Unconfined to prison walls, infections may be carried back to society itself upon a prisoner's release, or even by staff and visitor contact with the infected. This brings serious challenges to prison administrators and health care providers alike, especially in times of constrained budgets. However, opportunities do exist for intervention.
In 1996, the Joint United Nations Program on HIV/AIDS (UNAIDS) emphasized the importance of health care/disease prevention by stating, "Prisoners are the community. They come from the community, they return to it. Protection of prisoners is protection of our communities."1
In the late 1980s, the California Department of Corrections' Health Care Services Division (HCSD) created the Inmate Peer Education Program (IPEP.) While similar programs now exist elsewhere (Florida, Louisiana, Texas, etc), all share a unique commonality in challenging the long-held stereotype of "convict mentality," and bring about an opportunity for positive change in the attitudes and behaviors of others. Peer educators are able to "speak the language" of other inmates, and may share similar experiences -- thus having a more inherent credibility than those who represent "the system" (often distrusted or even ignored). Peer educators can be quite successful in winning the trust of the inmate population. Inmate educators also develop a positive focus and purpose in their lives, empowered by the perception of their ability to influence others in ways never believed possible -- thus improving self-esteem, knowledge, and renewed commitment to the community.
Peer education programs focus on developing student attitudes and feelings, encouraging honesty, cooperation, and independent learning. Such programs emphasize mutual respect, discussion, and reinforcement of positive behavior. Peer programs provide a more humanistic approach, recognizing that learning is a change that develops in oneself that results from experiences. Through their efforts and behaviors, peer educators promote change in the prison culture and some of the socially accepted "norms" as a result. Through this commitment, peer educators can be deeply affected. As they see the change they bring about in others through fairness and balance in their presentations, inter-group relations overcome racism, sexism, and culturalism. Stereotypes are replaced by a more positive socialization; differences in others are acknowledged and embraced.
Developed and audited by the HCSD, Field Operations, Office of Continuing Education and Training, the IPEP is designed to serve the prison population throughout the state. Inmate educators are trained to provide current, medically correct health information to raise awareness regarding infectious diseases (HIV, hepatitis, STDs, TB, Staph), as well as other health-related subjects that plague the prison system, and society at large. Daily operations and supervision are delegated through each institution's chain of command to the staff member designated as the Institutional Peer Education Coordinator.
Those selected to become peer educators have a tremendous responsibility -- not only do their peers expect them to be knowledgeable and current on recent developments in infectious disease, but staff and inmates alike expect them to be positive role models. Inmate educators are held, and hold each other, to a high standard of conduct. A screening and training process is employed, and subsequent to certification, all agree to adhere to a set of standards and expectations -- failure of which are grounds for removal from the program. Such a process is used to avoid participation of those who may have their own "personal agendas" that are adverse to the mission of the program.
Candidates are recruited by either referral or through postings in the housing units. The applicant's central file is reviewed to see if there are case factors that would impede his/her credibility and effectiveness, or pose a threat to security. Applicants are interviewed by the IPEP Coordinator, who then determines their suitability for training. A rigorous training program ensues, after which the candidate gives presentations that are evaluated by the group and coordinator. Upon successful completion, certification is issued. Work does not stop here, however, as all Peer Educators must participate in regular training sessions and Continuing Medical Education, and conduct a minimum of one presentation per quarter to maintain certification. Educators offer a variety of services including formal classes, informal groups/support groups, and personal counseling, in order to combat the enormous amount of ignorance and misinformation that exists within and outside the prison. Misconceptions that have bred fear, prejudices, and stigmatization are countered by the vital exchange of information which improves the general public's health and safety, as inmates often relay information to relatives and friends, either at visits, by mail, or telephone. Educators have also shared current information on disease management with medical staff unaware of recent developments.
Program success is a collaborative effort between peer educators, the HCSD, administrators and custodial staff that wholly depends on involvement and support which are vital in enabling access to housing units, classrooms, and work sites. Equally important is support given by individuals and community-based organizations (CBOs), where training and resources are acquired or shared. Prison administrators are realizing that peer-based programs have four key advantages: credibility, range of services, benefits to inmates and peer educators, and cost-effectiveness.
Problems that beset the program are the occasional obstacles raised by lockdowns, correctional staff who are either unaware of the program's efficacy, or unwilling to accept the idea that inmates can take on personal responsibility for themselves and others. Yet, as the program grows, such obstacles are removed. Another problem that arises is the availability of accurate and current information. Inmates in maximum-security institutions cannot directly access websites created by various health agencies/organizations. They must depend on the kind support of agencies like the CDC, NIH, Immunization Action Coalition, American Foundation for AIDS Research, IDCR, AIDS Project: Los Angeles, Immunization Action Coalition, UNAIDS, and a host of others to obtain such invaluable educational tools freely.
Here at the California State Prison in Lancaster, the IPEP has continued to receive the excellent support of the warden, associate wardens and custody staff in enabling its mission to continue.
Peer education continues to remain an effective means of addressing HIV/AIDS, hepatitis, STDs, and TB cases within the prison system(s), as well as target populations in the public sector. One often gets lost in the eddies of mass campaigns that exist to address the various epidemics, unable to see clearly how it takes each individual person's efforts to create changes in people's lives, and eventually changes that would bring such epidemics under control. Even the smallest, seemingly insignificant person can change their world, their future, and that of the world around them. Peer education proves that.
Thomas Michael Simmons is incarcerated at California State Prison, Lancaster, where he serves as an Inmate Educator of the Inmate Peer Education Program. Disclosures: Nothing to Disclose.
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