NY program provides HIV interventions for inmates
NY program provides HIV interventions for inmates
Both condoms and jobs are focus
[Editor's note: This is the second part of a special report on how prisoners returning to the community often need specific HIV prevention interventions. In this issue of AIDS Alert we highlight the efforts of a New York prison re-entry program that serves as a vehicle for HIV prevention, as well as a way to reduce prison recidivism. In the July, 2009 issue of AIDS Alert, we featured a study that found a large portion of HIV-positive prisoners released into the community do not immediately access care or treatment.]
A New York AIDS service organization (ASO) has found that a good HIV prevention program for people who were incarcerated in state prisons involves a multi-step program that includes health/HIV education, finding them a place to live, finding them a job, and following up with community support.
In the nearly three decades the world has been dealing with HIV/AIDS, it's become clear to public health officials, ASOs, and clinicians that effective HIV prevention, particularly for some of the most vulnerable and highest-risk populations, requires a holistic approach.
"When guys are first getting out of prison they have much more immediate needs than HIV prevention," says Nancy Fisher, director of prevention services for AIDS Council of Northeastern New York in Albany, NY. The AIDS Council has five offices that work with 15 counties in Northeastern New York, and it's located 160 miles from New York City.
The organization also works with HIV positive inmates, providing them with services in their home communities through a case management model.
"They have issues with housing and employment, so we stabilize them in most things and make referrals, and then we deal with teaching them safer behaviors," Fisher explains.
Here's how the organization handles HIV prevention for newly-discharged prisoners:
• A community re-entry specialist works with men and women upon prison discharge.
"I work with people who are at risk for HIV simply because of their lifestyles before they went into prison," says David Howard, community re-entry specialist with AIDS Council of Northeastern New York.
The re-entry prevention program's goal is to slow down the prisoner recidivism rate by helping prisoners returning to the community receive positive support and reinforcement.
"I see men in the department of parole who I develop a positive relationship with," Howard says. "Parole officers refer them to me."
The newly-released men and women have to contact Howard, but once they do he is flexible about when and where they'll first meet.
The stigma of HIV/AIDS leads to many ex-offenders choosing to meet outside of AIDS Council's offices, he notes.
"We have a one-on-one consultation and evaluation," Howard says. "I ask at every intake: 'Have you been tested for HIV?'"
Nearly all of the people say they were tested while in prison, so Howard offers to have them retested if they wish. He also hands out condoms and information, along with making them referrals for housing and employment services.
• Provide support services to released prisoners.
"The thing is that when a guy comes home from prison he paints a picture that everything is all right, but the reality is that he doesn't have a place to live, he doesn't have Medicaid, and he doesn't have too much to look forward to," Howard says. "So they come in and meet with me, and they can be honest with me because I'm an ex-offender, and I identify with not having anyone out there that I can talk with."
Howard helps them both find and prepare for job interviews, and he cultivates contacts throughout the region with the goal of finding people who will hire ex-offenders.
"David has many connections with employers who will hire ex-offenders, so he knows where to send them so they'll have a better chance of success," Fisher says. "He tells them how to dress and how to carry themselves, and they can hear it from him because they see him as a mentor."
Howard also helps ex-offenders address substance abuse problems by helping them attend group support meetings.
"Ninety% of the people who return from prison have substance abuse issues," he says. "I'm also in recovery, and I serve as a model for them."
• Work with other organizations that target same population.
AIDS Council also works with other organizations that help ex-offenders, including ROOTS — Re-entry Orientation and Opportunity Toward Success, which is a group for ex-offenders, Fisher says.
"They've developed a curriculum that points ex-offenders toward success," she explains. "And we have a subcontract with them where we provide twice monthly meetings."
The meetings are small group interventions that discuss HIV prevention, along with behavior change strategies, including changing one's attitude toward life and work.
"I have a lot of young men who show up and who are serious about changing their criminal thinking and who don't want to go back to the corner to sell drugs," Howard says. "They want to make a contribution to their community."
The problem is their low frustration tolerance and proclivity toward easy boredom.
"We have some young men on a waiting list to enroll in a community college," Howard says. "We have to create things to keep people occupied and busy so they won't fall back into recidivism."
Within this context, teaching ex-offenders about HIV prevention is one part of the package, while teaching them how to be happy and productive members of society is another part, he explains.
• Provide HIV prevention classes within prison walls.
Howard has taught basic HIV information in correctional facilities in 16-session classes of 1.5 to 2 hours duration per session.
"I taught basic HIV information and about how if you are getting high with someone, here's how to sterilize the utensils you're using," Howard says. "If you don't have a constant partner, here's how to properly use condoms, and I teach communication skills and how to adjust and deal with HIV."
• Provide peer associate program.
For ex-offenders who are staying in AIDS Council's region, there are opportunities for them to become peer associates, Fisher says.
"For folks who are ready, we provide training and individual interventions," Fisher says. "They're dealing with their own risk reduction behavior, and we provide opportunities and outreach for them to share the HIV information they've learned with others in their community."
This reinforces HIV education among a high-risk population, and it helps peer associates build their own HIV risk reduction behavioral skills, Fisher adds.
"This is a positive thing for them to do and to spend their time," she says.
The peer associates program helps teach ex-offenders responsibility, and it gives them something positive to do rather than to just hang out on their block, Howard says.
Howard also hoped that informal peer educator relationships would be built during the prison HIV prevention sessions.
"So maybe the guys with younger siblings could take it back and share it with their families," Howard says.
"I have some inmates who returned to the community who had peer education training for HIV," Howard adds. "These men received education about HIV and a certificate, and then they shared HIV prevention information with their family and close friends."
For the men who received the certificate upon completing all of the HIV sessions, this was a proud moment, Fisher says.
"For some, it's the first time they've stuck with something all the way through, and they're very proud," she adds.
A New York AIDS service organization (ASO) has found that a good HIV prevention program for people who were incarcerated in state prisons involves a multi-step program that includes health/HIV education, finding them a place to live, finding them a job, and following up with community support.Subscribe Now for Access
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