ColumnsHealth & Wellness

AIDS Watch: Stemming the Tide

HIV and the prison system.

Kelly McCann

By Kelly McCann

Anyone who knows me knows I’ve got a soft spot in my heart for prison.

Does that seem weird? It’s because I started my career some 20-odd years ago working as an associate clinical psychologist at the Texas Department of Criminal Justice Goree Unit in Huntsville.

Since that time, whether working in community mental health or HIV, I’ve managed to stay connected to correctional facilities and incarcerated persons, much to my delight. I even had the privilege of serving as a consultant to the U.S. Surgeon General’s Call to Action on Correctional Health Care in 2004.

My experiences over the years have taught me several lessons:

1) Correctional staff members have a very difficult and often thankless job, and I have immense respect for them;

2) Prisons and jails are communities with their own unique culture, and we must be aware of that culture to effectively operate in the correctional setting;  

3) Inmates are more resourceful than MacGyver. They can create a beautiful floral sculpture out of toilet paper, turn a toothbrush into a deadly weapon, and make booze (or as inmates refer to it, chock) with a jug of water, a piece of bread and some raisins;  

4) There are evil people in the world who need to be locked away forever, but most inmates are pretty decent folks who got themselves into trouble because they exercised bad judgment due to substance abuse, mental illness, poverty, lack of education, poor impulse control, or desperation; and most importantly,  

5) Those of us who work in HIV must intervene in correctional facilities to provide prevention and treatment education to inmates, as well as discharge planning and continuity of care services for those prisoners being released and returning to our communities.  

Why, you ask? Why should we care about prisoners? First of all, in prison we have (forgive the pun) captive audiences who are usually sober and more receptive to educational messages than when they are not locked up. Therefore, the information we provide to inmates actually sticks with them. We can conduct HIV prevention interventions to help those who are not infected stay that way. And for those inmates who are living with HIV/AIDS, we can teach them the importance of safer sex, disease monitoring, and medication compliance so they can live longer lives of greater quality.

When HIV-positive prisoners are released from custody, they will take their newly acquired knowledge with them and perhaps that will help keep our communities safer. Through discharge planning and continuity of care services, we can assist recently released offenders with securing medications and medical treatment, as well as other supportive services that will help them stay healthy and out of jail. All these actions benefit the inmates and the corrections system, and they also serve public health interests, our communities, and the taxpayers.

Another reason we should address HIV issues within correctional institutions is that the burden of disease is greater inside prison than in the “outside world.” For example, TDCJ statistics for August 2007 show a total prison population of 152,671. Of that number, 2,499 inmates, or 1.6 percent are living with HIV/AIDS. That is approximately four times the rate of infection in the general U.S. population!   If you want to go where the disease is, prison is a perfect destination.

AIDS Foundation Houston has been working inside the TDCJ since 1999 when we developed an HIV prevention curriculum and peer education program for inmates. We conducted a pilot study in five prison units, and our evaluation showed statistically significant increases in knowledge and assessment of personal risk for HIV infection among the offenders who participated. TDCJ administration was impressed with the results and made it a permanent program.

In 2002, AFH secured a large federal grant that allowed us to expand the peer health education program which became known as Wall Talk. With such funding, we were able to revise the curriculum to include hepatitis, sexually transmitted infections, tuberculosis, and other health issues pertinent to incarcerated populations. Moreover, we radically increased the number of prisons participating in the program.  

To date, AFH has trained more than 1,500 inmates in 80 TDCJ units to serve as Wall Talk peer educators. In turn, those offenders have conducted classes about HIV and other infectious diseases for tens of thousands of their fellow inmates. Even more striking is the number of educational encounters that take place outside the classroom settings. Our evaluation indicated that informal education routinely occurs in the chow halls, housing pods, and recreation yards of TDCJ prison units, and more than 154,000 such “teaching moments” occur each year!

In addition to Wall Talk, AFH provides linkage to care services for HIV-infected inmates who have been released from prison. Through our nationally recognized Get Started case management programs, we connect HIV-positive offenders to medication programs and primary medical care, and we either provide, or assist them in securing, clothing, housing, food, transportation, and other essentials they need to get started on their new life, back in the “free world.”

We at AFH are committed to serving TDCJ and the disenfranchised population of incarcerated persons. And we believe that is of benefit to us all.

Editor’s note: For more information, read “Outcomes of Project Wall Talk: An HIV/AIDS Peer Education Program Implemented within the Texas State Prison System,” AIDS Education and Prevention, 2006, volume 18, pages 504-517.

Kelly McCann is the chief executive officer of AIDS Foundation Houston, which recently marked 25 years of service. Details:


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