The Failure of Peer Support Groups in Women's Prison in Western Australia
Ruth Wykes, 1997
Community Education Manager; Western Australian AIDS Council
For the past seven years the AIDS Council has been conducting workshops in Bandyup Women's Prison in Perth, Western Australia. Bandyup is the only women's prison in the state and is classified as maximum security, even though most of the inmates are serving time for relatively minor offences. In those seven years a number of strategies have been implemented in an attempt to reduce HIV and other blood borne viruses among women in prison.
The foundation of these strategies has been a number of attempts to work with women in prison to establish a Peer Support Group that would:
provide ongoing education about HIV and Hepatitis C
advocate, on behalf of that group, for changes that would enable women in prison to adopt healthier behaviours relating to their drug use.
This paper will attempt to describe the reasons why Peer Support has failed in this environment, and will put forward the only alternative solution that will work to reduce the transmission of blood-borne viruses in the prison setting.
Bandyup Women's Prison has up to one hundred and twenty prisoners at any given time. Seventy percent of these women are incarcerated for drug related offences such as theft or fraud. The average age of a prisoner is twenty four, the average length of incarceration is three to six months, and there is a disproportionate number of indigenous (Aboriginal) women in prison. To give you some idea of how disproportionate the levels are, 2% of Australia's population are indigenous, and up to 60% of the prison population is made up of indigenous women. Levels of literacy, of education, and the rate of employment prior to being imprisoned, are all lower, on average, than in the general population.
It is ironic, in many ways, that we on the outside are sitting around discussing the concept of " peer support in prisons " with any sense of expertise. We say that we know how it works, that our research has shown it to be useful, and that all anecdotal information from prisoners points to an effective strategy. But effective in terms of WHAT?
Imagine that you are a twenty-six year old woman who has just entered the prison for the second time in your life. You stole someone's credit card and you have been sentenced to three months imprisonment. You occasionally inject drugs and you know, from last time, that your using is likely to increase while you are inside. Having been there before, you know that at least fifteen percent of the women will regularly inject with something that remotely resembles a syringe, and that in excess of thirty-five percent of the prisoners are Hepatitis C positive. But are these women your peers?
There is an assumption that these women are an homogenous group, and that they naturally fit: into a peer group by virtue of the label " prisoner ". These women are also mothers, children, indigenous, ethnic, Caucasian, heterosexual, lesbian, middle class, working class, educated, uneducated, rural, urban, young, and middle aged. The labels that people try to stick on them in order to make them fit into some artificial " peer group" keep falling off.
Peer Support Groups are designed to perform a range of functions. In the context of harm reduction they exist for two main reasons:
• for prisoners to provide ongoing support to other prisoners who receive a diagnosis of hepatitis C or HIV;
• for prisoners to educate other prisoners about how to prevent themselves from becoming infected with a blood borne virus.
The expectation is that a small group of oppressed, disempowered women who have NC) decision making control, NO access to sterile injecting equipment and NO ability to change a system that keeps them oppressed, are going to take responsibility for a significant public health crisis.
I am not arguing that Peer Support doesn't have a role to play, but in the Women's Prison in Perth, it has failed injecting drug users, it has failed people with Hepatitis C, and it has failed women who are at significant risk of blood - borne viral transmission. Why?
In the past seven years I have had a number of discussions with the women in Bandyup. There does exist a Peer Support Group, which is affectionately called " The Sunday Knitter's Club ". This is a reference to a small number of longterm, conservative prisoners who run this group and who are perceived by prisoners and prison staff alike to take advantage of meeting times to sit around and gossip. Every attempt to get the Peer Support Group to address issues surrounding hepatitis C and other blood-borne viruses, or the needs of injecting drug users in prison has failed.
Prisoners themselves, in their discussions with me, have offered the following insights into the failure of Peer Support Groups:
• Women who identify as injecting drug users suffer negative consequences from prison staff. For example they are subject to more frequent random urine tests, regular random cell searches, and they experience discrimination from medical staff in the prison.
There is no appropriate medical treatment ( such as interferon for women with hepatitis C ), and NO counselling for women who receive a blood-borne virus diagnosis in prison. Women with chronic hepatitis C frequently report that they are not allowed to take a day off work when they are suffering from severe fatigue, and it is very common for the staff to offer paracetamol for headache, rather than the less hepatoxic aspirin.
Most women are not in prison for long enough to sustain an ongoing support group. As I mentioned at the beginning of this paper, most women are incarcerated for between three and six months.
Prison culture demands that drugs and equipment are scarce, and as such become very valuable trading items. This sets prisoners up to be competitive, rather than supportive of each other.
Preventative education among peers is impossible when prisoners have no means to adopt the changes that would lead to healthier choices. One syringe in Bandyup is frequently used by up to twenty women, and is reused numerous times. Sharing syringes is common and fact it is rare that a prisoner can or will inject alone.
Prison Officers have ultimate control over the ability of peer support groups to meet, and have been known to stop meetings without any justifiable reasons.
Prisoners themselves don't really see the need for Peer Support. Their attitude towards hepatitis C is fatalistic, and the threat of hepatitis C transmission is not enough to deter drug use and needle sharing.
On the other :side of Australia, in New South Wales, women in prison hold similar doubts about the effectiveness of peer support groups in prison. In her book " Prisons and Women " Blanche Hampton, an ex-prisoner, describes it this way:
" The few excursions into the realm of peer support groups have generally failed due to limited support in terms of funding or programme time allowed, the release of key members, or the transfer of staff who had been particularly supportive. The fact is that groups have a tendency to become political when they perceive the inequities in their treatment, that this usually doesn't take long, and that such groups are not seen as being conducive to the only thing that really matters - the good order and management of the jail ".
Prisoners who are HIV or Hepatitis C positive, or who inject drugs while they are incarcerated, have identified much more basic needs than a Peer Support Group.
If we are serious about reducing blood borne viral transmission in prisons, we need to stop arguing for soft changes. Privately it is acknowledged in many sectors that radical changes need to occur, but very few people or organisations Eire prepared to take a public stand.
According to the women in Bandyup it is unrealistic to expect drug use in prisons to stop, or even to be significantly reduced. Very few strategies have had any success in slowing down the rate of Hepatitis C transmission. In fact they have rarely worked.
In order to reduce Hepatitis C and HIV transmission in prisons there is only one strategy that would have an immediate impact. It is:
To make needle and syringe exchange programmes available to prisoners.
Australian needle exchange programmes have had enormous success in reducing HIV transmission among injecting drug users. Thirteen years after the establishment of the first needle exchange programme, less than 3% of injecting drug users are HIV positive. Australian studies have also shown that people in prison are eight times more likely to become infected with HIV than people in the general community.
If we are serious about balancing the scales, and about reducing the risks of blood borne viral transmission to prisoners, we must accept that:
Peer Support Groups won't stop blood borne viruses
Drug treatment programmes won't stop them
Preventative education, with no means to adopt the education messages, won't stop them
A needle exchange programme won't completely stop them
it is the single biggest step we can take towards achieving meaningful harm reduction for prisoners.
I want to encourage everyone to go back to your workplaces, that you seek out the people who can make the decisions to take that step. And lobby them. And push them. And support them. And keep doing it until they listen. And... refuse to take no for an answer.