CONTEXTUALIZACIÓN DE LA MATRIZ DE MARCO LÓGICO

The following is a recommendation of a minimum standard for HIV education programs in U.S.-based state prisons that house male inmates that can be adopted at a national level or tailored at the state level. It is an evidence-based synthesis of previous prison HIV education interventions that were grounded in public health theories3_.

Incoming inmates are the target population for the program; however, any interested inmate should be allowed to participate. The main focus of the program is to increase knowledge of prevention methods, address stigma, decrease misunderstanding, and reduce the HIV risk of inmates and prison staff. An emphasis is placed on behavioral change to reduce risky behaviors (both inside and outside of prison) and increase prevalence of HIV testing in correctional facilities. Program components should be completed by prison medical staff and assisted by peer educators identified within the prison inmate population. Implementing an HIV education program in this setting can lead to increased HIV knowledge, increased HIV testing in prison facilities, and improved linkage to care following release.

1. Program Components

Program components include: HIV education curriculum topics, education

session structure, peer educators, training for prison staff and correctional officers, and linkage to care following release.

Curriculum should include information on HIV transmission (including risky behaviors), prevention (i.e. proper condom use and not sharing needles), infection (i.e.

3 _{Health behavior theories were used by these programs to promote health behavior change. A}

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symptoms and opportunistic infections), common misconceptions and myths (i.e. erroneous perceptions of transmission), testing procedures (including inmate rights, testing methods, results, and confidentiality), treatment (i.e. what is available in the prison and linkage to care following release), and additional pertinent health issues (e.g. STIs, hepatitis, Tuberculosis, and staphylococcus). These components come from Beyond Fear, Project Wall Talk, the unnamed Alabama education program, and project START (Ayanwale et al., 2008; Bryan et al., 2006; Ross et al., 2006; Wolitski et al., 2006).

HIV education curriculum must be culturally-sensitive to increase likelihood of program success. Behavioral change includes improved self-efficacy (by targeting psychosocial barriers such as stigma, prejudice, fear, and perceived risk), increased anticipation of high-risk situations (i.e. situations that can lead to HIV exposure), reduction of risky behaviors, and promotion of peer educator behaviors (to increase number of peer educators and promote program sustainability).

HIV education sessions should be administered by self-volunteered peer educators; moreover, these sessions should be interactive, meaning peer educators should engage inmate participants in open discussions of HIV education topics. Inmates should be encouraged to ask questions and share relevant personal anecdotes.

Education could be provided once a month for six months, for a total of six sessions. Prison staff should also be required to undergo general HIV education as a component of job training. This training should be similar to the HIV education provided to inmates, but must be targeted toward staff and correctional officers.

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Partnerships with community-based health organizations that provide linkage to care services are necessary, to assist inmates who are tested following education and test positive in obtaining treatment and ensuring medication adherence following

release. Organizations that follow the START program model are highly recommended, as it is an evidence-based method that is endorsed by the CDC. Additionally,

organizations that can provide HIV education training to peer educators should also be identified for partnership opportunities.

As this is a recommendation of best practices for HIV education programs provided in U.S. state prisons that house male inmates, program specifics will need to be tailored at the state level to ensure compliance with state law. A general discussion of potential stakeholders and feasibility is provided to give an idea of the types of individuals and factors that may need to be considered. Recommended program objectives, resources, and activities are also provided; however, these program components can also be tailored toward specific prison systems.

2. Stakeholders

Stakeholders are the external and internal individuals that are affected by, involved in, or have the potential to be involved in interventions (W.K. Kellogg Foundation, n.d.). Stakeholders for education programs include state correctional boards, state governors that oversee correctional facilities, inmates, inmates’ family, inmates’ community, prison health staff, prison administrative staff, correctional officer staff, state and local health departments, and community-based health organizations (particularly those that provide linkage to care services such as Project START).

31 3. Feasibility

Including these essential elements in a prison-based HIV education program is a practical approach to an important public health issue that affects a large proportion of the national population. By using peer educators to provide HIV educational sessions to inmates, overall program cost is reduced (Collica, 2007; South et al., 2016). Peer

educators are also perhaps better equipped to communicate with inmates, as they can relate to the situation they are in, unlike staff members or outside health educators (Collica, 2007; Ross et al., 2006; South et al., 2016). Ensuring cultural sensitivity is an important aspect of HIV education and can be addressed by recruiting multiple diverse peer educators that understand the backgrounds of inmates (Bryan et al., 2006; Ross et al., 2006).

Since each state has different requirements for testing in prison, as well as the addition of private prisons in many states, this program would need to be adopted by each state government. Contracts with private prisons would need to include the program as a stipulation of their continued utilization for inmate housing. As there are minimal anticipated costs associated with this program, it is anticipated that private correctional facilities would not present any significant resistance (Collica, 2007; South et al., 2016).