HIV Treatment Education in 2002
HIV/AIDS is now the leading cause of death in New York State prisons, accounting for 66 percent of inmate deaths. In fact, New York State has more inmates living with HIV than any other state prison system in the United States.
Access to medical treatment can be difficult within the prison system. Prisons are already financially strapped without the additional stress of the expensive medical treatments sometimes necessary for people with HIV. Because of the overpopulation of New York State's prisons and the high demands placed upon prison doctors, it is difficult for even the most dedicated medical professionals to update their knowledge of the most cutting edge treatment strategies. Doctors rarely have the time to educate their patients even when they are up-to-date on current treatment options. The huge number of patients that need to be seen every day limits actual patient-doctor time. There just isn't the time to build healthy doctor-patient relationships. These factors make it hard for prisoners to access up-to-date and adequate treatment. Even if prisoners are able to get good medical treatment while in prison, they often face a gap in treatment upon being released.
Some prison administrative officials feel that educators are there to promote specific drugs instead of providing AIDS/HIV education. Because there is the potential for informed prisoners to advocate for specific (and often expensive) medications by name, administrators look at education as a hindrance in the system. One well-informed prisoner that I worked with was taking an antiretroviral combination that he was comfortable with and felt worked well. His doctor wanted to change him to a combination that the prisoner did not feel comfortable with due to possible side effects. Soon after refusing to switch medications, he was moved to a higher security prison. Even if his transfer was a coincidence, this type of incident can heighten tensions between administrators, inmates, educators and medical professionals. The perception that this prisoner's self-advocacy led to negative consequences -- accurate or not -- can lead to other prisoners feeling apprehensive about speaking out about their own medical needs. The possibility of prisoner resentment and anger building up towards administration and medical providers is already high without the added stressor of perceived retaliation for simple medical advocacy.
Educators have to work hard first to dispel the belief of administrators, and even the occasional medical provider, that inmates in possession of information are dangerous before even being able to start the real job of providing education. The education of prisoners not only includes providing information on HIV/AIDS and available treatments, but also the importance of self-advocacy without furthering the rift between those in charge of the prisons and the prisoners.
Because of the high incidence of HIV in the system and the difficulties that those infected face while in prison, education is especially important. However, there are very few community agencies going into the prisons to provide education because of the difficulty in obtaining funding. There are very few grants available. Those that do obtain funding and go into the prisons face strict restrictions. Even providing condoms to encourage safer sex is impossible because they are considered contraband items! Educational materials are limited to literature/handouts because demonstration materials such as models for proper application of protective devices are also considered contraband. Videos often need to be sent at least a month ahead of time so that they may be viewed and approved by administration before being used.
One of the most successful models to help prisoners combat these many obstacles is the P.A.C.E. program (Prisoners for AIDS Counseling and Education) at Eastern Correctional Facility in Ulster County. This group was founded in 1988 by a small group of HIV-positive inmates who felt the need for peer education and awareness. Prisoners are more receptive to peer education than presentations from outside educators. There is a feeling that peer educators understand the life of a prisoner better than any visiting educator ever could. That said, those who do volunteer to become peer educators are often enthusiastic and very appreciative of any outside resources they may receive. Some prison administrators are also supportive of peer education efforts. In prisons where staffing is especially tight, officials often appreciate efforts to bring prisoners into meaningful activities that they might not otherwise be able to provide.
I work with eight different facilities in four separate counties, providing two trainings approved by the New York State Department of Health. The first is a four-day Peer Educator Training that offers the skills necessary to deliver peer education within the facility. The second is a two-day HIV Test Counselor Training, which provides the rules and regulations for providing HIV testing in New York State. I also present smaller workshops on topics like "Basic HIV Infection and Prevention" and "Domestic Violence." Providing HIV medication updates is also an important part of my job. The fact that I am able to provide these services to an underserved population with such a high rate of HIV infection is what motivates me to keep going back to these faculties. I am proud to be part of such a dedicated group of individuals. Hopefully, through the dedication of those working both outside and within the prison system, New York State will not continue to have the highest incidence of prisoners with HIV.
Hugo Mendez is Prison Services Coordinator, AIDS-Related Community Services (ARCS), Elmsford, New York.
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication ACRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.