Pilot Inmate AIDS Peer Education Project Underway in New Brunswick
The precise number of inmates with HIV-infection in Canadian federal and provincial prisons remains unknown. However, in July 1995 almost one in every 100 federal inmates was known to be living with HIV/AIDS, a 25 percent increase over a period of just over one year, and rates of infection continue to increase in all regions.[1]
In prisons, unsafe sex, sharing of needles for injecting drugs, piercing, tattooing, and injecting steroids are behaviours that pose a high risk for the transmission of HIV.
Traditionally, HIV-related education in federal penitentiaries has been passive, and has included audiovisual materials, brochures, information sessions, and conversations with Correctional Service Canada (CSC) Health Care staff.[2] Such education has frequently been criticized as lacking comprehensiveness[3] and being ineffective[4]. Because most HIV-related risk activities constitute institutional offences or are illegal in prisons, inmates have understandably been reluctant to discuss the associated risks with correctional staff.
Recommendations for inmate AIDS peer-education approaches have been made in several documents, and were repeatedly echoed at the First National Workshop on HIV/AIDS and Prisons.[5] In March 1994, the Expert Committee on AIDS and Prisons (ECAP) recommended, among many other things, that inmates "be assisted in delivering their own peer education, counselling and support programs," and that "in each institution, CSC should create or designate one or more inmate job positions as peer health counsellors and provide for appropriate training, support and evaluation."[6] The need for peer-led AIDS programs had also been stressed in the brief prepared by the Prisoners with AIDS/HIV Support Action Network (PASAN).[7]
In response to ECAP's report, CSC agreed to pilot-test a program of paid inmate peer-health promotion.[8] AIDS New Brunswick (AIDS NB) had already undertaken education and support work at Dorchester Penitentiary, a medium-security federal penitentiary housing approximately 400 male inmates in eastern New Brunswick, and submitted a proposal for the pilot project. The proposal was approved for funding, and work started in February 1995.
The 15-month "CAN" Project (Cons AIDS Network Peer Education Project) is aimed at developing, implementing and evaluating a sustainable peer-education and support model in which inmates provide their fellow-inmates with the necessary information, motivation and skills to prevent HIV and other communicable diseases and provide support to those living with HIV/AIDS. The program is the first of its kind to be pilot-tested in Canada, and, if effective, may be adapted for use in prisons throughout the country.
It involves developing and implementing an AIDS-related training curriculum for inmates interested in becoming peer educators. These inmates will participate in a four-week training program that will be delivered in an interactive and prisoner-centred format. Following this program, participants will be assessed in terms of their interest and suitability for becoming peer educators or the program coordinator. The inmate hired as coordinator will receive four additional weeks of one-on-one support and training. He will play a strong supervisory role, and will be responsible for the coordination, ongoing education and supervision of peer educators.
An evaluation of the program will be conducted through the administration of a knowledge, attitudes and behaviour (KAB) questionnaire administered prior to and three months following the implementation of the program. A training manual will also be prepared to provide other community-based organizations and prisons with guidelines regarding the setting up, implementation, evaluation and sustaining of peer education and support programs within correctional facilities. In addition to suggested facilitation strategies, the manual will include a number of overheads, hand-outs and exercises developed specifically for inmate AIDS peer education.
A critical component of this project is the involvement of a number of key players. The project coordinator is working with a national advisory committee consisting of representatives of CSC, Health Canada, the John Howard Society, various AIDS-service organizations, and inmates. A Dorchester advisory committee has also been formed, with representation of staff from health care, case management, psychology, personal development, security, and of inmates. HIV-positive and HIV-negative inmates have and will continue to play an instrumental role throughout all phases of the project.
For many reasons, education by peers has been held to be particularly effective in preventing the spread of HIV/AIDS in prisons:
• Inmates do not often trust correctional staff; HIV-related information from peers is not viewed with the same suspicion.
• Peers may be the only people who truly understand the prison culture and inmate code, along with strategies that work in the prison setting.
• Because they reside in the same setting, peers are able to respond both formally and informally to educational needs in an ongoing manner.
Conclusion
Effective and comprehensive inmate AIDS education strategies are needed to prevent transmission of HIV and other transmissible diseases, such as hepatitis, in Canadian prisons. Inmate peer education programs, successfully adopted in various prisons worldwide, are an important part of these strategies, and offer the most promise of success.
For further information, contact Caroline Ploem, AIDS New Brunswick, at 1-800-561-4009 or (506) 459-7518.
- Caroline Ploem
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ENDNOTES
[1]Correctional Service Canada, Health Care Services. Monthly Reported Cases of HIV/AIDS in Federal Penitentiaries, July 1995.
[2]Correctional Service Canada. HIV/AIDS in Prisons: Final Report of the Expert Committee on AIDS and Prisons. Ottawa: Minister of Supply and Services, 1994, at 42.
[3]PASAN. HIV/AIDS in Prison Systems: A Comprehensive Strategy. A Brief from the Prisoners with AIDS/HIV Support Action Network (PASAN) to the Minister of Correctional Services and the Minister of Health. Toronto: The Network, June 1992 at 12.
[4]Parliamentary Ad Hoc Committee on AIDS. Confronting a Crisis: The Report of the Parliamentary Ad Hoc Committee on AIDS, 1990.
[5]Correctional Service of Canada, supra note 2 at 50.
[6]PASAN, supra note 3 at 3-4.
[7]Correctional Service Canada, Health Care Services. Backgrounder: CSC Response to the Expert Committee on AIDS and Prisons (ECAP), 24 March 1994, at 2.
[8]Centre for Education and Information on Drugs and Alcohol, in association with The Prison AIDS Project of the N.S.W. Department of Corrective Services. National Prisons HIV Peer Education Program: Training Manual. Sydney, 1991, p. 19.