Introduction

Globally, the number of incarcerated people continues to rise annually, including in sub-Saharan Africa (SSA). The SSA region remains at the epicentre of the HIV epidemic with two-thirds of all people living with HIV residing in SSA member states.1 One of the key vulnerable populations at risk of HIV acquisition is incarcerated people.2 3

The conditions in Malawi’s detention facilities remain harsh and potentially life-threatening. This is attributed to overcrowding and poor sanitation, and a lack of access to basic needs such as adequate food, bedding, clothing, security, healthcare, potable water, heating, ventilation and lighting.4 5 Evidence suggests that the current Malawi prison population is more than double the estimated capacity.4 While no official crime rate figures are publicised, indicators suggest that there has been an increase in crime in Malawi,6 leading to congestion in detention facilities. Arguably, as a consequence, such a congested prison environment fuels serious health issues, thus leading to the death of incarcerated persons.6

Young incarcerated individuals are those between the ages of 15 and 21, with the group further broken down into juveniles (15–17) and young adults (18–21), both convicted and not convicted.7 However, research suggests that young incarcerated people are at higher risk of sexual assault and victimisation while in custody than adult incarcerated people.8 Further, evidence suggests that young and adult offenders are held in the same cells in Malawi,9 which may result in different forms of violence. Much has been written on the subject of younger incarcerated people worldwide.10 11 There have been limited studies of this nature in Malawi’s semiurban detention facilities. As such, this study is aimed at exploring the experiences of incarcerated male youths within two semiurban Malawian prisons.

MethodologyStudy approach and design

This study used a qualitative descriptive research approach. Moule and Goodman12 assert that researchers tend to use qualitative research approaches to look at questions around the life experiences, beliefs, motivations, actions and perceptions of study participants. The approach was ideal in this study because it offers a comprehensive summary of the phenomena where there is a dearth of knowledge within a particular subject, and also addresses the ‘who, what and where’ of participants’ experiences.13

Study setting and population

This study was conducted at two detention facilities in semiurban settings in the Northern and Central regions of Malawi. The study population comprised male incarcerated youths. We used purposive sampling. The study was announced verbally by the warden to groups of men at each facility. Men who were interested in participating identified themselves to the warden, who then arranged a meeting with researchers. The researchers determined if the identified incarcerated persons were eligible to participate in the research study based on the eligibility criteria.

Inclusion criteria

The inclusion criteria were as follows:

Aged 18 years exactly.

Those that were there incarcerated for less than 1 year.

The researchers selected men of the same age (18 years) and length of incarceration (<1 year) because youths in prisons are more vulnerable to sexual exploitation. However, younger males (16–17 years) who are perhaps the most vulnerable were excluded because the researchers doubted their ability to provide informed consent. Additionally, this study targeted the youths and those aged 18 years were available in the prison.

Exclusion criteria

The exclusion criteria were as follows:

Aged 19 years and older.

Unwilling to voluntarily participate and unable to give consent.

The researchers excluded older men as including them during focus group discussions (FGDs) might result in them not expressing their views freely because of fears related to the presence of older incarcerated persons.

Ethical considerations

Clearance from the national prison authorities was sought in order to gain access to the prisons. All participants were fully informed both in written and verbal formats, were provided with the opportunity to ask questions prior to consent and participated voluntarily with the option to withdraw. It was made clear through the detailed consent form that participating in this study would have no impact on their sentence or their treatment as an incarcerated person. The confidentiality of the participant was maintained through the use of an identification number on all transcribed interview documents and notes. Procedures for the selection of participants within the prison were fair to all incarcerated persons and immune from arbitrary intervention by prison authorities or other incarcerated people. The information was presented in a language that is understandable to the participant population.

Data collection procedure

Three FGDs were conducted with incarcerated male youths composed of six participants per group (n=18) during normal working hours at the detention facility. None of the participants who were approached refused to take part. Hennink et al14 recommend a sample size ranging widely from 2 to 40 focus groups, with a commonly cited guideline to conduct at least two focus groups. Data were collected in May 2022 using a semistructured interview guide. The semistructured interview guide allowed the researcher to prepare a written topic guide, which is a list of areas or questions to be covered with all study participants.15 The semistructured interview guide was developed in English by the researchers and translated into Chichewa. The interview guide had two sections; the first part contained questions aiding in collecting demographic data for participants’ identification. The second part contained open-ended questions that were formulated according to the study objectives. Polit and Beck15 indicate that a semistructured interview guide allows the researcher to have a framework in which open-ended questions are posed to encourage the participants to talk freely about their experiences. The main thematic areas for the open-ended questions focused on tuberculosis, HIV, and violence in prisons. The use of a semistructured interview guide with open-ended questions stimulated participants to give rich information about their experiences, and probes were asked when necessary. The third FGD resulted in data saturation. The interviews were terminated after the third FGD since this group of participants did not share any new information, leading to the conclusion that data saturation had occurred in terms of their experiences. Our study participants shared features such as age, length of prison stay and prison conditions. Participants were also good informants, able to share their lived experiences and communicate effectively. In addition, Guest et al16 point out that employing a semistructured discussion guide, 2–3 focus groups are sufficient to capture the most prominent themes in a homogeneous study population. There were no repeat of interviews.

FGDs were done by EN, with assistance from the research assistant as a note taker, in a room away from the prison staff; with security maintained by having prison staff observe the interview process from a distance. The FGDs were held in Chichewa, a local and national language. The focus groups were audiorecorded. During the interviews, field notes were taken. The average length of each FGD was 50 min (table 1).

Table 1

Profile of participants

Data analysis

The data analysis was conducted manually, guided by the thematic analysis. EN and BCM listened to the recorded interviews and then transcribed them verbatim. All the interviews and transcripts were checked for accuracy against the original audiotapes. Transcripts were translated into English and translated back into Chichewa by two independent translators to ensure content consistency. BCM and EN coded each transcript independently. To ensure scientific rigour, a quality framework in thematic analysis was guided by Braun and Clarke.17 This involved several key steps as follows:

Reading and re-reading the transcription, individually and in pairs to note early ideas.

Coding in a systematic and logical manner and paying attention to interesting concepts and ideas within the data.

Organising codes into corresponding groups using an iterative process. Topics raised were grouped under potential thematic categories that were often renamed when a more appropriate title emerged. The ideas and issues that emerged were grouped into categories and further grouped into themes.

Refining and reviewing of these themes by WK, examination of the coherence of patterns across these themes and development of a thematic map.

Final clear defining and naming of themes with data extracts representing and articulating the essence of these and overall analysis.

The first author (EN, female) is the principal lecturer in the nursing and midwifery department, with experience in qualitative research; KW (male) is the Assistant University Librarian and accomplished academic researcher. Associate professor BCM (male) has relevant experience in health-related research. All of the researchers had received qualitative research training and had no prior relationship with any of the participants.

Trustworthiness of data

Four criteria for data trustworthiness proposed by Lincoln et al18 were used. These include: credibility, dependability, confirmability and transferability. In this study, peer debriefing and member checking were used to promote the credibility of the findings. Hamilton19 asserts that peer debriefing helps to manage interviewer bias and assists with conceptual clarity during data analysis and manuscript writing. Peer debriefing was done among the research team members after data collection and it was also a useful strategy during both data analysis and manuscript writing. Member checking was done by probing for clarity during the interviews. The research team members agreed that this was easier and more appropriate for the participants as opposed to members checking postinterview for interpretive validation. Furthermore, trustworthiness was achieved through the inclusion of excerpts from participants’ verbatim narratives. Dependability was achieved through the detailed reporting of all processes within the study. These processes include: the research methods, the detailed collection of data and the analysis of the data. Lincoln et al18 indicated that to ensure transferability, thick descriptive narratives must be provided for readers to judge the applicability of the findings in other settings and the verbatim quotes included in this paper also serve this purpose. Furthermore, to establish confirmability, the research team kept records of the raw data: field notes, transcripts and a reflexive diary to enable readers to make an audit trail of all the decisions taken during the research process. All the decisions agreed on during the peer debriefing among members were documented. Transferability was accomplished by providing sufficient detailed information about the methodology, participants and their contexts so that the reader could judge how transferable the findings were to other settings. The Consolidated Criteria for Reporting Qualitative Research20 (see additional file) was used when writing this report.

Patient and public involvement

No patient or participant was involved in designing this study, recruiting study participants or conducting the study. However, the research objectives were chosen to reflect incarcerated people’s experiences. Researchers randomly chose one focus group transcript and returned it to participants for comments within 2 days of the FGD to ensure transcription accuracy. There were no revisions required after the participants checked. Participants were informed that the research team would disseminate the final study results to them.

Study findings

The following themes emerged from the analysis of the participants’ narratives:

Sexual violence perpetuated by incarcerated persons; (2) the need for sexual violence communication and prevention; (3) incarceration-related trauma and (4) youth surviving prison life. Themes and subthemes are presented in table 2.

Table 2

Themes and subthemes

Sexual violence perpetuated by incarcerated persons

Participants’ accounts show that same-sex sexual activity is being practiced in the detention facilities. The following voices illustrate this malpractice:

Male inmates are having sexual relationships in this prison (Participant #2-KK)

We could easily get HIV infection here. Some incarcerated individuals have a tendency to have sexual intercourse with male inmates (Participant #4-NB)

Participants in this study repeatedly reported that young offenders and newcomers are vulnerable to sexual abuse. Some older incarcerated persons have leadership roles and responsibilities sometimes they sexually abuse incarcerated male youth, this is indicated below:

Young inmates are more likely to be approached by older inmates who want sex (Participant #5- KK)

We also have some individuals who have been imprisoned recently. These people are prone to sexual abuse by the old inmates, as the abusers are bosses in the cells’ (Participant #4-NB)

The young offenders were given incentives such as extra food in exchange for sexual encounters with adult incarcerated people. This puts young incarcerated people at risk of being sexually abused.

Here in the prison, we are lacking so many things, so the older inmates usually give us something with the intention of having sex with them. They entice you with food as it is insufficient in the prison. We eat only once a day, so they want to have sex with us in exchange for food (Participant #3- NB)

We take meals once a day; many incarcerated individuals are malnourished due to food deficiency since it is difficult for them to get additional meals. Other inmates take advantage of this situation, and young inmates are mostly the victims of sexual abuse. (Participant #2-NB)

Furthermore, incarcerated male youths are reported to be provided adequate sleeping space in exchange for sexual favours from some incarcerated persons.

If the prisoner has a better sleeping space and/or has been imprisoned for a longer period of time and has more authority in the cell; he would be able to invite the young inmate who has insufficient space to sleep together on the comfortable space and have sex (Participant #4-NB)

Yes, if they have extra space to accommodate two inmates, they could invite another inmate with the intention of having sex with him (Participant #5-KK)

Perpetrators of sexual violence were incarcerated longer than their victims. Some of the perpetrators were incarcerated individuals with leadership positions:

Mainly, inmates, so-called bosses, those who lead, us are in the forefront of sexual misconduct behaviours. (Participant #2-KK)

At times, the inmates influence others to commit malpractice or are threatened by those who are serving long jail terms and have the authority (Participant #3-KK)

The young incarcerated person who refuses to have sex with the older person is ill treated and punished. The punishment included beatings and being denied access to medical care when they were sick.

If he notices that you are not interested in the sexual malpractice, the perpetrator will find other reasons to punish you; many times you end up being beaten up for an offence you didn’t commit (Participant #3- NB)

He could tell a lie that you have done something wrong. They called you before ‘gawo 5', where you are disciplined and if found guilty, you are beaten up (Participant #3- KK)

The young inmates would never be assisted when sick. We are subjected to ill-treatment or mistreatment by the leaders if we refuse sex (Participant #1- KK)

Finally, some of the incarcerated persons could not do otherwise but agree to sexual practices so that they would have a better place to sleep, as they are tired of sleeping in a sitting position.

We have just been arrested and kept here; we are new inmates like those youths on remand. Sometimes the long-serving inmate gets to you and asks for sex. When you refuse, he would tell you that you are going to be punished; out of fear, you accept (Participant #3- NB)

When you realize that you are going to sleep in a sitting position every day, you agree to have sex in order to be provided with a better place so that you can at least sleep well (Participant #5- KK)

You just accept it as you will have a better place to sleep in. Thus, you let them do whatever they want (Participant #4- NB)

The need for sexual violence communication and prevention

The study findings revealed that incarcerated individuals who were sexually abused had difficulties reporting it to the authorities. This is due to a non-existent reporting system for such matters to prison officials. Furthermore, prison authorities do not respond positively to complaints related to sexual abuse. The following verbatim quotes illustrate this:

Even if you have been beaten for refusing to have sex and you report it to the prison authorities, you will not be assisted because they do not attend to prisoners' complaints. They simply conclude that you are wrong (Participant #1- KK)

Basically on several occasions if you want to present a complaint to the prison authorities regarding any abuse inflicted on us, we don’t get assisted accordingly. This is due to a rule in prison that stipulates that any issues related to sickness or any other problem should be communicated to the prison warden through our fellow inmate, who is in charge. The problem arises if the person in charge is the one asking you to have sex with you (Participant #6- NB).

The study found that prison wardens have too much trust in long-serving prisoners who have been given leadership roles. Most of them are perpetrators of sexual violence. The following voices illustrate this finding:

When you have decided to report on your own to the prison authorities about the leaders who want to have sex with you; the wardens at the gate won’t listen to you. They ignore you completely; instead, they only attend to issues presented by inmates with leadership roles. When you insist on telling the officials the same, the leaders change the story and instead tell the wardens lies that I was intending to escape from the prison. They deliberately report lies so that I should not be attended to. Unfortunately, the prison wardens listen to whatever our leaders have said (Participant #1- NB).

The wardens have entrusted so much to the fellow inmates who have been vested with authority over us. It is even more difficult for the newly incarcerated individual to present a complaint to the relevant authorities (Participant #4- NB).

Young incarcerated persons need to communicate regarding sexual violence; however, quite often they are obstructed by the so-called ‘in-charge’:

The prison managers should be able and willing to listen to us, regardless of whether we are on remand or not. When we have presented a complaint, they should listen to us and consider our problem. However, the same leaders frequently demand sex from us, so we are challenged to who shall attend to our problems. This is unfortunate since those who were given responsibility to look after us they abuse their powers (Participant #3- NB).

In this regard, we are asking the prison management if we might be given an opportunity to report such matters without any stumbling blocks (Participant #1- NB).

Incarceration-related trauma

Some of the participants in this study believed that living in a Malawi prison was traumatic and associated with torture. When an individual is a prisoner, he is more like a slave.

Being imprisoned implies that everything you do is ‘slavery.’ You must physically and mentally experience the pain and torture. (Participant#2- NB)

Yes, some inmates use their physical strength to torture others; that is what being imprisoned entails; you must be tortured, you're a slave here (Participant #5 -NB).

Usually life in prison means torture or deliberately causing suffering, just being a prisoner means you are a slave here; you stop doing what you want to do other than follow orders; the inmates with physical strength are those who enslave us’ (participant #4- NB).

According to the study findings, incarcerated people reported having insufficient sleeping space due to congestion. As a result, they spend sleepless nights lying on one side for the whole night. Others sleep the entire night while seated. Incarcerated persons contract skin infections due to overcrowding:

We sleep in congested cells. We are forced to sleep one-sided for the entire night. As a consequence, the body becomes sore and hurts in the morning’ (Participant #4- NB).

We don’t even sleep as we spend the whole night seated instead of lying down due to lack of space; it is quite impossible to sleep during the night (Participant #6- NB).

Basically, we contract various skin infections; in this cell, there are a lot of inmates who have skin infections. Because we are overcrowded, it is easy to get infections because at night we sweat so much. So our skin is in close contact with our fellow inmates all night long, and we get infected easily. We do not even cover ourselves to protect our bodies, so I scratch my body every day. I don't know what to do next (Participant#3- NB)

Incarcerated people are spending entire nights sleeping in a sitting position in the middle of the cell due to overcrowding. This sleeping arrangement is known as ‘shamba’ in Malawi prisons. The environment is unsuitable for sleeping because it is filthy and foul-smelling. Basically, new incarcerated people do not have a specific place to sleep. As such, incarcerated people on remand usually occupy this space.

A shamba is a middle place in the cell where inmates sleep on the floor in an organized way. This is necessary so that space should be adequate to accommodate all the inmates (Participant #4- NB)

Inmates who are on remand have no specific place to sleep and are forcefully placed in the middle of the cell known as ‘shamba’. This is not an appropriate place as it is where food leftovers are stored and often filthy and smelly (Participant#1- KK).

The middle area is not an ideal place for prisoners to sleep on (Participant #6-NB)

In addition, in other facilities, special arrangements are made so that limited space accommodates all. Incarcerated people are arranged like 'firewood' so that everyone can find a place to sleep. That’s how they figure out how to fit everyone in a small cell.

We are packed like firewood while sleeping. We are arranged roughly in order to get accommodated in the small area (Participant #2- KK)

Inmates sleep on the floor in an arranged way. This is vital so that space should be sufficient to accommodate all inmates. We don’t actually sleep where we want to. We need to figure out how all of us shall fit into a small cell (Participant #4-NB)

The study revealed that incarcerated people with leadership roles or those serving long sentences have adequate space to sleep:

Prisoners who have been given long sentences have adequate space to sleep on. Some of them have leadership roles in the prison too. They have enough space, particularly in all corners of the cell. (Participant #2-KK)

Youth surviving prison life

As a way of trying to cope with abuse in detention facilities, participants often narrated that they would appear rude and tough, so that other incarcerated people would not take advantage of them. Supporting excerpts include:

When you seem to be scared of this place, some inmates take advantage of you. If you are a very quiet person, you become a victim of circumstances and struggle so much. Hence, we try our best to appear tough’ (Participant #6- NB).

Mainly we want to protect ourselves. One has to be strong to survive prison life. If you are constantly pushed around and obedient, you are going to be severely abused (Participant #1- NB).

Some of the participants perceived that the tendency of prison wardens to spend most of their time during the day in prison surroundings promotes safety, which helps them survive prison life:

The advantage of this prison is that the prison warden spends almost all of their time inside the detention facility during the day. This indicates that some prisoners may not have a chance to indulge themselves in sexual misconduct. On the other hand, inmates who want to have sex agree and plan the act (Participant #1- KK)

Participants frequently stated that some of the incarcerated persons are supportive; this enables them to cope with prison life easily as indicated below:

As for me, I shared a sleeping space with him, but he never asked me to sleep with him; he was released last week. We were like colleagues, and thus we could collaborate and support each other (Participant #1-M-10-06 NB).

Some inmates have good intentions and want to help a friend, but others intend to have sex with you (Participant #1-KK)

One day, I informed some of the senior inmates about this incidence. He advised me that I should never accept such misconduct, as it’s a crime to do so. I was also warned that I could contract diseases like HIV (Participant #3- KK)

According to the study findings, church members regular visits to the facility facilitate support for some of their daily needs. The church members provide them with basic necessities such as soap for bathing and laundry, as well as food. This is evidenced by the following quotation:

We are provided with soap etc when church members visit us here. Sometimes our relatives also give us things such as sugar, soap, etc. This tendency helps us to have soap for bathing and washing clothes (Participant #4- NB)

One of the detention facilities has a television set in each cell. This was commended by the young incarcerated people who indicated that watching television from 15:00 hours when it’s time to be locked up in the cell, up to 21:00 hours prevents boredom and mental illness. This is demonstrated by the following voices:

Without such entertainment facilities in the cells, prisoners would go through a rough time. This could lead to boredom and finally suffer mental sickness (Participant #6- KK)

Discussion

The study not only found evidence of sexual violence, but it also showed how sexual violence is connected to social-environmental conditions in prisons. According to our findings, youth are victims of sexual violence. This study revealed that some of the perpetrators of sexual violence were incarcerated individuals with leadership positions in the detention centres, while others were older men or men serving longer sentences; similar findings have been reported elsewhere.21 Literature suggests that youths are more than eight times more likely to be victims of sexual violence22 and that sexual violence is aimed primarily at young incarcerated persons.23 Incarcerated people at Malawi’s central and some district prisons have reported such cases.23 It can be argued that as a result of our research, there have been limited changes in addressing sexual violence 21 years after the report on detention conditions in Malawi. We are urging the Malawi prison authorities to take this issue seriously and ensure that young prisoners in Malawi are no longer subjected to sexual violence and degrading treatment. It will help their dignity be respected.23 We recommend that authorities ensure that the separation of adults and young incarcerated individuals is strictly enforced according to United Nations Office on Drugs and Crime (UNODC) recommendations.24 Corrections officers should prevent young incarcerated people from having sight or physical contact with adult incarcerated people while they are housed.

Additionally, this study revealed that incarcerated male youths who refused sex were mistreated, punished, beaten and summoned to a disciplinary hearing. From the standpoint of public health, there are a number of potential victims susceptible to HIV and mental health issues as a result of sexual victimisation inside prison. Hartsfield et al25 highlight that sexual victimisation may have physical, emotional and psychological implications for current and future behaviour inside and outside prison. However, the majority of people who are incarcerated eventually return to their communities. They typically relocate to communities where they committed their crimes or where they have familial or interpersonal ties.11 Youths who have been released from prison are more likely to return to socially disadvantaged urban communities with high rates of criminal behaviour and drug use and few opportunities for healthy and prosocial living.26 Victims of sexual violence arrive in these communities with increased needs for physical and mental healthcare, contributing to the spatial concentration of poor health. Consequently, these patterns of sexual victimisation inform interventions aimed at preventing such violence within prisons.

Our study found that incarcerated male youths who were sexually abused had difficulty reporting such incidents to prison authorities due to a non-existent reporting system for such incidents. Young incarcerated persons advocate for open communication about sexual violence and argue that incarcerated persons who file complaints should not be barred from doing so. According to Allen et al,27 sexual abuse of any kind in prisons is almost always underreported, even with the best reporting system. When young incarcerated persons are sexually assaulted while in custody, the Prison Rape Elimination Act (PREA)28 allows them to report it verbally, either in writing or anonymously, to the detention facility or an outside entity. Many detention facilities around the world have anonymous hotlines27 which Malawi could emulate. We also recommend that prisons put in place systems that allow abused incarcerated persons to report abuse without fear of repercussions from perpetrators of sexual violence or prison officers.

The main findings point to difficulties that incarcerated youth face, such as congestion and a lack of sleeping space. Manda6 attests that prison conditions in Malawi are deteriorating and that the current population is more than double the estimated capacity. Overcrowding in Malawi’s prisons is the root cause of several problems highlighted in literature, such as a lack of blankets, adequate food, soap, medicine, inadequate numbers of staff23 and also an increase in the spread of diseases, including HIV/AIDS, tuberculosis, that lead to the untimely deaths of incarcerated people.8–10 To be locked up in cells from 15:00 hours to around 7:00 hours the next day, as testified by the study participants in this research, shows that prisoners spend more than 60% of their time in crowded, dark cells. Overcrowding, according to our findings, leads to sexual exploitation and violence. In exchange for sexual favours from other incarcerated people, young offenders were given incentives such as adequate sleeping space. This finding is supported by a study conducted in America,27 which discovered that youths are frequently sexually exploited or coerced into having sex. These institutions, it is argued, facilitate sexual violence against young men.

Narratives from the participants flag that incarcerated youths spend their entire nights sleeping mostly in a sitting position, in what they call ‘shamba’. The term ‘shamba’ refers to the space in the centre of a prison cell that prisoners normally use as a passage to the restroom during lockup. Incarcerated persons, however, use this space as a sleeping area due to limited space and congestion. According to this study, incarcerated male youths and remanded incarcerated people mostly sleep on ‘shamba’. Participants reported that ‘shamba’ is an unhygienic place and not suitable for sleeping. Surprisingly, in Swahili, the word ‘shamba’ refers to a small plot of land used for farming. Most incarcerated persons in Malawi believe that they are meant to ‘work’ in the shamba because they can hardly sleep during the night.6 Additionally, Pękala-Wojciechowska et al29 revealed often reported signs of incarcerated people’s deteriorating health while incarcerated, such as extreme fatigue, weakness and lethargy caused by insufficient rest and sleep. Obviously, these people cannot effectively participate in any reformatory or rehabilitation programmes.

Participants repeatedly stated that in order to cope with abuse in detention facilities, they would appear rude and tough in order to prevent other prisoners from taking advantage of them. Male youths survival skills and coping strategies identified in this study may be helpful to avoid victimisation. However, it is possible that the harsh prison conditions and such coping strategies used by the male youths could make such young incarcerated people bitter, potentially increasing the rate of recidivism.30 31

There were some limitations to this study. Interviews were held in a room away from the prison guards, but security was maintained by having prison staff watch the interview process from a distance. This may have prevented some of the participants from freely expressing what they were experiencing. Finally, only incarcerated people of the age of 18 and those who had served less than a year in prison were recruited, so we do not know about the experiences of older, younger or female incarcerated people.

Conclusion

This study sheds light on issues concerning male youths in prison, particularly in SSA countries, that are relevant not only to Malawi but also to other prison settings with similar conditions. It discusses the implications of Malawi’s unsafe prison environment, particularly for incarcerated male youths who are more likely to become victims of sexual violence. Unwanted sexual touching or forced sexual activity as well as the related fear of sexual victimisation, have profound physical, emotional and psychological consequences for incarcerated people’s current and future behaviour both inside and outside prison. As a result, it is critical to prevent sexual violence in prisons. We, therefore, propose that Malawian prison authorities strictly enforce the PREA implementation.28 The PREA requirements provide that a young person should not be put in a housing unit where he or she will have sight, sound or bodily contact with any adult offender via a shared dayroom or other common space, bathing area or sleeping quarters. PREA requires organisations to either: (1) maintain sight and sound isolation between young inmates and adult inmates in places outside of housing units or (2) provide direct staff supervision when youthful inmates and adult convicts have sight, sound or physical contact. Furthermore, prison authorities should implement a zero-tolerance policy for sexual misconduct. In addition, the literature28 lists additional evidence-based interventions that should be undertaken to prevent sexual violence. First, surveillance cameras should be installed to decrease blind spots and record evidence for investigations. Second, prison personnel should be trained in crisis intervention to teach them about sexual assault and to assist victims of sexual abuse in reporting. Furthermore, policymakers, prison authorities and researchers must safeguard and empower survivors of sexual violence in prisons.