Medical Foundation for Aids and Sexual Health

Prescribing of condoms in prisons: survey report (1997)

Contents

Background and introduction
Survey method and response data
Quantitative findings: awareness of condom prescribing arrangements
Issues raised by qualitative responses
Conclusions
Recommendations
Acknowledgements
References
Annex 1: "Dear Doctor" letter
Annex 2: covering letters and questionnaire

Background and introduction

This report describes the findings of a questionnaire survey into the availability of condoms within prisons which was undertaken by the BMA Foundation for AIDS, in association with the National AIDS and Prisons Forum, between September and November 1996.

Provision of condoms within prisons for the prevention of HIV and other sexually transmitted infections has been a matter of debate in the UK and internationally from as early as 1987, when a World Health Organisation (WHO) expert consultation called for "careful consideration" of condom availability for disease prevention in prisons1. During 1988 the British Medical Association adopted policy that condoms and health education on the risks of HIV infection
should be freely available in prisons, and the Prison Reform Trust took a similar view2. Since then, various countries have introduced condoms within their prison systems without encountering substantial problems, and by 1993 WHO felt able to strengthen its position and state that "Since penetrative sexual intercourse occurs in prison, even when prohibited, condoms should be made available to prisoners throughout their period of detention [... and] prior to any form of leave or release"₃. WHO added that prison authorities have a responsibility to combat sexual violence and exploitation within prisons.

Progress in England and Wales has been slow. In 1991, HM Prison Service initially began to encourage prison governors to introduce schemes whereby prisoners being released from custody (permanently or temporarily) could have access to condoms. A thorough review by the Service's AIDS Advisory Committee4 recommended in 1995 that all prison establishments should be required to introduce such schemes, and said that there was "an unanswerable public health case" for condoms to be made available to male prisoners while serving their sentences, despite the lack of hard evidence on the extent to which penetrative anal sex occurs. The Committee similarly called for dental dams to be made available to women prisoners. The Home Secretary accepted all the Committee's recommendations except the one relating to making condoms available to male prisoners during sentence, and consequently HM Prison Service has not been able to implement this recommendation. This means that there is no scheme for general availability of condoms throughout the service, although governors are not prevented from distributing condoms within their prisons.

Given the lack of general availability of condoms, there were concerns about the potential legal liability of prison medical staff if a prisoner contracted HIV or other infection sexually while in prison. For this reason, Dr Rosemary Wool CB, the Prison Service's Director of Health Care, issued a "Dear Doctor" letter dated 16 August 1995 (see Annex 1) encouraging prison doctors to prescribe condoms and lubricants to individual prisoners, when in the doctor's clinical judgement there is a known risk of HIV infection through sexual behaviour. The letter stated that there might be a legal risk of a doctor being found in breach of his/her duty of care for not providing condoms when circumstances warrant, and that homosexual acts between consenting adult prisoners are not automatically unlawful as a prison cell is often capable of being deemed "a private place" under the relevant law. It is Prison Service policy, accepted by Home Office ministers, that doctors can prescribe condoms to prisoners within the circumstances covered by Dr Wool's letter.

The BMA Foundation for AIDS believes that condoms should be available in all prisons without the need for direct involvement of health care staff. However, since this has not yet been achieved, the Foundation wished to draw attention to the "Dear Doctor" letter and to assess how its guidance has been implemented in practice. The Foundation accordingly conducted a questionnaire survey as described in the remainder of this report. It should be stressed that this was not an entirely neutral research exercise, since survey respondents were informed of the Foundation's views, and the findings should be interpreted against this background.

Survey method and response data

A questionnaire with a covering letter signed by Dr Fleur Fisher, vice-chairman of the BMA Foundation for AIDS (Annex 2) was sent addressed to the "Senior Medical Officer" of each of 126 prison establishments in England and Wales at the start of September 1996. In mid October 1996, a follow-up letter and another copy of the questionnaire was sent to the senior medical officer of each establishment from which no identifiable response had been received. As a result, 76 questionnaire responses and one letter stating refusal to respond were received by 29 November 1996, and have been included in the analysis.

These 77 responses may not correspond to 77 prison establishments, for the following reasons:

Some respondents sent combined responses covering more than one establishment in which they worked. This was apparent from the response in four instances, but may have been inapparent in other cases.
More than one response may have been received from some establishments. One way this could have occurred was through the follow-up letter being sent to establishments from which anonymous replies had already been received. Although the follow-up letter foresaw this problem and asked recipients not to reply if a response had already been sent from their establishments, it is possible that some may have done so.

Table 1: Response to questionnaire

Establishments to which questionnaire was sent	Completed questionnaires received	Refusals
126	76 (60%)	1 (less than 1%)
	Of which 20 (26%) were anonymous

Quantitative findings: awareness of condom prescribing arrangements

At a quantitative level, responses to the questionnaire showed good awareness of the arrangements whereby doctors are encouraged to prescribe condoms as set out in the "Dear Doctor" letter. More than 90% of respondents said that they had received the letter, that they had passed it on to at least one other person within their prison establishment, and that all doctors working in the establishment were aware of it. Somewhat fewer respondents, 71%, said the letter had been discussed by the AIDS management team or multidisciplinary HIV team at their establishment. However, this is not surprising in view of another survey, conducted at around the same time, suggesting that about 20% of establishments do not have such a team (National AIDS and Prisons Forum, Report 1995/1996).

Most respondents reported that they had taken at least some positive steps to fulfil their duty of care in respect of prescribing condoms to prisoners who might be at risk of HIV. In many cases, the information given was quite vague, and there is a degree of subjectivity in the categorisation of responses into whether or not any steps were being taken. It was noteworthy, however, that when asked how they monitored the prescribing of condoms, 28% of respondents volunteered the information that no condoms had been requested by prisoners. Where some method of monitoring was reported, it was most commonly through pharmacy records or stock checks.

The quantitative results are summarised in the following tables. All percentages are based on the number of completed questionnaires received (76). Because of rounding errors, they may not add to 100%.

Comparison between different types of establishment

An attempt was made to analyse the questionnaire responses according to different types of prison establishment, ie: whether holding male or female prisoners; whether for adults or young offenders; and whether open or closed (the latter comprising local, training, remand and dispersal prisons). This was difficult because:

some responses were anonymous
some responses covered more than one establishment at which the respondent worked
some prisons combine more than one type of establishment
only small numbers of responses were obtained from some types of establishment. This appears to reflect actual numbers of prisons, most of which are adult male closed establishments, rather than differential rates of response to the questionnaire.

However, it is possible that there were statistically non-significant trends towards greater condom availability in adult as compared to young offender institutions, in male as compared to female ones, and in open as compared to closed ones.

Table 2: Awareness of "Dear Doctor" letter

	Yes	No	Don't know/no answer
Did you receive the Dear Doctor letter from Dr Wool?	72 95%	2 3%	2 3%
Did you pass this letter on to anyone else at your establishment?	69 91%	5 7%	2 3%
Was the letter discussed by your AIDS Management Team/Multi-discliplinary HIV Team?	54 71%	15 20%	7 9%
Are all the doctors working with your establishment aware of this letter?	71 93%	5 7%	0 0%

Table 3: Steps taken in relation to condom prescribing

Any steps reported No steps reported No answer

What steps have you taken to ensure that you have fulfilled your duty of care in respect of prescribing condoms? 64 84% 11 14% 1 1%

What steps have you taken to ensure that this duty of care is carried out by those involved in health care at your establishment? 60 79% 15 20% 1 1%

What steps have you taken to ensure that prisoners who may be at risk of HIV are aware that condoms can be prescribed? 57 75% 18 24% 1 1%

Table 4: Monitoring of condom prescribing

Any method reported No monitoring reported Condoms not requested*

How do you monitor the prescribing of condoms at your establishment? 34 45% 21 28% 21 28%

*Note: Based on unsolicited comments volunteered by respondents as this question was not asked.

Issues raised by qualitative responses

The foregoing quantitative analysis provides a crude summary of whether the survey respondents had taken steps to implement the "Dear Doctor" letter from the HM Prison Service Director of Health Care. However, their written comments revealed a variety of additional issues affecting the extent to which condoms are genuinely accessible to prisoners who may be at risk of HIV or other infections. These comments are grouped under the following headings:

How is the availability of condoms made known?

Most responses suggested that health staff and key personnel such as HIV counsellors were aware of arrangements for providing condoms. In some establishments steps had clearly been taken to ensure that prisoners knew how condoms could be obtained:

"Published to all prisoners. Induction etc"
"Advertising"
"The Governor published a notice to all inmates..."
"Posters and other info throughout prison"
"A leaflet is provided"
"Information within prisoner information package"
"HIV team informing new prisoners"
"National and local radio coverage. Also individual consultation and inmate training"
"Progressive health education programme..."

This approach is not entirely unproblematic, however:

"Notices ... were put up, but defaced by prisoners"
"We don't advertise but each year we have an AIDS day and then those who attend are made aware." This raises questions about those who do not attend and about new prisoners entering between AIDS days.

In other establishments, it appeared that only inmates who were identified as being at possible risk of HIV or other sexually transmitted infections, through consultations with health personnel or counsellors, would be told that condoms could be provided:

"Patients at risk informed by HIV consultant on twice weekly visit"
"Through the normal counselling of prisoners by HIV trained staff and doctors"
"GUM specialist, confidential counselling"
"All persons who come to my attention as at risk are advised by me re condoms"

This seems problematic, since it may be unrealistic to expect prisoners to disclose risk behaviour to health workers/counsellors unless they already know that condoms are available. Some respondents reported that no individuals at their establishments were thought to be at risk (and, by implication, that no inmates were offered condoms for use while in prison):

"So far no inmate has been identified with such issue here .... I have no problem in implementing [Dear Doctor letter]" (from a respondent who reported no action taken to implement it)
"The only HIV cases I am aware of are interviewed. All are due to drug injecting."
"No inmates known to be specifically at risk" [high level of drug taking acknowledged, but all smoking, not injecting]

While the true level of sexual activity in prisons is unknown, it seems reasonable to fear that these responses show unwillingness of prisoners to disclose risk behaviour and/or health workers not doing enough to elicit such information.

How are condoms made available, and what does "prescribing" mean?

There were huge variations in the ways in which prisoners could obtain condoms in different establishments. In some, condoms were widely available, and this appears to have pre-dated the "Dear Doctor" letter. Quotes from respondents at two open prisons were:

"For several years condoms have been freely available to whomsoever wishes. They can be obtained from health care, reception and gate, no questions asked just "help yourself"..."
"Free access. Not monitored specifically."

In other cases, "prescribing" appeared to have been interpreted as requiring at least some involvement from medical or health care staff. Respondents from several establishments said that nurses and/or counsellors could issue condoms in confidence without consulting a doctor. Other quotes were:

"Reception inmates are made aware that if they require condoms then they have to ask"
"We have free access ... explained to all inmates ... dispensed by nurse as required"
"Freely available ... via the medical officer"
"Available in the pharmacy and have been issued once"
"We will issue them when counsellor backed by GUM physician authorises their use" [notices to be posted about HIV, hepatitis and personal counselling in such a way that no one will be able to tell the specific reason why an inmate consults the counsellor]

Some responses suggested that the requirement for prisoners to ask for condoms might pose a barrier to their use. In particular, condom provision seemed easier in circumstances where prisoners were leaving an establishment than where sex might be taking place inside the prison walls. For example a prison where there were "2000 condoms in situ" found that the only demand was from prisoners going on home leave. A number of respondents stated that no prisoner had asked for condoms but that these were routinely given to those leaving the establishment. This finding may well reflect the stigma attached to homosexual activity within the predominantly macho prison culture. Such stigma may affect both the numbers of prisoners who engage in homosexual behaviour, and the likelihood of asking for condoms or advice among those who do so.

Whereas in some establishments "prescribing" of condoms seemed to be interpreted very loosely, in others the term was taken more literally. One respondent stated that condoms are not "a legal prescription item" and expressed concern about the potential legal liability of medical staff if they issued condoms which were not recommended by the manufacturers as suitable for anal intercourse, and an inmate subsequently contracted HIV. The establishment in question appeared to be dealing with this creatively, by installing a free dispensing machine from which inmates could get condoms without direct medical involvement. It is possible, however, that similar concerns might have led other establishments not to provide condoms at all.

Another respondent queried why clinical judgement in issuing condoms was felt to be necessary in the prison service when this is not the case in the NHS:

"Is this policy politically or medically appropriate? ... Why should patient have to disclose to GP.... Why not issue on request from health care staff (not necessarily doctor) ...[or] sell in prison canteen etc? ... I am fully aware of the very real political realities however I have heard no argument to counter the above."

Resistance to condom provision in certain types of prison/for certain types of prisoner

Some respondents considered that provision of condoms was inappropriate because of the prison population served. For example, the sole person who wrote a letter refusing to respond to the survey stated that s/he was "unable to complete this questionnaire" because s/he was working in a female establishment. Another wrote on the questionnaire that "condom prescription is not applicable" for the same reason. However, some respondents from other female establishments reported that they had taken steps to implement the "Dear Doctor" letter by providing condoms to inmates being discharged or going on home leave/town leave.

Similarly, respondents from two young offender institutions said that they did not provide condoms because "many [inmates were] legally under age for consent" and "all inmates under 18 ... letter does not apply". Again, some other respondents from young offender institutions did not appear to regard this as a barrier to condom provision.

Another respondent from an adult prison stated that "condoms [are] not prescribed because of the high numbers of sex offenders. Also seen as condoning homosexuality". While concerns about sexual abuse and exploitation in prisons may be valid, this respondent's reference to "condoning homosexuality" is intriguing. It could be argued that this expresses a moral judgement on matters which should be of no concern to the doctor, especially since the "Dear Doctor" letter had made clear that male homosexual behaviour within prisons is not necessarily unlawful. This respondent did, however, state that condoms were issued to prisoners on home leave/discharge.

Organisational barriers to condom provision

Some respondents reported organisational barriers to condom provision which went beyond their own role as health professionals. These could be vague:

"General apathy on the part of the prison will ensure that no inmate receives a condom."

Or specific:

[Prison management] "agreed condoms could be issued on request but cost was deemed to be prohibitive."

It is not clear whether this respondent was aware of the possibility of seeking funding from NHS health promotion/HIV prevention monies.

"Cannot proceed ... unless governor will agree that condoms can be legitimate items in a prisoner's possession which they currently are not. ... the Prisons Board has not endorsed this policy. ... I intend to revisit this issue ... if I come across any individual whom I believe to be at risk..."
Have involved security because "they will cell search, will need to be able to check authorised ownership of condoms".

The above two comments seem to relate to a belief that condoms are "contraband" which prisoners are not allowed to possess. This view was often expressed during the 1980s, but has no basis in current HM Prison Service policy (discussion at National AIDS and Prisons Forum, 1996).

Other comments suggested concern about the legal aspects of male homosexual behaviour in prisons:

"... open plan dormitory not a private place"

However, the HM Prison Service AIDS Advisory Committee4 states clearly that this is not a legal bar to issuing condoms. Even if the respondent is correct in presuming that homosexual activity could not be legal because of an absence of privacy, this would not imply any criminal liability on the part of the Prison Service if condoms were provided on health grounds.

Finally, one respondent attached a copy of his/her establishment's policy on condom prescribing to the questionnaire, as follows:

"CONDOM POLICY
1. Request by inmate in surgery
2. Counselling by Doctor as to use of condom.
3. If Doctor convinced of genuine need, Doctor will attempt to verify:-
- (a) by review of records
- (b) contacting GP for background information
- (c) possible interview with consort.
4. If Doctor convinced of need for condoms, he could issue two condoms.
5. Subsequent issues would depend on return of used condoms."

Commonsense dictates that such a procedure, while ostensibly designed to facilitate the issue of condoms to people at risk of infection, will in fact guarantee that no inmate discloses HIV risk behaviour or requests a condom.

Conclusions

Two main conclusions can be drawn from the results of this survey:

Most prison medical officers have taken at least some steps to implement guidance that condoms can be prescribed to prisoners at risk of HIV infection.

However, the way in which the guidance has been interpreted and the availability of condoms varies widely between different establishments.

In some prisons condoms are readily obtainable without direct medical or health worker involvement. However, there appear to be significant obstacles to condom accessibility in other establishments where these are only provided through individual consultation with a health professional or counsellor.

In particular, it can be problematic for prisoners to obtain condoms for use within the prison itself, as opposed to when going outside. These problems manifest themselves in different ways in different prisons, but they probably reflect underlying hostile attitudes and prejudices of prison staff and/or prisoners surrounding homosexual behaviour. While such attitudes persist, it is unrealistic to expect that all prisoners who require condoms will feel able to ask for them, even from medical staff in confidence.

Although there is little reliable information on the prevalence of male homosexual behaviour within prisons, it is reasonable to assume that this occurs in many if not all establishments. On public health grounds, there is a pressing need to make condoms genuinely accessible throughout the prison service.

Recommendations

The Prison Service should produce a circular for governors reiterating the guidance given in Dr Wool's Dear Doctor letter of 16 August 1996 and setting out the implications of this guidance for governors and their duty of care towards all prisons in their establishment.

The Prison Service should make a clear statement that possession of of a condom does not constitute an offence for which a prisoner may be placed on report.

The Prison Service should introduce practical guidance on access to condoms, including:

unobtrusive supplies of condoms in toilet areas
inclusion in standard hygiene packs to be issued to prisoners at reception and regularly thereafter while in custody
inclusion in a standard pack to be issued to every prisoner leaving the establishment whether on temporary release or at the end of sentence or remand period.

Prison governors should be asked to monitor and report on facilities for prisoners' access to condoms, and to record any problems arising. Similarly, governors should be asked to monitor and report on prisoners' awareness and staff training in relation to HIV/AIDS and other health risks. These tasks may be appropriately undertaken by establishment AIDS Management Teams.

Although it is good practice for doctors and other health workers to enquire about possible HIV risk behaviour, issue of condoms should not be conditional on this. Health professionals should offer condoms and health advice about how to avoid HIV and STDs to prisoners as a matter of course.

Issues of sexuality should be addressed in training for prison officers and health professionals in order to counter prejudice and promote acceptance of homosexual behaviours and lifestyles.

Acknowledgements

The author and the BMA Foundation for AIDS would like to thank the National AIDS and Prisons Forum, and Dr Silvia Casale in particular, for advice, encouragement and assistance throughout this project. Preliminary results from the survey were presented at the Forum's World AIDS Day conference on 29 November 1996, and comments made by participants at that meeting have been helpful in writing this report. Mr Stephen Barrow of the Prison Service Directorate of Health Care also provided useful information.

References

1. WHO consultation on prevention and control of AIDS in prisons. Lancet 1987; ii: 1263-64.

2. Prison Reform Trust. HIV, AIDS and prisons. London: Prison Reform Trust, 1988.

3. World Health Organisation. WHO guidelines on HIV infection and AIDS in prisons. Geneva: WHO, 1993.

4. HM Prison Service AIDS Advisory Committee. The review of HIV and AIDS in prison. London: COI, 1995.

Annex 1: "Dear Doctor" letter

HM Prison Service Health Care
Cleland House
Page Street
London SW1P 4LN
Heads of Health Care
All Prison Establishments
(cc. Governors, Health Care Managers)

16 August 1995

Dear Doctor

TRANSMISSION OF HIV WITHIN PRISONS: THE PRESCRIBING OF CONDOMS

I wrote to you on 18 May 1994 (DDL (94) 6) following the first recorded case of sexual transmission of HIV from one inmate to another. In that DDL I pointed out that doctors have a duty of care to prescribe as they see fit in order to reduce the risk of infection with unprotected sex. It seems that few of you interpreted this advice as including prescribing of condoms to patients known to be at risk of HIV. Prisoners do not have the opportunity to purchase across the counter medication or devices or dressings and therefore these must be supplied by the prison doctor.

The purpose of this DDL is to make it clear that prison doctors are free, in the exercise of their clinical judgement, to prescribe condoms for individual patients. The capacity to prescribe within prisons is indeed likely to reduce the likelihood of a prison doctor being found in breach of his/her duty of care if a prisoner-patient contracts HIV in prison.

Legal Advice is that consenting acts between adult prisoners in a prison cell are not automatically unlawful and that a prison cell is in many circumstances capable of being deemed a "private place" under the terms of the 1967 Sexual Offenses Act. Even in those circumstances where homosexual behaviour is not lawful (eg if one or both the participants is under the age of 18 years), neither the doctor nor the Prison Service could be liable since the demonstrable intent in making condoms available is to preserve health rather than to encourage homosexuality. The provision of condoms would not constitute "aiding and abetting". This follows on from the judgement in the case of Gillick v West Norfolk and Wisbech AHA and Another (1985).

The burden of our legal advice is in fact that there may be a legal risk in not providing condoms in the relevant set of circumstances through a failure in the duty of care. In order to meet this duty, doctors are encouraged to prescribe condoms and lubricants, when in their clinical judgement there is a known risk of HIV infection as a result of HIV risk sexual behaviour.

Enquiries regarding this DDL should be addressed to Mr Len Curran in Room 833, Cleland House, Tel: 0171-217-6594 or to Dr Robin Ibert, Room 835, Cleland House, Tel: 0171-217-6550.

Yours sincerely

Rosemary J Wool, CB
Director of Health Care

PDG (95) 324/16/18

Annex 2: covering letters and questionnaire

Initial covering letter (sent on BMA Foundation for AIDS letterhead)

To: The Senior Medical Officer of Each Prison Establishment

September 1996

Dear Colleague

Re: Transmission of HIV within prisons: the prescribing of condoms

I am writing following the "Dear Doctor" letter which was sent last year by Dr Rosemary Wool, Director of Health Care of HM Prison Service, concerning the prescribing of condoms to prisoners. In her letter Dr Wool emphasised that prison doctors are free to prescribe condoms for individual patients and that this capacity to prescribe is likely to reduce the likelihood of a prison doctor being found in breach of his or her duty of care if a prisoner-patient contracts HIV infection while in prison.

In view of our concerns about the potential scope for transmission of HIV and other infections in prisons, and the British Medical Association's policy that condoms and health education about the risks of HIV should be available in prisons, we are anxious to know how the guidance given in Dr Wool's letter is being implemented throughout the prison service. I would therefore be most grateful if you would please be kind enough to complete the enclosed brief questionnaire and return it in the reply-paid envelope which is provided. The aim of this exercise is to find out how prison establishments have responded to Dr Wool's letter and to assess whether there is a need for further guidance for doctors and other prison health professionals. Once the questionnaires have been analysed, we will be happy to share the overall findings with the Directorate of Health Care and with medical officers who request them, but the responses given on behalf of individual establishments will remain strictly confidential.

For further information I have attached a copy of Dr Wool's letter. If you have any queries relating to the prescribing of condoms or other aspects of HIV prevention and care, it may be helpful for you to know that the appropriate contact person at the Directorate of Health Care is Mr Steven Barrow.

Thank you for your assistance in this matter and I look forward to receiving your completed questionnaire.

Yours faithfully

Dr Fleur Fisher
Vice-Chairman of Trustees

Follow-up reminder letter (sent on BMA Foundation for AIDS letterhead)

To: Senior medical officers of prison establishments from which no questionnaire response has been received

14 October 1996

Dear Doctor

Re: Transmission of HIV within prisons: the prescribing of condoms

I am writing following Dr Fleur Fisher's earlier letter, because despite a generally encouraging response we have not received a reply from your establishment to our questionnaire following up Dr Rosemary Wool's 1995 "Dear Doctor" letter on the prescribing of condoms to prisoners. If you do feel able to complete this questionnaire it would be greatly appreciated if you would please be so kind as to return it by 31 October at the latest, to enable us to obtain a representative picture of how Dr Wool's letter has been implemented across the whole prison system. For convenience, I have enclosed another copy of the questionnaire and a reply-paid envelope.

Because the questionnaire can be completed anonymously, we are not able to match all responses to their establishments of origin. If you have already completed the questionnaire, or you believe that someone else at your establishment has done so, then please ignore this letter.

Thank you for your assistance,

Yours sincerely

Hilary Curtis
Executive Director

STOP PRESS: We can now be reached by e-mail at hilary@bmaids.demon.co.uk.

Mapping exercise following Dear Doctor letter from Dr Wool, Director of Health Care, dated 16 August 1995 concerning Transmission of HIV within prisons: the prescribing of condoms, which:

reiterated that prison doctors are free to prescribe condoms for individual patients

and emphasised that this capacity to prescribe is likely to reduce the likelihood of a prison doctor being found in breach of his/her duty of care if a patient contracts HIV in prison.

1. Did you receive the Dear Doctor letter from Dr Wool? YES / NO

2. Did you pass this letter on to anyone else at your establishment? YES / NO

If YES, please give the job title(s) or briefly describe the role(s) of the person(s) to whom you passed it on: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Was the letter discussed by your AIDS Management Team/Multi-disciplinary HIV Team? YES / NO

4. Are all the doctors working with your establishment aware of this letter? YES / NO

5. What steps have you taken to ensure that you have fulfilled your duty of care in respect of prescribing condoms?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. What steps have you taken to ensure that this duty of care is carried out by those involved in health care at your establishment?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. What steps have you taken to ensure that prisoners who may be at risk of HIV are aware that condoms can be prescribed?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. How do you monitor the prescribing of condoms at your establishment?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Please give your name and job title and that of your establishment, if you are willing to do so:

Name and job title (optional): . . . . . . . . . . . . . . . . . . . . .

Establishment (optional):. . . . . . . . . . . . . . . . . . . . . . . .

Copyright BMA Foundation for AIDS, 1997
Printed copies of this report are available from BMA Foundation for AIDS, BMA House, Tavistock Square, London WC1H 9JP, price UKP 5 inclusive of postage and packing.

The Medical Foundation for AIDS and Sexual Health is a charity supported by the British Medical Association.
Registered charity number 296689