Young, incarcerated people, sexual health and rights
Young people and incarcerated people are two vulnerable groups regarding sexual health and rights (WHO Citation2015; Wise et al. Citation2019). Being young and incarcerated places individuals in a vulnerable position, and access to knowledge through sexuality and relationships education (henceforth SE) is a sexual right with support in various policies (Public Health Agency of Sweden Citation2021; Starrs et al. Citation2018). This article explores how rights-based SE aimed at young men in Swedish jails and prisons was experienced by the educators providing it, and by the prison staff present during it.
Despite consensus concerning young and incarcerated people’s vulnerability (WHO Citation2015; Wise et al. Citation2019), research on sexual health in prison environments is scarce. In a recent review, Horley (Citation2019) claims that this absence may be caused by the taboo around sexuality research in general and the methodological challenges of reaching people in secluded environments. Research on sexual health among young men in prisons and jails in Sweden is also limited. No national survey on young people and sexual health has included members of this hard-to-reach subgroup. However, one interview study has explored experiences of sexuality and relationships among seven heterosexual men (aged 29 to 55) with long sentences in Swedish prisons (Ivezic Citation2015, Citation2018). The men expressed difficulty maintaining these relationships and initiating new ones. They reported how prison staff did not actively discuss sexuality or sexual relations. Rather, they used rules to regulate and control sexuality, for example access to pornography. In another interview study, eight adult men were interviewed on risks for HIV transmission in Swedish prisons. The findings reveal risky behaviour, including shared injection equipment, unprotected sex, and secrecy around HIV status while in prison (Lindbom, Larsson, and Agardh Citation2017).
International research describing sexual health interventions aimed at young men in prisons exist but tends to have a narrow medical or public health focus: e.g. by aiming to prevent transmission of HIV and other STIs in various sub-groups such as men who have sex with men and men who have sex with men and women (e.g., Li et al. Citation2018; Wiersema et al. Citation2019; Williams et al. Citation2018). Research using a rights-based approach to sexual health in prisons (i.e., not limited to safer sex interventions) is difficult to identify, but a recently published UK study exists, in which 14 young men were co-producers of a web-based intervention for sexual health promotion among incarcerated young men (Templeton, Kelly, and Lohan Citation2019). The use of a rights-based approach ensured incarcerated young men’s voices could be heard in the development of services that were relevant for them, with service providers being seen as duty-bearers. Four mechanisms for supporting rights-holders were identified: a designated-listener aware of the situation of rights-holders and duty-bearers and who seeks to build the capacity of both; framing sexual health issues in relation to national and international law and legislation; advocacy by duty-bearers on behalf of rights-holders with limited voice; and participation and empowerment of rights-holders to help themselves (Templeton, Kelly, and Lohan Citation2019).
Rights-based and holistic SE with young people
In line with the work of Templeton, Kelly, and Lohan (Citation2019), we see educators as duty-holders in relation to the people they provide SE to. Depending on the national or cultural context, educators may be expected to provide various forms of SE, and the politics of knowledge production are always at play within this process, especially concerning what comprehensive SE involves, for whom, when and where (Miedema, Le Mat, and Hague Citation2020). Holistic SE, as opposed to comprehensive SE, seeks to advance a critical perspective on dominant discourses, and challenge many of the negative connotations associated with youth sexuality (Miedema, Le Mat, and Hague Citation2020). In consequence, the concept of holistic SE is used in this article to frame a rights-based approach targeting young people.
SE is not only provided in school settings, but in a variety of other contexts such as health care and social work. However, education on how to promote sexual and reproductive health and rights (SRHR) is only minimally provided in higher educational programmes in law, midwifery, nursing, occupational therapy, physiotherapy, police work, psychology, social work, and undergraduate medicine (Areskoug-Josefsson et al. Citation2019). This can lead to a lack of knowledge and competence to work on sexual health and rights. The readiness of prison staff (as duty-holders in relation to SRHR), for whom higher education is not always a requirement, is equally insufficient. Lack of professional competence can create a culture of silence regarding the sexuality of young people in institutional settings (Lindroth Citation2021). Correspondingly, Stevens (Citation2017) describe a culture of denial among both prison authorities and staff regarding sexual activity between adults in prisons. This collective unwillingness to acknowledge and engage with both consensual and non-consensual sex is harmful for those who choose to engage in, or are coerced into, sex in prison (Stevens Citation2017). Baćak et al. (Citation2018) draw attention not only to existence of sexual activity but also the over-representation of same sex attracted/practising individuals in prisons and call for acknowledgement of their wider needs since incarceration itself is disadvantageous to health.
Fields and Toquinto (Citation2017, 285) state that people in carceral facilities are often cast as ‘poor decision-makers, bad parents, unloving and unloved intimate partners, hypersexual, and unable to control their sexual impulses’. Given this, and the absence of work to promote the sexual and health and rights of incarcerated young men it is important to explore what a holistic rights-based approach has to offer.
A holistic rights-based SE for young men in Swedish prisons and jails
Since 2014, the Riksförbundet för Sexuell Upplysning (Swedish Association for Sexuality Education, RFSU) has been conducting a project initiated by, and in cooperation with, the Kriminalvården (Swedish Prison and Probation Services, SPPS). Before visiting jails and prisons, RFSU sex educators underwent specific training within the organisation (i.e., additional pedagogical training, observation of colleagues running SE sessions in prisons, and debriefing) relevant to the task of providing SE in carceral institutions throughout the country. The training was led by a sex educator who was also the project manager. The overall pedagogy was inspired by SE provided to young people in secure state care (Lindroth Citation2014). In line with this pedagogy, RFSU educators were trained to use discussion-based approaches with young people rather than lectures, to adopt a harm-reduction perspective and to acknowledge risks, rights and resilience during the sessions. They were also encouraged to adhere to the RFSU values that everyone should have ‘the freedom to be oneself, to choose and to enjoy’ (RFSU Citation2021a). Sessions focused on themes such as 1) the body and sexuality, 2) boundaries, consent and sexual violence, 3) safer sex and sexually transmitted infections (STIs), 4) relationships, and 5) pornography. Different pedagogical strategies were used to prompt discussion: information related to the five specific themes, quizzes, and the use of a deck of playing cards constructed specifically for the project. Additionally, six short films on the subject of mutual consent, produced by the RFSU, were used.
The settings where the SE project took place were high security facilities. In 2019, the SPPS, the organisation running these facilities, was responsible for the care of 1,753 persons under 21 years of age (SPPS Citation2020). The vast majority were young men. The most common crimes were robbery, violent crime, and crimes in relation to narcotics. The crime with the largest increase between 2018 and 2019 was sexual crime (SPPS Citation2020).
The SE project aimed to reach all young men in jail (awaiting sentence) and prisons (convicted, serving a sentence), and for security reasons SPPS staff were present during the sessions. Two RFSU educators visited youth wings in jails and prisons for one hour every third week. By the end of 2019, more than 400 visits had been made. Due to the COVID-19 pandemic, all visits stopped in March 2020. Most of the sessions were group-based, but a few were conducted with just one or two young persons’ when under restriction (e.g., in isolation).
According to anecdotal reports, all the parties involved – the young men, SPPS staff, and RFSU educators – appreciated the value of the project. However, evaluation knowledge was lacking, and this article explores the experiences of RFSU educators and SPPS staff. Involving young men more fully in the study was not possible, as the COVID-19 pandemic restricted all visits to all carceral facilities starting March 2020.
Design and sampling
The study used a qualitative approach (Robson and McKartan Citation2016) and data were collected through individual interviews. The third author received access to the contact information (email) of all educators and prison staff involved in the project and randomly chose two persons from each organisation and every SPPS region (the East, West, South and Northern regions). In all, 16 persons (8 RFSU educators and 8 SPPS staff) received an email with study information, and 14 (8 RFSU educators and 6 SPPS staff) responded, via email, saying they wanted to participate.
Participants and interviews
Eight RFSU educators were interviewed between December 2019–January 2020, and six persons working within the SPPS were interviewed between February–April 2020. For an overview of participants, see . Overall, both women and men in both organisations participated, but the RFSU educators tended to be younger. Mean values for number of years with current employer, and the numbers of SE education sessions with youth participants had experienced were similar in both groups.
To ensure relevant topics were explored, the authors constructed a semi-structured interview guide with four open-ended questions for RFSU educators focusing on their experiences of 1) readiness to work with sexuality and relations with vulnerable young men before the project, 2) how session content was received by the young men, 3) specific pedagogical challenges encountered during the sessions, and 4) current readiness to work with sexuality and relations with vulnerable young men. Three open-ended questions were used in the interviews with the SPPS staff. These focused on their experience of 1) how the sessions had worked in their workplace; 2) resistance towards the project from the young men, themselves, or from colleagues; and 3) the potential benefits and risks associated with the project.
Interviews were held by phone, recorded with the permission of the participant, and transcribed verbatim. The interviews with RFSU educators lasted 25 to 50 minutes, and with SPPS staff 12 to 30 minutes. The twelve-minute interview was caused by the prison being in a state of alert due to the outbreak of the COVID-19 pandemic; the participant nevertheless wanted to share their experiences.
Using an inductive approach, a thematic analysis was conducted (Braun and Clarke Citation2006), and similar and different experiences within each group were identified. Based on our understanding that RSFU educators and SPPS staff varied in their experience discussing sexuality, we refrained from making a comparative analysis. In Word documents containing the interview transcripts, various themes were created, reviewed and adjusted until they were deemed to offer a good fit with participants’ experiences. The analysis resulted in three themes capturing the RFSU educators’ experiences of SE sessions with young men in jail and prison: encountering a new group in a new environment, challenging but feasible, and meaningful insights. Three other themes described SPPS staff’s experience of the sessions: professionally conducted and valuable, managing resistance, and more benefits than risks.
In line with Swedish research governance arrangements, approval by an ethics review committee was not necessary because the interviews concerned professional, not private experiences (Government of Sweden Citation2003). Nevertheless, the study adhered to accepted ethical principles. All participants were given written and verbal information about the study, and all gave oral consent to participate. The third author, who was employed by the RFSU, was the only one to sample and interview participants and to have access to interview transcripts. In reporting on findings, individuals have been assigned pseudonyms to protect confidentiality.
The first author is a social worker specialised in counselling. She has a master’s degree in sexology and has led training for RFSU educators visiting women in prison. The second author is a sexuality educator and was the project manager at RFSU. The third author has a doctorate in health and society and has research experience as well as practical experience (including SE for young men) regarding SRHR in secure settings such as prisons. The authors’ prior knowledge and experience was drawn upon during the study, and we have tried to be reflexive and avoid preconceived ideas in the analysis.
Consensus about holistic and rights-based SE
RFSU educators and SPPS staff experienced SE sessions with young, incarcerated men at Swedish jails and prisons as valuable and the project as useful. Despite the analysis not taking a comparative approach, the experiences described by educators and by staff were broadly similar. Informed by the work of Templeton, Kelly, and Lohan (Citation2019), the four mechanisms for assisting young men as rights-holders regarding SRHR were present: RFSU educators were designated-listeners, aware of the situation of the rights-holders (young men) and duty-bearers (SPPS staff), and tried to strengthen the capacity of both. Sexual health issues in the project aligned with national and international policies on SRHR, and the duty-bearers (SPPS staff) displayed a wish to advocate on behalf of rights-holders (young men) with limited voice. Given the constraints of the study, it is not possible to assess to what extent the participation and empowerment of rights-holders (young men) was achieved, as their voices were lacking in this study. However, the project had this ambition, and when COVID-19 prohibited RFSU educators from visiting the young men, a 36-page magazine called Tidningen Sex (The Sex Magazine) was produced and distributed in jails and prisons (RFSU Citation2021b), and a pod cast is being developed.
To the best of our knowledge, similar projects (i.e., holistic and rights-based SE with young men in jail or prison) remain undocumented in the research literature. However, the concept of letting young men in prison decide on the content in SE parallels the co-produced and rights-based sexual health intervention presented by Templeton, Kelly, and Lohan (Citation2019). Additionally, we see similarities with rights-based SE sessions conducted with homeless people above the age of 21 – where anchoring the work within the organisation, adjusting to participants’ needs and wishes, and the use of a respectful approach were identified as important implementation features (Wikström, Eriksson, and Lindroth Citation2018).
Study strengths and weaknesses
The study has several limitations limiting transferability, for instance the sparsity of similar studies limits both the positioning of this paper within a wider literature and hinders comparison. The study was a qualitative exploration of experiences among 14 individuals, and the context, Swedish jails and prisons, is not readily comparable with carceral institutions in other countries such as the north American context described in Fields and Toquinto (Citation2017).
However, in November 2018 the General Director (a position appointed by the Swedish government) of the SPPS, declared in one of the country’s largest daily newspapers that ‘Our prisons are soon [to be] full’ (Dagens Nyheter Citation2018), and in one of the country’s largest evening papers the situation in Swedish prisons has recently been described as ‘a crisis’ (Expressen Citation2021). In voter polls on 25 political issues linked to the 2022 election, ‘law and order’ was the second most important issue for 58% of the future voters, following health care which 60% saw as the most important issue (Kantar Sifo Citation2021). A changed socio-political landscape following the upcoming election might threaten work on SRHR in general. It could also lead to a change in the present view within the Swedish prison system that holistic SE is a sexual right. To be effective, work on SRHR with young people requires ongoing sustained engagement (Ollis, Coll, and Harrison Citation2019).
It is a study strength that interviewees represented different facilities in all four SPPS regions of Sweden, which minimises the risk of describing atypical local experiences only. SE within jails and prisons is an issue of global concern when it comes to reproductive health and rights, and the results of this study will be of interest not only locally but also globally, especially in welfare states where prisons are state-run and access for outsiders is possible.
One identified bias of the study was that RFSU educators spoke well of the project because it was their source of income. Likewise, SPPS staff may have been positive towards the educators and the project because it meant they did not have to handle issues of sexuality themselves. Even so, the responses of all interviewees appeared genuine, as they included both positive and negative experiences. Finally, bur most importantly, a major drawback must be the fact that the experiences of the incarcerated young men themselves were lacking in this study. Future work should address this deficit.
Some further considerations
Both RFSU educators and SPPS staff encountered homo- and transphobic as well as racist and sexist attitudes among young men during the sessions. These attitudes may be seen as products of a ‘toxic’ masculinity in the form of a ‘constellation of socially regressive male traits that serve to foster domination, the devaluation of women, homophobia, and wanton violence’ (Kupers Citation2005, 714) – qualities that may be exaggerated in prisons (Jewkes Citation2005; Kupers Citation2005). Initiatives to challenge these attitudes and behaviours are warranted to protect young people in jail and prison, as well as educators and prison staff. Despite the project’s and the educators’ rights-based ambitions, these attitudes may be understood as young men’s acts of resistance towards various sources of power they face, such as strong societal norms concerning non-discrimination, the secluded jail or prison setting, or the RFSU educators and SPSS staff aiming to influence the young men through SE.
Miedema, Le Mat, and Hague (Citation2020) argue against striving to achieve consensus regarding the articulation of sexual, gendered as well as racial and classed hierarchies within SE, and suggest that educators are offered tools to generate debate between learners on these areas of tension. The RFSU educators in this study had basic training in addition to the training created specifically for the project. Additionally, they used personal strategies (e.g., hiding their sexual identity or being more personal than usual) to achieve their goals. Nevertheless, discriminating slurs were voiced during the sessions. Consequently, the goals of fostering ‘recognition of the inevitability of difference’ (Miedema, Le Mat, and Hague Citation2020, 754) in SE, and learning to respect others’ right to exist differently were not fully realised. Such objectives are best pursued in settings where there is space for reflection, and where it is safe for educators to explore the possibilities of difference with learners (Miedema, Le Mat, and Hague Citation2020). Clearly, jails and prisons are challenging contexts for such endeavours.
SE in jails and prison settings is ‘always encumbered with the demands of the carceral institution’ (Fields and Toquinto Citation2017, 281), and our findings indicate that the sessions were made mandatory for young men in some jails and prisons. Mandatory SE poses a dilemma since it contradicts the rights-based ambition of the project. It also underlines how RFSU and the SPPS have different aims stemming from different traditions when addressing young men’s sexuality. The RFSU’s focus on free discussion derives from a ‘confessional’ discourse in which conversations about sexuality is promoted (Foucault Citation1978). Some prison staff may share this perspective, but their job descriptions focus on rehabilitation and therefore indicate an approach to young men’s sexuality that is part of a more corrective surveillance discourse (Foucault Citation2017). Regardless of aim or discourse, it is likely that young men, when navigating them, were rewarded when they ‘in front of adults had skilfully woven the garlands of discourse and sex’ (Foucault Citation1978, 29). An awareness of these different discourses and aims is vital for all involved in SE within carceral institutions. Additionally, jails and prisons are institutions permeated with power imbalances. Given their secluded nature, SE education in these settings, and research thereon, must always consider the potential discrepancies between ‘what the institution does and what their official spokespersons have to say they do’ (Goffman Citation2015, 59). In the words of one member of the SPPS staff, Johnny, it is vital for all the parties involved to be remain aware of the fact that the SE sessions are ‘for the guys’ sake’.