There's an inconspicuous metal box mounted on the wall of the gym at San Francisco County Jail No. 4.
When Kate Monico Klein turns a knob, the machine releases a condom in a small cardboard packet. Machines like this one — dispensing free condoms — are installed in all of the county's male jails.
"We set [the machine] off to the side, so that people would have a minor amount of privacy," explains Monico Klein, director of HIV services for Jail Health, a division of the county's health department.
San Francisco has been distributing condoms to inmates in county jails for decades, but a new California law requires condoms to be made available to all state prisoners. California is the second state after Vermont to do so, even though sex between prisoners is unlawful here.
"I get about 10 of them every time," says Jail No. 4 inmate Robert Greve, with a laugh. He has been in and out of prison in several states, but this is the first time Greve has been locked up somewhere that provided condoms.
"Condoms are very good to have around, I think, you know? Because it's a lifesaving device," he says. "A lot of people don't care about their health, I think."
But even though condoms are available inside the jail, Greve says deputies still enforce rules against inmates having sex.
"They freak out about it — like, I've seen them catch people in bed together and they're like, 'Hey, what are you doing?!' "
The Centers for Disease Control and Prevention estimates that 1 in 7 people living with HIV passes through correctional facilities each year."We still have the need of sex, and believe it or not the straight men, while they're in custody, they do have sexual activity with other males," Angel Ramirez says. "It's sad, because I heard from other inmates how they ... get infected with HIV while in custody."Inmate Rene Angel Ramirez, who is gay and HIV-positive, says condoms keep his partners safer and protect him from other diseases like gonorrhea, chlamydia or hepatitis C.
Back in the 1980s, San Francisco became one of the first places in the country to hand out condoms to inmates in the county jail. But three decades later, it's still one of only a handful of prison and jails in the country that do so.
Often that's for a simple reason: Sex in prison or jails is against the rules in every state, even if it's consensual. And in some states, including California, it's actually a crime.
Still, San Francisco Sheriff Ross Mirkarimi says he supports the condom distribution program if it helps slow the spread of HIV and other sexually transmitted diseases.
"The law is the law," he says. "But should this behavior occur ... there is a safer way. We want people to be protected — and we insist on it, that they be protected."
But not all deputies are comfortable with condoms being available.
"I could not report to you that there still is buy-in from the uniformed staff," says Matthew Freeman, San Francisco's chief deputy sheriff. There are reasons that even consensual sex is prohibited in jail, he says.
"We know from our experiences running and managing these county jails that even consensual sexual activity amongst inmates can lead to very real problems," he says, like disharmony in the jail, which the sheriff's department says is a potential security risk.
In the early days, deputies also were concerned that condoms could be used as weapons or to smuggle drugs. And while Monico Klein of the public health department says that hasn't happened, she adds that condoms have been put to some more unusual uses.
"We found that, among other things, the prisoners take the condoms and they use them as hair ties, they use them as pillows," she says. "One of the deputies told me that they blow them up and use them as balloons."
And although that initially bothered some people, she says, "one of the things we realized is that it is another way of destigmatizing HIV."
California's state prison system now has five years to come up with a plan to provide condoms in all of its facilities.
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Health officials, confronted with a shocking increase in heroin abuse, are developing a clearer picture of who is becoming addicted to this drug and why. The results may surprise you.
The biggest surge is among groups that have historically lower rates of heroin abuse: women and white (non-Hispanic) Americans. They tend to be 18-25 years old, with household incomes below $20,000. "In addition, persons using heroin are abusing multiple other substances, especially cocaine and opioid pain relievers," says a reportpublished Tuesday by the Centers for Disease Control and Prevention.
All told, more than half a million Americans used heroin in 2013, according to the report. That represents a nearly 150 percent increase since 2007.
Men still outnumber women, but that gap is narrowing. And 96 percent of heroin users said they'd used other drugs within the past year.
In 2013 alone, more than 8,200 Americans died of heroin overdoses. Most of them took that as a deadly combination with other drugs — most often cocaine. The death toll has skyrocketed in recent years. It's up from 1,800 in 2001, according to a reportfrom the National Institute on Drug Abuse.
"As a doctor who started my career taking care of patients with HIV and other complications from injection drugs, it's heartbreaking to see injection drug use making a comeback in the U.S.," says Dr. Tom Frieden, head of the CDC. He unveiled the report in a phone briefing.
Those stark facts define the challenge that health officials face. The epidemic isn't just a problem of inner city "shooting galleries" and a dead end for the down-and-out. To a considerable extent, Frieden says the heroin "crisis" is growing out of prescription drug abuse, especially opioid painkiller use. People who abuse painkillers are 40 times more likely to abuse or be dependent on heroin, the study finds.
"It's really a one-two punch," Frieden said.
First, he says, the widespread use of opiate painkillers has primed people for heroin addiction. These drugs and heroin have essentially the same active ingredient. The second punch is that heroin is increasingly available, and often far cheaper than prescription painkillers. Frieden estimates that heroin is available on the street at one-fifth the cost of prescription pain pills.
This problem calls for a comprehensive response — one that recognizes the changing demographics of heroin use, says the CDC report, which is co-authored by Christopher Jones at the Food and Drug Administration along with colleagues from the CDC.
Frieden said "an urgent all-society response" is needed. It would include:
Tracking the use of prescription painkillers and making sure doctors only prescribe them as necessary.
Providing treatment to individuals who are addicted to these drugs.
Cracking down on smuggling and street sales of heroin, to drive up the price and discourage abuse.
Increasing the use of naloxone, a drug that can be injected into someone with a heroin overdose to reduce the risk of death.
For the full article, please visit National Public Radio's website at the link below: