Hepatitis C educational programs provide access to the means to protect the individual and minimise the risk of hepatitis C transmission and are necessary and effective interventions for inmates and staff in custodial settings.
Education is a low cost intervention for the prevention of hepatitis infection and must therefore be a central component of any hepatitis C health program in custodial settings. Education is relevant to inmates while in prison and on release, and for custodial health and custodial staff. As there are commonalities in relation to the transmission and prevention of all blood borne viruses and sexually transmitted infections, combined education and counselling on all blood borne viruses and sexually transmitted infections should be considered.
5.1 Access to educational materialsThe ready availability of current, easy to understand information about hepatitis C in prison, its prevention and medical management supports inmates to prevent hepatitis C transmission and seek testing and clinical assessment if they are at risk.
Having correct information and understanding about a condition are the first steps to a reasoned response and changing health related behaviours (King 1999, AIVL 2006). Inmates need to be regularly informed and updated about hepatitis C and strategies to prevent transmission with special reference to the likely risks of transmission within custodial settings. Information must include ways to support hepatitis C negative people to remain negative. Information dissemination is most effective when it is coordinated and consistent with that disseminated in the general community.
Inmates should receive hepatitis C education on entry, during their prison term, and in pre-release programs. All inmates should have an opportunity to discuss this information with qualified people in a confidential environment.
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5.2 Purpose developed materialsResources that are designed to meet the educational needs of groups of inmates are a far more effective way of communicating information that can be understood and used by the audience.
Information intended for the general public (through posters, leaflets, and the mass media) should also be available to inmates, although education initiatives should not be limited to those targeted to the general public. All written materials distributed to inmates should be appropriate for the educational level in the custodial population, in which people with low levels of literacy are over-represented. Information should be made available in a language and form that inmates can understand, acknowledge the constraints of the custodial environment and be presented in an attractive and clear format. Community based and professional organisations and can provide these resources and some resources have been developed specifically for custodial settings.
Purpose developed materials should be age, gender and culturally appropriate, made available in low literacy formats and languages other than English. Other formats for the provision of information should also be available including video or computer based resources.
5.3 Peer educationThe provision of peer education that can be tailored to the custodial setting is another effective and proven method to decrease the transmission of blood borne viruses. Cooperative development of these programs between custodial staff and peer educators maximises their success.
The involvement of people living with hepatitis C and peer education has been proven internationally to be effective in reducing the transmission of blood borne viruses (Rutter 2001). People with hepatitis C have a unique understanding of the behaviours and contexts which place others at risk of infection. With appropriate training and support, inmates with hepatitis C are well placed to communicate messages about reducing transmission to those who are either unaware of their hepatitis C status or at risk of acquiring hepatitis C. They are also able to present information, and provide a personal view of the risks and benefits about the testing and diagnostic process.
Peer based drug-user organisations and hepatitis councils can provide a useful resource in the custodial setting and can assist inmates post release. Peer educators are uniquely placed to judge which strategies would work in custodial facilities. In particular, peer educators who have experienced treatment for hepatitis C can provide valuable support to inmates undergoing or considering treatment.
Hepatitis C related discrimination can arise from fear of transmission and/or from assumptions and judgements made about injecting drug use. Disclosure of hepatitis C status may therefore result in alienation from family and friends and have particular ramifications for Aboriginal and Torres Strait Islander communities. The high rate of incarceration of Aboriginal and Torres Strait Islander people can mean that a number of members from within one family group can be housed within the one facility. In some settings this may result in support for an inmate with hepatitis C, but in others it can result in stigmatisation. As previously discussed Aboriginal and Torres Strait Islander inmates are drawn from diverse populations and peer based strategies will need to be mindful of this heterogeneity, especially with respect to familial and kinship links, communication channels and power bases. A lack of appreciation of these variable cultural arrangements has the potential to undermine the success of any peer education program.
Custodial facilities should develop peer education programs which are appropriate to their settings. It is also important that peer educators are appropriately supported in the delivery of their education services. Close collaboration between custodial officers and peer educators in planning and deliver of programs is likely to improve outcomes (Devilly 2005).
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5.4 Access to counselling and support servicesImproved access to support and counselling by a range of service providers will benefit individual inmates and the broader custodial community.
Inmates have limited access to psychological support. The individual’s response to the possibility of a chronic illness as well as the other demands from the psychologically challenging environment of a custodial facility is improved by counselling and support (reference?). These services are best provided by health staff and augmented by custodial workers and staff from community based organisations. Consideration should be given to the training of peer counsellors from within the prison population. The use of hepatitis C peer counsellors in the community has been shown to be effective in improving hepatitis C knowledge and reducing risk behaviour (Aitken 2002). This must be a voluntary program and inmates should not be compelled to provide or receive peer education, counselling or support.
Given the overlap of issues in preventing the spread of all blood borne viruses, counsellors and peer educators should have the skills to provide services in relation to all blood borne viruses and sexually transmitted infections.
Custodial facilities should endeavour to make psychological services available to inmates with hepatitis C. In particular, inmates on hepatitis C treatment may experience higher levels of need at this time as hepatitis C drugs can cause side effects such as depression, irritability, anger, fever, chills, fatigue and muscle aches. A careful emotional and psychological assessment is therefore important before commencing treatment.