The issue has serious moral, administrative, medical, and philosophical ramifications. Many correctional administrators have objected to distribution of condoms, feeling that it would signify approval for sex in prisons. Others feel it is unnecessary because AIDS is not perceived as a major problem. In New York City's Riker's Island facility, condoms are being distributed to inmates, but inmates caught having sexual relations are still punished. Medical staff at the facility feel the program has not caused problems or encouraged promiscuity. Some feel the program is underutilized, as only three to ten condoms are distributed per day in a facility holding 2,600 men. In Philadelphia, proposals to distribute condoms and bleach to inmates have generated much opposition and controversy, although such a program is advocated by the City Health Commissioner. In general, prison clergy and members of the Board of Trustees have been opposed to condom distribution, despite evidence that such programs are effective in other prison systems in the United States and Europe. Following many meetings on the issue, the Board voted three to two, with one abstention, against making condoms available.