Sexual coercion prior to imprisonment: prevalence,demographic and behavioural correlates

INTRODUCTION

Estimates of the prevalence of sexual coercion in the community vary depending on the definition. Sexual coercion can be defined as ‘any unwanted sexual attention’, ranging from kissing and touching to rape. ^1–11 Studies which do not include all types of unwanted sexual attention may under-report the true prevalence of sexual coercion in the community. ^12,13 Gender differences also exist with regard to sexual coercion. Studies investigating sexual coercion in the USA and Australia report a higher prevalence among women (16% and 21%) than men (4–5%). ^12,13

Correlates of sexual coercion include an increased likelihood of being diagnosed with a sexually transmissible infection (STI), illicit drug use and tobacco smoking. ^12,14 Some studies have also showed an association between sexual coercion and increased alcohol consumption, ¹⁴ while others found no such relationship. ¹² However, only a few studies have examined the association between prisoners’ experiences of sexual coercion in the community and health and behavioural outcomes.

Most studies have focused on sexual victimization during incarceration rather than experiences occurring in the community prior to imprisonment. ^9–11,15,16 Information on prisoners’ experiences of sexual coercion in the community is uncommon and compounded by nationally representative sexual health surveys routinely excluding prisoners and the under-representation of marginalized and hard-to-access groups in these surveys such as the homeless, sex workers and injecting drug users: groups known to be found frequently among offender populations. One such study which investigated childhood sexual abuse (CSA) among New South Wales (NSW) prisoners pointed out similarities as well as differences in mental health and risk behaviour outcomes between men and women who reported a history of CSA. ¹² While both genders had an increased likelihood of psychiatric treatments, suicide attempts and STIs following CSA, the odds of a past STI were higher among women than men. ¹² Women with a history of CSA were also more likely to be involved in abusive relationships as adults, whereas men tended to report severe mental health problems and engagement in violent behaviour. This therefore suggests distinct differences not only in the incidence but also in the long-term sequelae between male and female victims.

In this study, we investigate the self-reported experience of sexual coercion prior to incarceration in a large random sample of male and female prisoners in Australia and examine demographic and behavioural correlates of sexual coercion. To investigate whether correlates of sexual coercion differ between genders, we analyse male and female prisoners separately.

METHODS

All prisons in NSW and Queensland participated in the survey, with only a small exception of prisoners based at remote work camps (estimated to be less than 1% of total prisoner population), which were logistically difficult to access. Potential participants were randomly selected from all inmates at a particular prison to achieve the target sample size. Inmates selected for participation were explained the purpose of the study by a research recruiter and given a consent form along with an information sheet detailing which demographic and criminographic data would be sourced from Corrective Services. The information sheet also reassured the inmates that participation was voluntary, that the interview would not be recorded or taped and that they were free to withdraw their consent at any time. Those who signed the consent form were included in the survey.

Interviews were conducted by a private social market research company in Sydney. All interviewers were highly experienced in social and health research and trained by the senior researchers. The interviewers were women, as nobody requested the option of having a male interviewer. The prison interviews were held in private rooms (such as a legal visit or consulting room in the health clinic), with no custodial officer or researcher present and averaged about 30 minutes (range 19–60 minutes).

The Sexual Health and Attitudes of Australian Prisoners (SHAAP) questionnaire was based on that used for the Australian Study of Health and Relationships with some minor adaptation of question and/or response wording to allow for the lower average education levels of prisoners, and the addition of further sections on experiences in prison. ^17–19

The SHAAP survey interviewed 1317 randomly sampled prisoners in NSW in 2006–2007 and 1034 prisoners in Queensland in 2008, using a computer-assisted telephone interview (CATI) format. ²⁰ The overall response rate in NSW was 82.9% (82.6% for men and 82.9% for women), and in Queensland the response rate was 75.3% (76.0% for men and 71.2% for women). Prisoners in these two states account for approximately 60% of the total Australian prisoner population. ²¹ The 2351 prisoners surveyed consisted of 2018 men and 333 women. Out of these, 2335 prisoners answered the question on sexual coercion; while 16 individuals who were unsure, refused to answer, or had missing values were removed from the analysis. We enquired about sexual coercion using the following question: ‘Have you ever been forced or frightened by a male or a female into doing something sexually that you did not want to do?’ prefaced by the advice ‘We would like you to think about times outside of prison only’. Our measure of ‘doing something sexually’ also potentially includes kissing and touching. Thus, it encompasses a broader range of experiences than ‘sexual assault’ or ‘rape’.

RESULTS

DISCUSSION

About 13.5% of men and 60.2% of women prisoners reported ever being forced or coerced into an unwanted sexual activity outside the prison setting. This is consistent with studies on childhood sexual abuse, which found higher rates among prisoners than in the general population. ^1,22,23 The higher rate of sexual coercion among women compared with men is also consistent with previous research. ^12,13

Although most correlates of sexual coercion were similar for men and women, including being paid for sex and mental health problems, consistent with previous studies, ^12,14,24 there were some notable differences between genders. Among men, sexual coercion was associated with a homosexual identity, higher level of education, current and lifetime (based on NSW data) convictions for a sex offence, past STIs and current sentence for a sexual offence. In comparison, among women, sexual coercion was associated with separated marital status, illicit drug use and current sentence for a violent offence. Smaller differences between genders were in being unable to work due to an illness or disability or being in part-time employment which was more strongly associated with sexual coercion among women than among men, while a bisexual identity had a higher likelihood of coercion among men compared with women.

Our finding that exposure to sexual coercion outside of prison was associated with mental health problems is consistent with American research of prisoners showing that prisoners with a mental illness reported sexual abuse prior to entering the prison system. ²⁵ The increased risk of mental health problems and their increased severity (as indicated by admissions to a hospital or a psychiatric ward) among those who had been sexually coerced outside prison could be either a consequence of experiencing sexual coercion or a result of the increased vulnerability to sexual victimization of those with pre-existing mental health problems. ^2,12,26–28 Depression and self-harm are common among survivors of sexual assault. ¹⁴

In contrast to community research showing increased levels of alcohol consumption and tobacco smoking among those who had been sexually coerced, ^12,14,24 we found no such association which is likely due to the ubiquitous use of tobacco and alcohol in this population. ^29,30 This result is consistent with previous research of childhood sexual abuse among NSW prisoners. ¹

A history of STIs was significantly associated with sexual coercion only in men, though the odds were also elevated among women. This contrasts with a NSW study of prisoners’ childhood sexual abuse which reported a greater likelihood of past STIs among women compared with men. ¹ This may be due to the use of self-reported STIs and the asymptomatic nature of many STIs. It is therefore likely that STIs exposure among prisoners is under-reported. Indeed, past research has shown that prisoners tend to underestimate their true prevalence of STIs. ³¹

Most sexual coercion occurred at a younger age, with 64.1% of coerced men and 60.1% of coerced women (or 8.6% of all men and 36.2% of all women) having been subjected to sexual coercion during childhood (by the age of 16 years), which is consistent with previous research. ^12,13 Studies of childhood sexual abuse have suggested two likely pathways: one leading to sexual perpetration, and the other to re-victimization.

The first pathway has been termed a ‘cycle of violence’ and is supported by research showing that some victims of childhood sexual abuse are likely to go on to commit violent crimes. ^32–34 Using data on the current prison sentence, we found that prisoners who reported sexual coercion before the age of 16 years (the legal age of consent in Australia) were more likely than those whose first sexual coercion occurred after that age to be incarcerated for a violent offence, although the difference did not reach statistical significance (42% versus 34%, N = 463, P = 0.09). Since this information relates to the current sentence only, it is likely to be an underestimate as previous violent offences would be obscured by the offence for the current incarceration episode. It has been suggested that sexual abuse during childhood disrupts the normal development of interpersonal relationship and leads to psychological problems in adulthood, such as feelings of hostility, antisocial behaviour and a sense of betrayal. ^4,14,35–37

The second pathway suggests that sexual abuse or coercion during childhood can lead to an increased likelihood of re-victimization in adulthood. While the studies vary with the reported extent of future victimization, there is some evidence that sexually abused children are at a greater risk of becoming victims of sexual and physical abuse in adulthood. ^5,35,38,39 In the prison context, our findings support this with those reporting histories of sexual coercion more likely to experience unwanted sexual contact and physical assault while in prison. With 60% of episodes of sexual coercion in men and women occurring before the age of 16 years and around 80% of episodes before the age of 20 years, it appears that most instances of coercion took place prior to imprisonment. Suggested reasons for later abuse include depression, fear and low self-esteem. ³⁵

Not all victims of sexual abuse or coercion show trauma-related symptoms, as some may develop coping strategies. Apart from negative coping strategies, such as dissociation and avoidance, ³⁵ emotionally strong and resilient individuals can recover from past traumatic experiences by becoming mentors and provide support for others who were traumatized by abuse to build their self-esteem and recover. ⁴⁰

One strength of this study is the use of a CATI format which allowed us to interview a large number of individuals remotely from a centralized location and offers the advantage of being less intrusive than face-to-face interviews on what is considered to be a highly sensitive topic. ^20,41 The utility of this approach is reinforced by the 94.1% of prisoners who reported that all or most of the time they did not feel embarrassed by the survey questions and would participate again in sexual health surveys.

Limitations of this study include the use of self-report and the possibility that some respondents may have under-reported sexual coercion. ⁴² We used a broad definition of sexual coercion, which included behaviours ranging from unwanted touching to assault or rape and may have inflated the numbers of prisoners reporting sexual coercion. Other definitions may be better able to differentiate between different levels of force or fear. In addition, prisoners’ recall and the response rate provided may be lower than in the face-to-face interviews. ⁴¹ Our study excluded prisoners who were being transferred between prisons, in court or hospital, or who were deemed ‘too dangerous’ to be interviewed by prison authorities, those who had insufficient English, and those who could not provide informed consent. As these findings are based on cross-sectional data, causal inferences cannot be made.

The high prevalence of sexual coercion reported in this study by prisoners prior to their incarceration compared with the Australian community suggests a need for a greater acknowledgement of this within the criminal justice system, and an acknowledgement of the possible sequelae. This could entail screening for histories of sexual coercion on entry to prison and the provision of counselling and support services within the correctional setting for those affected by sexual coercion. The association between prior exposure to sexual coercion and factors such as a history of mental illness, substance use, STIs, being paid for sex, and physical and sexual victimization while in prison is consistent with previous research in this area. Services within prisons dealing with mental health, substance use and sexual health should, at a minimum, be aware of the potential sequelae associated with sexual coercion. Amid the myriad of physical and mental health problems endured by this population group, it is likely that addressing issues associated with past sexual coercion has a role to play in prisoners’ overall wellbeing.