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Advisers Behind Bars

Charitable organisation Vektor Life (meaning Path of Life), along with the support of E.V.A, aim to form a commitment to the treatment of HIVs amongst people living in detention facilities.

Last year, Samara Charitable Foundation Vektor Life with the support of E.V.A won a presidential grant. This winning project aimed at organising the continuation of the treatment of HIV amongst people living in detention centres. Advisers from the foundation go to correctional facilities and speak about HIV- about ways of catching the virus, of the importance of taking ARV medication (treatment to prevents the virus replicating), sharing personal experiences of living with HIV, as well as providing psychological counselling and support.

Elena Titina, director of Vektor Life foundation, tells us about the progress of the project and its provisional results.

Background

In 2017, we carried out a regional meeting in Samara for HIV positive people. Specialists from state bodies and institutions who would be interested in working with us were actively invited to the event. Amongst others, representatives from the Management of Federal Correctional Services in the Samara region were invited. Against all odds, they all turned up and, moreover, came with a large group of workers- 9 people, including the chief medical office, representatives from the press and others. At the meeting, we spoke about peer education and the involvement of the patient community in the work of E.V.A organisation. The following day after the meeting, we received a call from the management of the Federal Prison Service. They told us they were extremely interested in working with us.

At that point in time, we only had a small project- working with drug users; during which we arranged to carry out two workshops in rehabilitation centres. We decided to carry these out in the prison camp.

First Trip

Entry to the grounds took a long time to negotiate. One girl wasn’t allowed in as she had herself served a sentence in a detention facility. However, the others were given permission and so off we went to the prison camp.

The first trip was in March. We went to the 15th women’s camp. This was predominantly where first time offenders stayed. In this particular prison camp, there was roughly 800 convicted inmates, and amongst these around 250 women had the HIV virus (an extremely high ratio).

This camp had an orphanage with around 50 children. The women fell pregnant, gave birth and stayed in prison.

We held 2 workshops and learned the women’s primary needs. Alongside representatives of the FSIN (Federal Penitentiary Service in Russia, responsible for the security and maintenance of prisons in Russia) we made these needs known. They said that the main problem was adherence to the project, as many women refused to take medication and therapy. A lot of myths and fears were circulating, and the women didn’t trust the prison staff. One person only found out about their diagnosis in prison, while someone else didn’t want to start taking ART (antiretroviral therapy); as she thought that a poor scheme was offered in prison and that on the outside it would be much better. Whilst a bad or good scheme doesn’t exist, there are appropriate and well suited methods and very unsuitable ones; and it is vital to account for this.

Following skills development workshops, the concept of the project was born. When I designed the blueprint for the project, I realised the weight of my responsibility- the prisoners were waiting and so were the FSIN. We handed in the application and made the decision with our colleagues that even if the project was rejected, we would go to the camp as volunteers. It was simply absolutely necessary.

The  focal point of the application was in three prison camps in the Samara region with the most severe cases of HIV infection. Here, we carried out “peer to peer mentoring”, were once a week a peer counsellor goes to every prison camp.  In one of the prison camps (the 15th women’s camp), we are developing the guideline of peer mentoring, and we are delivering training for future peer to peer counsellors (women who are living with HIV). Our project won the award for a presidential grant. In November, we started work.

13 Women

At first we thought, how do we approach this? The first time we went, we met the convicts in a large hall. In front us were 400 people. We decided that we would tell personal stories. I was lucky- I had three peer counsellors in my team, who all had studied  psychology and had experience working in this field. Two of my colleagues also had plenty of experience working with addicted and dependant behaviour, as they had worked in rehabilitation centres for quite a long time. The mentors told the women of their experiences, about how they ended up in activism, how to accept the diagnosis and how in some ways they adopted therapy. For two hours they listened to us and asked questions. 

For a while, the prison warder referred specific women to us on the loud speaker. Then, more and more women began to sign up for consultations with us by their own accord. Women come to us with different questions, whereas others just need someone to talk to.

In the women’s camp, the project works significantly well. The Chief Medical Officer goes to the meetings and works on Saturday (his day off) in order to accompany us. I can already see the outcome in working with convicts. At first, we proceeded with caution, only asking a few questions. Now, we can talk about all kinds of different things. We have already held 3 peer to peer counsellor training workshops. At first, only 7 people came, and then 8 to the second meeting. The last time we met, we already had 13 people; who were extremely interested. I don’t know yet if they will become peer to peer counsellors, but they are actively involved and ask plenty of questions.

It shows that something on a personal level can definitely work out. The girls began to ask more in depth questions about addiction. For example, one woman said “In 9 months I will be let out. I have a 17 year old son, he said that if I return to my old ways and start to take drugs again, then that’s it. I’m scared. I’ve been inside for three and a half years and haven’t taken anything in a long time, for me it’s important to stay clean. Help me.” Given that my colleagues have a lot of experience dealing with addiction, they had at this stage already stepped in and started to help.

We also had a heavily pregnant women in our group, who had refused treatment for a long time and who couldn’t be convinced to take it. We worked with her as carefully as possible, and after several counselling sessions, she finally started to accept treatment.

 My colleagues received very positive feedback. I believe that the women will be far more committed now as they can understand why treatment is necessary.

The project will continue throughout 2019. We really hope that in the future a “peer to peer” system will be implemented without our help. However, it’s difficult to turn everything around in just a year.

Mistakes and Plans for the Future

The project hasn’t yet finished, but I am already thinking of what could be done differently. Now I understand what we need more and less of. Mistakes were also made: several times we were turned away because our entrance form wasn’t signed and authorised. One day, the chief medical officer misunderstood us and gathered a hall full of HIV deniers for a workshop. Of course, working with this type of audience was impossible, as the ignorance and aggression was off the scale. We deliberated and discussed this. In times like these, the FSIN definitely learned things along side us.

I understand that we need to carry out more behaviour adjustment training in order to create a more supportive environment. Interestingly, not for the senior executives, but specifically for prison wardens. Now, we have scheduled two workshops and in order to be successful, there has to be as many as there were for the convicts. It’s important that correctional officers know that the treatment must be taken on the hour and that the women must be allowed to take their medicine.

We also want to set up a collaboration with the 28th woman’s camp. At the moment, there are no resources for this. In this camp, there are women who are serving their third or fourth sentence. Here, the hopelessness is dire- they leave prison, realise they have completely lost all social connections, no one believes in them and so they end up returning to prison. It seems to me that our help here is also needed and important. I would like to raise not only the question of commitment to treatment, but also the question of the psychological acceptance of diagnosis. The FSIN has psychologists, but they primarily focus on other issues.

Not long ago, we had a woman be released just three days after the workshop. She phoned me straight away from the train station. She said that she was going to a small town in the Saratov region, and asked me what she should do, where she should go. We happened to find contacts for peer-to-peer counsellors in Saratov. Now, they are closely supporting this woman. I think that we should create some sort of system for women after they have been released from prison. It would be helpful to assign measures, even it they were only about medical questions- where to get a medical permit from, where to go for medicine, etc.

I had one patient who I had counselled present me with a card on International Women’s Day on the 8th of March. On it she had written “You’re like a sister to me”.

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