full-text available
Dental dams are a barrier method of protection, which may help prevent the spread of sexually transmitted infections during oral-vaginal or oral-anal sex. Despite their relative simplicity of use, data on dental dams are limited and patients infrequently utilize this method of barrier protection because of the lack of awareness, perceived barriers to procurement and accessibility, and unfamiliarity on the part of health educators. Nevertheless, increased knowledge of dental dams may be beneficial especially in high-risk populations, where sexually transmitted infections are more common and remain a significant cause for morbidity. This article aims to increase awareness and knowledge of dental dams, as well as provide an informational guide on their procurement and use that may be helpful to dermatologists when counseling patients.
... In-depth interviews were conducted in New South Wales, Australia as part of the qualitative research component of the Sexual Health and Attitudes of Australian Prisoners (SHAAP) study (Wilson et al. 2017;Yap et al. 2010;Yap et al. 2011), which included a larger quantitative cross-sectional randomised survey of sexual attitudes and behaviours of male and female prisoners in New South Wales and Queensland prisons . We used an inductive or grounded theory framework as very little was known on the sexual behaviour and sexual identities of Australian prisoners prior to the study and elsewhere. ...
Many papers have been written on the process of coming out by individuals with predominantly same-sex sexual orientation but few of these papers have explored the concept of how people negotiate the idea of coming out in prison. We conducted in-depth interviews with 13 prisoners and one ex-prisoner in New South Wales, Australia, who self-identified as gay, homosexual or bisexual men. Data was collected and analysed using an inductive or grounded theory framework since very little was known on the sexual behaviours and identities of Australian prisoners prior to the study and elsewhere. We examined and discussed the lived experiences of prisoners whose disclosure stories were seen to fall under four thematic categories: ‘coming out’, ‘forced out’, ‘going back in’ and ‘staying out of the closet’ on entering prison. Respondents were required continuously and contextually to manage their sexual identities and disclosure to different audiences while incarcerated. Findings suggest that the prison environment and its attendant heteronormative values and hyper-masculine culture, apply significant pressure on gay and bisexual men on how to manage their sexual identities and disclose their sexuality in prison.
Purpose: Incarcerated women are a vulnerable population in terms of sexual and reproductive health. In French Guiana, most incarcerated women come from unsafe environments and are incarcerated because of drug trafficking. Medical follow-up processes used in prison (medical assessment on arrival, and then two half-days per week upon request but without an obstetrician-gynecologist) does not allow for a thorough assessment of the impact of incarceration on women prisoners' health to take place. In the absence of data, the purpose of this study was to describe incarcerated women's experiences in relation to sexual and reproductive health. Design/methodology/approach: Semi-structured interviews were conducted among French-speaking adult women who had been incarcerated for at least four months in a French Guianan prison. Menstruation, contraception, pregnancy, abortion, sexually transmitted infections and sexuality were described by means of interpretative phenomenological analysis. Findings: A total of 14 women were interviewed. They suffered from menstrual cycle disorders, poor hygiene and menstrual insecurity. They appeared to have emotionally disinvested sexuality. However, intra-prison sexual activity existed for some (masturbation, conjugal prison visits, homosexual intercourse between fellow prisoners). Homosexual relations were a source of discrimination. Being pregnant while incarcerated was viewed negatively. A lack of knowledge about sexual and reproductive health and high-risk behaviors such as piercing and tattooing practices were widespread. Originality/value: Incarceration is a vulnerable time for women's sexual and reproductive health. Sexual activity exposes women to risks and discrimination that should be taken into account in a multidisciplinary approach adapted to the prison environment.
Purpose The imprisoned population is increasing worldwide and is overrepresented in the HIV epidemic. The purpose of this paper is to explore the HIV vulnerability of female Filipinos who are pre-trial prisoners, as the specific needs of imprisoned women are poorly understood and fewer resources are granted to pre-trial detainees, especially in low and middle-income countries (LMICs). Design/methodology/approach This study was based on a Qualitative Descriptive Design. In total, 18 semi-structured interviews were conducted with prisoners and NGO directors. Data were analysed through Framework Analysis, using the individual, social and community categories of the Modified Socio-Ecological Model. Findings Results from this study suggest that the prison environment and management practices maximise the HIV vulnerability in the sample. This vulnerability is shaped by low HIV knowledge, combined with the existence of multiple social vulnerabilities prior to incarceration. Social implications HIV care in Filipino prisons needs urgent attention from government and international organisations, as it is a major public health and human rights concern. International goals of ending the epidemic by 2030 cannot be reached if efforts are not translated into action within this setting. Originality/value In the Philippines, few studies have addressed this issue and little is known about the conditions of Filipino prisons. This paper aims to fill a gap in literature regarding the vulnerability of imprisoned women in LMICs, which is even more limited in examining pre-trial detention.
Prevalence rates indicate that receptive anal sex is increasingly part of heterosexual women’s sexual repertoire. However, there is a body of literature linking this behavior to risk for adverse sexual health outcomes. Women’s anal sexual health knowledge and awareness of behaviors associated with elevated risk have received less attention in the research literature. The aim of the current study was to examine anal sexual health knowledge and product use among heterosexual women aged 18 to 30 years. A total of 33 self-identified heterosexual women recruited from the general population participated in one of six focus groups. The results suggest that knowledge was variable. Salient sexual health themes centered on risks of human immunodeficiency virus/sexually transmitted infections (HIV/STIs), other infections, and physical harm/damage. Product-use themes included cleanliness/hygiene, comfort, and product safety. Participants expressed the desire for anal sexual health education. The results have implications for sexual health research, education, and clinical practice.
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This guideline provides evidence-based guidance on the content of safer sex advice and the provision of brief behaviour change interventions deliverable in genitourinary (GU) medicine clinics. Much of the advice is applicable to other healthcare settings including general practice and clinics providing HIV care. Advice on condom use and effectiveness, oral sex and other sexual practices, testing for sexually transmitted infections (STI) and partner reduction is provided. Advice specific to the transmission of HIV infection including seroadaptive behaviours and negotiated safety is also included. An accompanying review of the evidence supporting the guideline with a complete reference list is available online. A patient information leaflet based on the advice statements developed is also available through the BASHH website.
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National population surveys of attitudes towards sexual issues typically exclude prisoners and little is known about their attitudes compared with the community. Using computer-assisted telephone interviews, we compared a representative sample of 2289 prisoners (men=1960, women=329), aged 18-59 years, from two Australian states against a national community sample of 6755 participants (men=3333, women=3421). Overall, prisoners were slightly more conservative in their attitudes towards sex than the community. They were more likely than the community to agree with the statement that abortion is wrong (men: adjusted odds ratio (AOR)=3.3, 95% confidence interval (CI): 2.8-3.9; women: AOR=1.7, 95% CI: 1.2-2.4) and that male homosexuality is wrong (men: AOR=2.6, 95% CI: 2.2-3.1; women: AOR=1.7, 95% CI: 1.2-2.3); these differences were more pronounced for men than women. The attitudes of prisoners and the community varied with age. Attitudinal differences between prisoners and the community tended to be larger than the differences between women and men (agree that abortion is wrong: prisoners, AOR=0.5, 95% CI: 0.4-0.7; community, AOR=0.8, 95% CI: 0.7-0.9; agree that male homosexuality is wrong: prisoners, AOR=0.4, 95% CI: 0.3-0.5; community, AOR=0.6, 95% CI: 0.5-0.7). Prisoners have either similar or less accepting attitudes towards sex than the general population. These attitudes contrast with the higher engagement in risk behaviours reported by prisoners.
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Safer-sex information for women who have sex with women (WSW) is often very difficult to locate. is one of the only websites focussed on safer sex for WSW. The present article describes the predevelopment consultation and evaluation of A risk-reduction framework was used to develop the website. was developed in 2004 using questionnaires and focus groups with 36 consumers who were WSW, largely based in Canberra, Australia. In 2006-2007 the site was evaluated using mixed methods of questionnaires with 74 WSW and interviews with 17 health professionals around Australia. This research has identified some key attitudes toward safer sex of WSW participants, in particular a misperception that the majority of WSW are at low risk for sexually transmissible infections and a consistent aversion to using latex for safer sex. The article concludes that the promotion of a risk-reduction approach - including non-latex-based safer-sex practices - for WSW is both a theoretically appropriate and engaging form of health promotion for WSW.
Mild, benign postpartum depression is an often overlooked aspect of the birth process. This study investigated the prevalence, symptomatology, and attending risk factors of mild postpartum depression. Utilizing a self-rating index of depression results from 108 women indicated an overall prevalence rate of 84%, with 21% of the respondents having developed a relatively severe depression. Some of the more frequently encountered symptoms included tiredness, insomnia, irritability, and unprecipitated, episodic crying. Such characteristics as education, maternal age, parity, employment status, enrollment in prenatal classes, and husband's assistance in the home were examined for their relationship to postpartum depression. Using the Chi-square statistical test, significant relationships were found between postpartum depression and both maternal age and the amount of assistance in the home by the husband. These two factors were also found to be important relative to other variables using stepwise regression. In addition, results of the regression analysis indicated that prior expectations of depression and age spread between a woman's oldest and youngest child are associated with the depression syndrome. Other results illustrate the flow of such medical information in that a majority of women became aware of the syndrome by reading about it, while the least common source of information was their physician.
A community-based HIV prevention project for lesbians and bisexual women was implemented in San Francisco from June 1, 1993 to June 30, 1994. The purposes of this qualitative intervention research were to (a) discover HIV risk-taking and HIV risk-reduction activities of lesbians and bisexual women and (b) offer them context-specific HIV prevention education. Twenty peer researchers conducted open-ended field interviews with a racially diverse sample of 563 lesbians and bisexual women in naturalistic settings including women''s bars and dance clubs and lesbian/bisexual community events. Sexual and drug use practices reported by lesbians and bisexual women demonstrate that they are indeed at risk for HIV Content analysis revealed that emotion-driven, socially motivated practices underlie lesbians'' and bisexual women''s HIV risk behaviors and attempts at risk reduction. Findings about emotional and social contingencies challenge conventional cognitive approaches to HIV prevention.
Dental dams are distributed and promoted in some safer sex campaigns for use in oral sex. However, whether and how often dams are used for sex between Australian women remains unknown. We investigated the use of dental dams for sex by lesbians and other women who have sex with women, and the relationship between dam use and sexual risk for this group. In 2004, a self-completion questionnaire was distributed to women attending the Sydney Gay and Lesbian Mardi Gras Fair Day and lesbian community venues and health services in Sydney (n = 543). Among the 330 women who had had oral sex with a woman in the previous 6 months, 9.7% had used a dental dam and 2.1% had used one 'often'. There was little evidence of dam use for prevention of sexually transmissible infections. Although women who practised rimming (oral-anal contact) or had fetish sex involving blood were more likely to have used a dam, dam use was not significantly more common among women who had more partners, or had casual or group sex. Some women avoided oral sex during menstruation or had oral sex with a tampon in place. Latex gloves and condoms were used by more women and more often than dams.
We describe a 24-year-old woman infected with the human immunodeficiency virus (HIV) whose sole risk behavior was prior sexual contact with an HIV-infected woman. Our patient's clinical course suggests that viral transmission occurred during the beginning of their sexual relationship. Our case, combined with those previously reported, provides evidence that female homosexual activity can be a risk behavior for acquisition of HIV infection. Seroprevalence studies, however, have not provided evidence for transmission of HIV by this behavior. These studies, combined with the sparse number of individual case reports, suggest that female homosexual activity is an inefficient mechanism of HIV transmission.