Peer-Based Programs

Inmate peer-based programs have four key advantages: credibility, range
of services, cost-effectiveness, and benefits to peer educators themselves.
Peer educators probably have more inherent credibility with inmates than
representatives of “the system.” They speak the language of inmates and
have had similar life experiences. To be effective, however, it is important
and challenging for peer educators to avoid being seen as allies of or
spokespersons for the system, particularly in programs in which
correctional officials play evident roles in their selection.

Peers can offer a range of services, including orientation (”AIDS 101″);
individual and group risk-reduction counseling; and informal interaction
with inmates in the yard, during programs, and at other times and places
apart from structured meetings and presentations. Peer educators often go
on to work with inmates with HIV disease, explaining drug regimens and
improving adherence, serving as “buddies” and offering other supportive
services, and providing hospice care for terminally ill patients. Elizabeth
Mastroieni, Coordinator of AIDS Counseling and Education (ACE) at
New York’s Bedford Hills women’s facility, one of the first and best
established HIV peer inmate programs, described some of ACE’s tangible
and intangible benefits.

I witness miracles here every day. I see women. . . sharing their
commissary and sharing their experiences. I witness women volunteering
their time to nurse women back to health, to educate them about their
health and cry with them about the experience of loss. I have been filled
by the bittersweet memorial services where a woman’s life is celebrated as
her memory fills the room and enlivens the spirit.

For three years I have witnessed the energy of brainstorming, creating,
planning, and physically walking to raise money for children they do not
know but care for because of their emotions as wife, mother, lover, aunt,
sister, and friend . . . .

There is laughter. There is community. There is a sense that I can do for
others and they can and want to do for me. There is support. . . . There are
many miracles here at Bedford.[5]

Peer programs can be highly cost effective. Peers can provide formal and
informal services almost around the clock. They are often available when
regular staff are not. The only substantial costs of peer programs are likely
to be for training the peers. It is advantageous to have regular inmate work
slots designated for peer educators (as at the Albion women’s facility in
New York State and at several California prisons), but inmate wages are
very low and in many systems are negligible, so this should not represent a
large expense, particularly in comparison with the cost of other models of
delivering education and prevention programs. The Oklahoma Department
of Health developed a peer program for women inmates in that State for
$4,000 in outside grant funds.[6]

Finally, inmate peer educators commonly report tremendous improvements
in self-esteem, knowledge, and commitment to the community based on
their experiences in these programs. Many go on to paid positions in HIV
prevention following their release from prison. Kathy McGrath became a
peer educator at Massachusetts Correctional Institution-Framingham and
now works as an HIV educator for Great Brook Valley Health Center in
Worcester. McGrath reported that “becoming a peer educator was the start
of my life” after years of drug addiction and repeated incarceration.
Moreover, she stated, “There are so many women like me who have
everything it takes inside, but no outlet for it.”[7] Miguel Cruz was the first
HIV peer educator at Hampden County (Massachusetts) Correctional
Center and is employed as an HIV outreach worker at Holyoke Health
Center. Cruz spent 18 years of his life as a heroin addict and dealer.
According to a coworker:

Miguel is a man at peace with himself, and he is enjoying what life has to
offer him for the first time in two decades-going to the movies, playing
sports, doing a job he loves and doing it well, owning a car and nice
clothes. These are the rewards of a new life and he is not about to give that
up. His old friends from the street, he says, were at first skeptical just
waiting for him to do that first bag. This hasn’t happened and that
skepticism is being replaced with unmistakable respect and admiration.
Miguel, their old compatriot, who was every bit one of them, now has
turned his life around and is back to the same old streets, trying to help his
buddies in any way he can to do the same. . . .

Miguel’s 18-year training program for his present job gives him the ability
to accomplish things on the street that I, for example, simply never could.
His mere presence on the street, as living proof to all his old neighbors that
the evil power of addiction can be beaten, has more life-changing potential
than 10 doctors trying to patch these people up and to keep them alive. . . .
Miguel is not a doctor, but he is a healer. [8]

Although HIV/AIDS peer programs are finding increasing acceptance
among correctional administrators, there may still be resistance.
Opposition is most often based on suspicion of initiatives that seek to
“empower” inmates. Some administrators may view any empowerment of
inmates as an ultimate threat to discipline and order in their facility. At
one Federal facility, a new warden discontinued HIV/AIDS orientation
presented by peer educators because he considered this an “inappropriate”
role for inmates.

Inmates themselves may have to address and overcome stigma that may
result from their involvement. It may be assumed, for example, that
anyone volunteering to be an HIV peer educator must be HIV infected.

Inmate peer programs are easiest to implement in prison systems in which
inmates stay long enough to have a stable group of educators. However,
peer programs have been successfully established in jail systems as well.
In jails, peer educators are generally drawn from sentenced inmates. As of
the end of 1995, nine county jails in Massachusetts had established HIV
peer education programs with funding from the State’s Department of
Public Health (DPH).[9] All of the Massachusetts county jails were
expected to implement peer education in 1998 as part of comprehensive
HIV/AIDS programs funded by DPH.[10]

Factors in successful peer-based programs include the following:

o Working closely with correctional officials in planning the program. To
address common objections and overcome resistance, a written proposal
should be submitted describing the program and its benefits.

o Involving outside organizations, such as public health agencies or AIDS
service organizations, in leading or otherwise key roles to demonstrate the
program’s independence from the correctional system and thereby to build
credibility with the inmates.

o Carefully screening peer educator candidates for motivation, sincerity,
commitment, and absence of emotional problems and inappropriate
personal “agendas.” Candidates’ length of time left to serve should be
sufficient to allow them to contribute significantly to the program before
they are released.

o Ensuring that peer educators reflect the linguistic, racial, and cultural
profile of the inmate population.

o Giving peer educators specific goals and incentives, such as academic
credit, prison job slots, or “good time.”

o Developing a peer-driven curriculum rather than one that is driven
primarily by the goals of the correctional system.

o Being sensitive to the stigma still associated with HIV/AIDS in many
correctional facilities that may adversely affect the recruitment of peers
and attendance at programs.

o Providing counseling and support for peer educators as necessary.[11]

The advantages of peer programs and the factors facilitating the success of
such programs are well illustrated by case studies of programs in the adult
correctional systems of Louisiana and California and the Los Angeles
County juvenile system, observed during site visits for the survey.