HIV Prevention in Prison

Today I visited PSI's HIV prevention activities in Mexico's largest prison.  The program activities consist of regular workshops to raise awareness of HIV risks, improve knowledge of modes of transmission and prevention, and build skills around condom use and condom negotiation.  A group of peer educators recruited from the prison population distribute condoms and engage in one-on-one interpersonal dialogues with other prisoners.

Having lengthy discussions with the peer educators really highlighted for me how much peer educators can benefit from particpating in such programs.  They were incredibly dynamic, knowledgable and enthusiastic about their work despite the fact that they often experienced stigma from prisoners who assume they are gay or HIV-positive.  One peer educator is HIV-positve and due to his status would typically be transferred to a maximum security prison known for its violence, however, because of his active participation in the program he has been allowed to stay in the current facility.

The visit also underscored the many misconceptions held by this prison population about HIV transmission especially in the context of men who have sex with men.  Most of the prisoners did not self-identify as gay; only receptive sexual partners were categorized as gay, and risk perception was low.

Finally, observing the activities also indicated the many challenges inherent in translating knowledge to actual changes in risky behavior.  All participants had a general understanding of the modes of transmission, yet one prisoner admitted that he had never, in his life, ever used a condom.  Yet, he engaged in unprotected sex with other inmates as well as with his wife during conjugal visits.  He didn't know his status, and expressed fear at potentially infecting his wife.

The program has it's work cut out for it, but it is comendable to conduct this work with a group that is often overlooked.