Drug Abuse

EXERCISES FOR TRAINING SEMINARS

In the training seminars, the emphasis is not only on knowledge about safer behaviour but also on skills, attitude, social norms and self-efficacy. To ensure that more than just factual knowledge is transmitted, the interactive character of a seminar is important. Participants should not be taught but stimulated or even provoked to take part in the discussions. Therefore, we have made up and selected exercises based on active participation, which can be useful elements of a seminar program.
Below we present exercises on the two major risk reduction subjects: safer use and safer sex, in addition to some other exercises.
In general the following instruction applies to all of these exercises:
¨    Start off with short but clear instructions!
w Explain why you want to use the exercise
w Stimulate participants to ask the trianer questions, inplenary sessions as well as while working in small groups.
w Make participants feel comfortable about asking questions. A statement like “Anyone can make mistakes regarding Safer Use!” may be helpful.
w When working in small groups someone should keep minutes to be able to report on the group’s discussion in the plenary session.
¨ Arrange for the right composition of the groups! Frequently, participants who get on well will sit next to each other or join the same group when small groups are formed. Try to move them into different groups by ‘forming groups through counting off’. Establishing new contacts is a valuable side effect of seminars, so try and facilitate participants’ exposure to new points of view.
¨ Observe what is going on in small groups attentively! When splitting up the group of participants into small groups, you should keep in mind that you cannot supervise more than 3 or 4 small groups, meaning that 15-20 participants is the maximum number of participants.
During a role-play, which will generally last 30-45 minutes, you
should join each group for a few minutes, to find out how the par-
ticipants are working together and participating, and whether the
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Some of the exercises have been taken from Trautmann / Barendregt ‘European Peer Support Manual’ (see References)
group is failing to make progress due to an unfavorable composition of the group, etc. In this latter case, you can take up the role of a mediator and initiator of new problem-solving strategies.
_+ Keep a record of the most important things happened, the most relevant contributions by participants.
Although a record is kept in each group, interesting suggestions or cross references are frequently missed, particularly if they have been expressed by participants who are less dominant. These suggestions can sometimes be very useful!
_+ Immediately after the group work, summaries should be presented by those who kept the minutes.
The results developed in the small groups should not be flogged to death by commenting on and discussing all the unimportant aspects! First, it is important to gain an overview all of the solutions expressed. Therefore a summary of the most relevant results of the groups should be presented back to the plenary by the participant who kept a record of the minutes. These should be noted on a flipchart so that all participants in the training program can see them. These recordings can also be used to structure further discussions after the conclusion of the program.
8.1 Exercises on safer use (primarily for inmates)*5
Applying precautions to avoid getting infected or proper injecting techniques are skills which are not learned overnight. A skill is learned and improved by practice. For injecting drug users, safe injecting is an important skill. Unfortunately some drug users have not learned this skill correctly or are not always capable - often due to difficult situations in prisons - of avoiding risks. Sometimes they are not informed adequately about alternatives, ‘second best solutions’ and ‘better than nothing strategies’. For example, many drug users are used to have easy access to clean injection equipment in the community. To stay ‘safe’ in prison circumstances requires different approaches that are far removed from the daily routines in the community.
The exercises in this manual aim at improving drug users’ skills and risk awareness. The starting point is the experiences that drug users have themselves. Each exercise should be valued, whether it is suitable for the prison situation and the target group. For some users, talking about drug use may be too close to their personal situation with drugs. It should be clarified - especially to prison
staff - that talking about the risks of drug use doesn’t mean that exercises are intended to promote an acceptance of drug use.
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When necessary, one should adapt these exercises to the specific needs of the group or prison conditions. One basic requirement for all these exercises is to carry them out in an ‘interactive’ way, integrating views, perspectives, questions and competence of the target group. They are meant as practical tools to allow ‘learning by doing’.
Although the exercises in this chapter are primarily appropriate for seminars for inmates, most of them can also be valuable elements in mixed seminars (for both staff and inmates) as our experiences in the European Peer Support Manual have shown. You should, however, check beforehand if a certain exercise will be acceptable in a mixed seminar. An important issue here, for instance, is if there is enough mutual trust between those who are involved.
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Introducing the subject of safer use
This exercise uses a part of the manual (chapter 6.3 + 6.4). The trainer can choose whether to focus on:
¨ the preparation of a shot, or,
¨ the technique of self-injecting
Objectives:    1. Introducing the subject of safer use.
2. Showing the correct preparation and self injection sequence.
Duration:    30 - 45 minutes
No. of participants: Minimum 4, maximum 20
Material needed:    Preferably videotape on self-injecting, e.g.
the video included in the European
Peer Support Manual
Injecting equipment (see 6.2 in chapter 2) and a soluble powder that resembles heroin, e.g. sugar
In case injecting equipment is not available or allowed to use you should use materials that can replace the equipment (such as a pen for a syringe, etc.)
Exercise outline:
u    Show the video
u    Ask for comments afterwards. Focus on:
w Different ways participants inject
w What was your everyday routine before getting to prison?
w What are the obstacles to applying these routines when using drugs in prison?
u    Focus on the differences and the possible hygienic
mistakes.
Variations:
u    One can ask one of the participants to show how he
is used to preparing a shot and how he would inject it. This can best be done with real injecting equipment and all of the paraphernalia normally used (see 2.6.2.)
u    The other participants watch carefully and make
comments afterwards, about things they do in a different way and about mistakes made in the presentation
u    Correct mistakes and omissions in the discussion
Remarks:
Use photocopies of I 6.3. and I 6.4. as background information If you are using the European Peer Support video or another
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‘safer use’ video, please check the contents beforehand (is the information presented correct, relevant and acceptable?). Also check if there is video equipment available for playing the tape.
Assessment of disadvantages of injection techniques
Continuous intravenous drug use under street or prison conditions often leads to severe damage to the tissue and blood-vessels (veins). In this exercise you try to identify possible damage and how to avoid it by improving injection techniques.
Objectives:    1. Participants assess risks and potential for
damage from their injecting technique
2. Participants learn how to avoid them by
improving injecting technique
Duration    30 to 60 minutes
No. of participants: Minimum 4, maximum 20
Material needed: Work sheet of man and woman (attached), pens and flipchart
Exercise outline:
u    Split the group into smaller groups of two or four people
u    Each group receives a copy of the work sheet (male
participants use the sheet with a male, female participants with a female)
u    Ask participants to judge and mark possible injecting
spots on the work sheet according to the following standards (allow 20 minutes):
1 = very suitable
2 = only in emergency,
3 = risky
4 = never
u    In a plenary session, the small groups present their
work. Use a drawing of a human body on a flipchart to mark the correct standard.
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ASSESSMENT OF THE DISADVANTAGES OF
INJECTION TECHNIQUES
(WORKSHEET)
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rnative routes of administration
Choose whether to focus on: ¨ Chasing the dragon, or ¨ Snorting and smoking
Objectives:    1. Introducing ‘chasing the dragon’ as an alter-
native way of taking heroin.
2. Discussing safer use techniques.
Duration:    30 - 45 minutes
No. of participants: Minimum 4, maximum 20
Material needed: Material used for chasing the dragon and snorting and smoking (see chapter 2, 6.5 ) (if available, videotape from European Peer Support Manual,video equipment)
Exercise outline:
u    Show the 3rd part of the video or ask one of the
participants to demonstrate injecting and/or snorting;
u    Ask for comments on this method of taking drugs;
u    Discuss the advantages and disadvantages of
alternative routes of administration
u    Is ‘chasing the dragon’, ‘snorting’ or ‘smoking’ an
alternative in prison?
u    What makes it so difficult to apply alternative routes
of administration in prison?
Remarks:
Use 6.5 as background information. Make use of participant’s experience of alternative routes of administrating drugs.
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‘In case of...’
- How to respond effectively to difficult circumstances
Every injecting drug user is interested in injecting drugs quickly and efficiently. This is especially true of the prison setting, where nearly all areas are intensively controlled and common meetings generally have limited time. To be successful, certain conditions must be fulfilled, e.g.:
u    All equipment should be at hand
u    Veins should be easy to inject
u    A comfortable area where one won’t be disturbed
should be available
u    The drug user should have the knowledge and skill to
inject safely.
In prison, these conditions are rarely fulfilled. It often happens that the conditions are far from favourable at the moment that drugs are available.
For drug users it is very handy to have a repertoire of alternatives available which can help to limit the risks related to unfavourable circumstances.
Objectives:    1. How to respond effectively to unfavourable
circumstances regarding proper injecting.
2. Drug users share the improvising skills they have regarding proper injecting.
Duration:    45 - 60 minutes
No. of participants: Minimum 4, maximum 20
Material needed:    Copies of the ‘in case of...’ list (next page),
pen and flipchart
Exercise outline:
u    The trainer splits the group in two groups (A and B)
or into couples.
u    Each group is given some unfavourable circumstances
from the list on the next page (the A’s from the list to group A, the B’s to group B) to which they have to respond as if it was a real life situation.
u    After a set time (e.g. 15 - 30 minutes) the various
responses are discussed in plenary.
u    The trainer corrects mistakes and presents alternatives
not mentioned by participants, using page 3 of this exercise as checklist (see some possible alternatives in chapter (2.6.5.).
Alternative:
Make up your own list of unfavourable circumstances or add to or modify the attached list.
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‘IN CASE OF...’
(WORK SHEET)
A # no clean needles and syringes are available
B # no bleach is available
A # no fresh tap water is available
B # a shot of cocaine and the needle clogs
A # a shot of heroin and the needle clogs
B # the syringe lacks a good vacuum (piston/plunger leaks)
A # the needle has a barb (burr)
B # no drugs and 10 clean needles and syringes.
A # no spoon is available
B # no fresh cotton is available
A # no alcohol swab is available
B # the plunger cannot be pulled back any further
A # you notice you missed the vein (bubble)?
B # you have difficult veins; hard, rolling, lying deep
A # you do not have a quiet place of your own
B # you have an abscess
A # you hit an artery
B # no heater or cooking plate is available
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‘In case of ...’some alternatives
To be honest: it’s a risky business, isn’t it? You know that yourself. If no clean syringes or disinfectant is available, you should avoid using drugs intravenously. What we recommend here in case you think you cannot avoid injeckting, are only second-best solutions. Be aware of that!
u    No clean needles and syringes are available
¨ w Boil it out for 15 - 20 minutes (see chapter 2, 6.1) w Clean it with bleach (see chapter 2, 6.1)
w Use the drugs by chasing the dragon
(see chapter 2, 6)
w Snort the drugs (see chapter 2, 6.5)
u    No bleach is available
¨ w Boil out the syringe for 15 - 20 minutes
w Chase the dragon w Snort the drugs
w Clean the syringe carefully with anything else (cola,
alcohol, anything)
u    No heater/cooking plate and no bleach is available
¨ w Try to clean the syringe and needle as often as you can with fresh water
u    No fresh tap water is available
¨ w Use mineral water
w Or boil water for 15 - 20 minutes
u    One portion of drugs, one clean syringe, one used
syringe and two people willing to share the drugs equally.
¨ w Boil out the used syringe or clean it with bleach w Both chase the dragon
w One person divides the drugs into two equal portions, the other chooses.
u    one portion of drugs, two people with one used
syringe of their own each and willing to share the drugs equally.
¨ w Boil out the used syringes or clean them with bleach
w Or second best: rinse your own syringe well
w One person divides the drugs in two equal portions,
the other chooses.
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u    A shot of cocaine and the needle has clogged.
¨ w Stop injecting, put the liquid back in the spoon, remove the clot, add some cold water, put on a new needle or take a new syringe and needle,
w To unblock the needle: warm the needle with a lighter to expand it.
w Pull up some fresh cold water and shake
the syringe.
u    A shot of heroin and the needle has clogged.
¨ w Stop injecting, put the liquid back in the spoon, put on a new needle or take a new syringe and needle.
u    The syringe lacks a good vacuum
(piston/plunger leaks)
¨ w Take a new syringe
w Wet the rubber of the piston and try again
u    The needle has a barb (burr).
¨ w Sharpen it on a glass or match-box and clean it with a (lighter) flame.
u    No drugs and 10 clean needles and syringes.
¨ w Stupid question
w Try to sell them to make money.
u    No spoon is available
¨ w Prepare the bottom of a can, cleaning it by flame
u    No fresh cotton is available
¨ w Use the filter of a cigarette
w Use whatever is available, such as an alcohol swab, the lining of a coat etc.
w Use no filter. Carefully tip the spoon and keep the
residue at the other end from where you draw up
u    No alcohol swab is available
¨ w Clean the injection spot with water and soap w Clean it with water only
w Do not clean it.
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u    The plunger cannot be pulled back any further.
¨ w Stop injecting, untie tourniquet, squirt half the contents of the barrel back on the spoon or into a second syringe then let your arm hang down, tie off again and look for another vein.
w Take a second syringe
u    You notice you missed the vein (bubble)?
¨ w Cover it with wet bandages
w Massage the bubble gently and evenly
u    You have difficult veins; hard, rolling, deep-lying.
¨ w Learn to chase the dragon
w Ask someone else to help you
u    You don’t have a quiet place of your own.
¨ w Find a friend with a quiet place
w Use a public toilet (if door opens inward, you overdose and fall against the door, then nobody can open it to help you)
u    You have an abscess
¨ w Make a compress of wet bandages
w See a doctor as soon as possible.
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Negotiation skills
Apart from all kind of individual ‘technical’ problems (as covered in the last exercise), drug users can run into situations where problems have to be sorted out with other drug users. This exercise tries to raise this subject of solving problems together.
Objective:    Preparing drug users for high risk situations.
Duration:    30 to 60 minutes
No.of participants: Minimum 4, maximum 20
Material needed: At choice: a flipchart to write down reactions/solutions
Exercise outline:
u    The trainer splits the group in smaller groups of about
5 people
u    Each group gets one or two high risk situations
(giving different groups the same situation might lead to interesting comparisons).
u    The participants are asked to present and discuss pos-
sible solutions, and to decide on the safest solution.
u    In the plenary discussion the solutions found are com-
pared and discussed
u    The trainer corrects mistakes and presents alternatives
not mentioned by participants,
High Risk situations:
u    Two people have 1 gram of cocaine. It is nearly time
to go back your cell and you have only one syringe available. How do both get a ‘hit’ and not get infected?
u One portion of drugs, two people each with a used syringe of their own and willing to share the drugs equally.
u    Two cell mates and 1/2 gram of heroin. It is 06.00
am and both are getting sick. The medical unit will open at 08.00 am and you do not have any needles around.
u    Three inmates take a good shot of heroin, all with
their own (clean) needle. They get really stoned for a while. Then they want to take another ‘hit’ but they are not sure whose syringe is who’s.
u    Let the participants introduce a high risk situation which
has been settled in a safe way.
u    Let the participants introduce a high risk situation which
could not be settled in a 100% safe way.
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Prison drug-using situations
- how and when to intervene?
Drug using inmates regularly might run into situations where other inmates are talking about injecting drugs. They can use these situations to inform these inmates about safer behaviour. However, it is a question of careful timing to raise the issue of proper and safer injecting. In this exercise, we try to find out what a third person (a friend or inmate, for example) can do to improve injecting technique. By means of discussion and practical exercises, several situations regarding good injecting technique are reviewed.
Objectives:    1. discuss the best timing to raise the
subject of proper injecting in prison
situations.
2. discuss how to support drug users with good injecting techniques.
3. exercising practical support
Duration:    30 to 60 minutes
No. of participants: Minimum 4, maximum 20
Material needed: A tourniquet. The European Peer Support
or another ‘safer use’ video tape (if available).
Exercise outline:
u    Show one of the injecting parts of the video (if video
tape is available)
u    Ask participants: if you were in the same room as the
drug user, when and how would you start a conversation about safer use.
u    If video tape is not available, ask participants to think
of their last use of injectable drugs: when and how could a conversation about safer use best be started
Questions to ad:
u    What kind of situations are most suitable for starting
a conversation about safer use with drug users in prison? Or to put it differently: As a (former) drug user, when do you definitely not want to be disturbed with a talk about safer use?
u    What kind of introductions are appropriate for raising
the subject of safer use (unavailability of needles, a recent case of an inmate overdosing, etc.)?
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Additional elements of the exercise:
u    An explicit peer support action is to help each other
finding good veins. Participants look for good injection veins on their neighbour’s arms. Roll up the sleeves, take the arms and examine them carefully.
u    The correct use of the tourniquet is essential for
many drug users. Participants practice the correct and incorrect use of the tourniquet. The results are watched closely (veins coming up, going down). This exercise is particularly interesting if done by people with difficult veins.
u    Question: what can be done to help veins come up
w if there is no tourniquet available,
w if it is cold and veins are deep down.
(see chapter 2, 6.2)
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Simulation of a Stressful Situation: “Imagine    ”
In this exercise, a stressful situation in which different injecting equipment is used is simulated in a role play. The situation should be as realistic as possible. The given situation is always the same, no matter if prison staff is trained or if drug users are educated about drug-related risks.
Objectives:    1. To experience a stressful situation that
is as realistic as possible and to feel its impact - to get an idea of the readiness to take bigger risks
2. To exhaust the participant´s creative abilities to identify safer solutions
3. To prevent infections, despite continued drug consumption - to develop behavioral patterns which reduce the risks involved in drug consumption
Duration:    45 - 60 minutes
No.of participants: Minimum 4, maximum 20,
split up in groups of 4 people
Material needed: Overhead projector
Flipchart and pens
Injecting equipment (see 6.2) and a soluble, heroin-like powder, e.g. sugar
If injecting equipment is not available or allowed, you should use materials that can replace the equipment (a pen for a syringe, etc.)
Exercise outline:
The participants are asked to imagine the following situation:
Imagine...
You are in jail. You have been provided with fresh stuff of the best quality - 1 gram for 4 people. Three of you have not consumed heroin for a long time, one of you is priggish. The score is his. You are running out of time because locking of the cell doors is imminent. You are determined to use the drug, however in the least damaging way.
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The only items you have available to consume the heroin are:
D 1 unused syringe
D 1 used syringe
D 3 used needles
D 1 small bottle of water D 1 lighter
D 1 lemon, not entirely fresh
And now all of you start to consume the drug as quickly as possible because - as mentioned above - time is running out. Please try to think of realistic but meaningful ways in which the drug can be consumed in the least damaging way under the given conditions and put the solutions you have developed to the test, i.e. pretend to prepare a drug injection with the equipment available.
One of your group keeps a record of all solutions suggested, those accepted and those rejected; these notes can then be used in the discussion to be held in the plenary session later on.
-    Divide the group into small groups of 4/5 participants
-    Give 30 minutes time to ‘imagine’ and discuss
-    Give 20/30 minutes for short presentations of the results from the small groups and discussion of these results
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Needle-sharing and drug-sharing
In this exercise, the risks of sharing drugs, needles, syringes and paraphernalia are tackled (see chapter 2, 6). Different techniques of sharing drugs - hazardous or non-hazardous ones - are examined.
Objectives:    1. Recording the various sharing practices
applied
2. Identifying the risks involved in drug shar ing
3. Pointing out alternative modes of sharing drugs
4. Making needle sharing into a taboo and pointing out alternative ways of consuming drugs in a less hazardous manner.
Duration:    45 - 60 minutes
No.of participants: Minimum 4, maximum 20,
Material needed:    Flipchart, markers
Injecting equipment (see 2, 6.2) and a
soluble, heroin-like powder, e.g. sugar
If injecting equipment is not available or allowed you should use materials that can replace the equipment (a pen for a syringe, etc.)
Exercise outline:
The most important element of this exercise is a demonstration of the various distribution techniques:
u The participants are given the task of demonstrating
distribution techniques in which typical material is
used (syringe, spoon, needle, imitation heroin) u They are asked to name the risks involved
u The participants are asked to develop and
demonstrate alternative techniques.
Remarks
Use chapter 2, 3 as background information
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Work-sharing
This exercise also focuses on health risks that may arise from paraphernalia (see chapter 2, 6.2) needed for drug injection that is commonly shared among drug users, i.e. materials like filters, water, spoons, swabs.
Objectives:    1. identification of drug consumption para-
phernalia as potential carriers of infection 2. use of clean equipment to protect the user’s tissue and blood-vessels.
Duration :    45 - 60 minutes
No.of participants: Minimum 4, maximum 15,
Material needed:    Flipchart, Felt pen,
Injecting equipment including all possible paraphernalia and a soluble, heroin-likepowder, e.g. sugar
If injecting equipment is not available or allowed begin with summing up paraphernalia
Exercise outline:
u    Show or request that participants name possible
injecting paraphernalia
u    Collect all items named on the flipchart
u    Ask individual participants to demonstrate or describe
the use of certain paraphernalia. The other participants are asked to comment on this, identify possible ‘mistakes’ and risks they have witnessed. Correct statements where necessary.
Remarks:
Use the information from chapter 2, 6.2
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rcises on safer sex (primarily for inmates) *6
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Some of the exercises have been taken from Trautmann /
Barendregt ‘European Peer Support Manual’ (see References)
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Aside from injecting, safer sex is the other important topic involved in the transmission of HIV and hepatitis B. There is evidence that safer sex is a rarely or poorly practised, particularly among heterosexuals. In many western European countries, the incidence of new infections with HIV is highest among heterosexuals. An additional problem is that it has proved harder to discuss safer sex than safer drug use with drug users. Sex in general is still a touchy topic to discuss.
General considerations for safer sex seminars
u    Inform participants exactly what you want to focus on in
pre sentations, discussions and exercises. When discussing or doing exercises on certain sensitive issues, allow people on beforehand to decide whether or not they will participate. Show respect if they decide not to do so. Emphasise that people are free to decide whether or not they answer certain questions.
When presenting this rule use preferably positive formulations, e.g. “please feel free to decide whether or not to participate or answer” instead of negative ones “you have the right to refuse...”.
u    In general, it might be better to work with participants of the
same gender (see 3, 7.4). However some issues, e.g. relationship issues, sensitising participants for gender specific problems, emotions, etc. can be dealt with in mixed groups. Even in these cases you should check carefully if partici pants feel at ease in a mixed group.
u    In some cases, one might consider whether to involve - per-
haps just in a part of a seminar - a second trainer of the opposite sex, for example, to bring in the point of view of the opposite gender.
u Secure agreement with the group over the need to be respectful towards participants’ sexual orientation. Interfere if people do not comply with this rule.
u    As a trainer, you should be able to talk freely about sex
and sexuality, e.g. being able to respond openly to personal questions. In response, of course, you can state that some questions might be touching upon issues you consider to be strictly personal.
u    When using sex tools, make sure that this is acceptable
to participants. When using a dildo, for example, consider whether the colour is adapted to the group. Do not offend dark-skinned people by using a white dildo.
u    It has been widely experienced that many people are reluc-
tant to practice ‘condom technique’ on a dildo. Our sugges-
tion is to use other, less intimidating, ‘penis shaped’ objects
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s well. Using a banana, for example, generally makes eople laugh. Laughing and humour can work as an ‘ice reaker’.
The exercises in this part of the manual deal with safer sex in various ways. It starts with some exercises which aim at making sex a subject of discussion. After this, the safer sex part can come in. Experience has shown that this is a suitable build up.
As with the exercises about safer use, the exercises in this chapter are primarily appropriate for seminars for inmates. However, most of them can also be valuable elements in mixed seminars (for both staff and inmates) as our experiences in the European Peer Support Manual have shown. You should, however, check beforehand to see if a certain exercise will be acceptable in a mixed seminar. An important issue here for instance is whether there is enough mutual trust.
In order to unite the group again, plenary tries to compose a list of words on which everybody agrees.
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‘Dirty words’
Objectives:    1. Participants discuss sex in order to make
them more comfortable with the subject.
2. Making clear that different language is used with different people.
Duration :    15 to 30 minutes
No. of participants: Minimum 4, maximum 20 Material needed:    Pens, paper, flipchart
Exercise outline:
u    Give every participant pen and paper and ask to write
down as many words possible for the male genitals; medical words, dirty words, pet names etc.
for 5 minutes.
u    Ask participants to name the different words and write
down the results on the flipchart. The one who came up with the most words is the winner.
u    Repeat this procedure, but now with words for the female
genitals.
u    Discuss the results along with a question about which
words can be used for different categories of people: parents, your children, partner, peers.
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Sexual or not
Objective:    1. Make participants conscious of the differ-
ent impact words can have for different people.
Duration:    30 to 45 minutes
No.of participants: Minimum 6, maximum 20
Material needed:    List of words, participants sheet, pens.
Exercise outline:
u    Preparation: compose a list of words adapted to the
group (see: example list)
u    Make copies of the participants sheet (see: next page).
u    Distribute participants sheets
u    Read aloud the words of the list and ask the participants
to write them down, individually, in the column that they think is right (no discussion)
u    Split up the group into two or more smaller groups, in
which the results are compared and discussed
u    In order to unite the group again, plenary tries to com-
pose a list of words on which everybody agrees
Sexual or not - Example list of words
to hug    exciting    to lick
horny    sucking    to rub
security    sensitive    toys
kissing    tenderness    partner
warm    tickle    confidence
dick    fuck    dark
scratching    surrender    ecstasy
caressing    smell    sharing
safe    hold    tied
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Sexual or not
own the words mentioned in one of the columns.
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SEXUAL    NOT SEXUAL
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Sex education
Many people are not used to, or do not feel comfortable talking about sex or safer sex. They haven’t learned to speak freely about sex. However, when the risk of getting infected through sexual contact is the issue, it is of vital importance to talk about sex. This exercise makes clear to everyone that it is normal to feel a little embarrassed or shy about it, because we have never learned otherwise. In this exercise, the plenary discussion is limited in order to maintain privacy.
Objectives    1. Introducing the safer sex issue in a non-
threatening way.
2. Making clear that most people’s sex education was very limited, i.e. not including a lot of open talk.
Duration:    15 to 30 minutes
No. of participants: Minimum 6, maximum 21 Material needed: None
Exercise outline:
u    Split the group into threes
u    Each individual in these smaller groups gets a maximum
of 3 minutes to tell the other two about their sex education. Key words are: when did it happen, who did it, and what have you been told.
u    After everybody has told their history, the general out-
come is briefly discussed in a plenary session.
Remarks:
useful as an icebreaker, or as the start of a discussion of a safersex issue.
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Safe or not?
Objectives:    1. Catalogue the extent to which participants
have knowledge of safer sex techniques and supply lacking information.
2. Raise awareness regarding the fact that there are more safe than unsafe sexual techniques.
Duration:    30 to 45 minutes
No. of participants: Minimum 6, maximum 20
Material needed:    3M post-it notes (the little yellow self-
adhesive pads), pens, 4 flipchart sheets of a naked man and woman one flipchart with two columns titled ‘safe’ and ‘unsafe’
Exercise outline:
u    Split the group in two or more smaller groups.
u    Supply each group with post-it notes, a pen and the
instruc tion to write down as many variations as
possible on lovemaking (techniques, positions, acts). On each little sheet another technique. Sheets are
stuck on the table for the time-being. (10 min.)
u    Put the 4 prepared flipchart sheets on the wall. On the
flipchart, the naked front and back of man and woman are displayed.
u    The participants have 5 minutes to put the post-it sheets
on those parts of the body where they think a certain variation belongs.
u    Then, put the 5th flipchart sheet against the wall.
This flap-over sheet has two columns: one labelled ‘safe’, the other ‘unsafe’.
u    Let each participant take some attached post-it notes
and read aloud the variation written down. Then the participant puts the sheet in the right column.
u    To conclude, discuss the result and give additional
information if necessary.
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y go round
Objectives:    1. Participants experience talking about
intimate sexual subjects
2. Participants experience posing intimate questions.
Duration:    30 to 60 minutes
No. of participants: Minimum 12, maximum 30. Material needed: Cards with questions.
Exercise outline:
u    Preparation: copy the questions on the following pages
onto heavy paper.
u    Cut them into cards.
u    Form an inner and outer circle. Place an equal number
of people in each circle. Participants sit in pairs, face to face.
u    Give the people in the outer circle a pile of cards.
u    The participants in the outer circle ask a question from
a card to the person opposite, but only if they would have answered the question themselves. Make clear in advance that participants may decide whether or not answer questions put to them. Five minutes.
u        The outer circle moves two places and the procedure is
repeated. Five minutes.
u    Depending on the available time and the number of par-
ticipants, the procedure can be repeated.
u    The pairs change chairs and the inner circle becomes
the outer circle.
u    The new outer circle moves one place and the question-
ing starts again.
u    Afterwards, in the plenary some experiences can be
exchanged.
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MERRY GO ROUND
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MERRY GO ROUND
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MERRY GO ROUND
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MERRY GO ROUND
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MERRY GO ROUND
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MERRY GO ROUND
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ruction condom use
Objective:    1. Participants practice giving instruction in
condom use and experience the obstacles they can be confronted with.
Duration:    30 to 45 minutes
No. of participants: Minimum 4, maximum 20
Material needed: Several dildos (or bananas/cucumbers etc), different (types of) condoms. Instructions on condom use (see next page; in addition you can use the text from chapter 2, 4.2 + 4.3)
Exercise outline:
-    Preparation: copy the instructions on condom use on the next page.
-    Split up the group into pairs and give each pair a condom and a dildo (or a dildo look-alike).
-    One of the pairs teaches the other how to use a condom (5 minutes).
-    Make an inventory of reactions in the plenary.
-    Distribute the instructions on condom use and let participants read them carefully
-    The same pairs sit together again but now the exercise is done the other way around; the second person, with a new condom, gives condom instruction according to the instructions they have just read (5 minutes).
-    To conclude, let participants react to the instructions given and stress the obstacles one can face while demonstrating the use of condoms.
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INSTRUCTION CONDOM USE
Check if you have the right condom:
w Is it for vaginal or anal use ?(Special, extra stong condoms are suitable for anal use only).
w Is it big enough?
w Is it an approved brand?
w Check the expiry date
u    Open the wrapping carefully:
w Do not use teeth or scissors, avoid tearing the condom
u Take out the condom:
w Be extra careful with long nails
w Make sure that you don’t hold the condom inside out
u    Pinch (squeeze) the semen reservoir, so that there is no
air left.
w This reduces the chance that it will tear because the reservoir does not come under pressure
w If the condom has no reservoir, make one yourself by squeezing the air out of the top of the condom (2-3 cm)
u    Put the condom on top of the penis and unroll it carefully to
the base of the penis
w When fully unrolled there is less chance that the condom will slip off
w Again, be careful with long nails
u    Use only water-based lubricant
w Always use lubricant for anal penetration
w A non water-based lubricant will dissolve the condom
u    Withdraw the penis carefully shortly after ejaculating
w While withdrawing, hold the condom at the opening to avoid it slipping off
w If you wait too long, the penis can become flabby, the condom slips off and semen drips out
u    Make a knot in the condom and dispose of it
w Not in the toilet because it can stop up the drain
Use a new condom each time you start fucking. Never use two condoms on top of each other, as this can cause the condoms to tear.
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dom relay race
Objective:    Participants practice the use of condoms
by playing a game.
Duration:    10 to 20 minutes
No. of participants: Minimum 6, maximum 12
Material needed:    Dildos (or bananas, cucumbers, etc.), con-
doms, a written condom instruction (see copy sheet from exercise instruction condom use).
Exercise outline:
-    Instruct participants on how to use a condom.
-    The written instruction is used as the ‘gold’ standard (see copy sheet)
-    Split the group into equal numbers.
-    Give each member of the groups two condoms
(one as a spare)
-    Participants stand in a line
-    The first person of each group gets a dildo and has to put on the condom in the proper way, then take it off again and make a knot. Then the second can start the same sequence
-    The group who finishes first is the winner
Remarks:
-    The trainer can decide to appoint referees who judge the participants actions’
-    If participants make a mistake they should start again
-    The winners should receive a small prize
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The safer sex debate
People use all kind of pretexts against condom use. The aim of this exercise is to bring those pretexts to the surface and find valid counter arguments.
Objective:    Discussing condom use, pros and cons.
Duration:    30 to 45 minutes
No. of participants: Minimum 6, maximum 20 Material needed: Two different viewpoints
Exercise outline:
-    Split the group in two, one group pro condom use, one group opposing condom use
-    Each group is handed the participants’ worksheet, see: next pages
-    The groups prepare their assignment for 10 minutes
-    The groups then come together and sit face to face. The group opposing condoms gives their first reason for not using them. The ‘pro’ group is then given the opportunity to respond to that. The reasons for and against condoms are then exchanged, one by one, as many as possible.
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THE SAFER SEX DEBATE (1/2)
Write down the arguments for condom use one by one and keep in mind that your partner will probably not agree with you.
Short stories PRO.
“You have been watching this attractive person for a couple of weeks. Now you both have met and have fallen in love. After an exciting night out, you find you have both ended up in bed together, willing to make love. You want to use a condom but are not sure how to raise the subject. The last thing you want to say is that you are HIV positive. Convince your partner to use the condom”.
“You are having your period. It’s the first day and it is a heavy flow. It is your last night on holiday, and your last chance for romance with the sexy man you have met in the bar at the harbour but he’s told you he has a history of drug use and a regular partner with high risk behaviour. It’s 01.30 in the morning and you have only one hour before he has to return home to his fiancé. There are no condoms available. What do you do?”
“After months of heavy quarrels about money and drug use with your partner, the situation has become unbearable and you leave the house. You are lucky to find a place to sleep at one of your friends’ houses. After being his guest for a week, your friend wants to see some ‘rent’. He wants you to have sex with him. When you are in bed with him it appears that he does not want to use a condom”.
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THE SAFER SEX DEBATE (2/2)
Write below the arguments against condom use one by one and keep in mind that your ‘partner’ probably will not agree with you.
Short stories AGAINST.
“You have been watching this attractive person for a couple of weeks. Now you both have met and have fallen in love. After an exciting night out, you find your have ended up in bed together, willing to make love. Because you hate condoms you are not going to use them. Besides, you are not HIV positive. Your partner proposes that you do use a condom. Explain why you don’t want to use it”.
“You and your girlfriend have been using drugs for 10 years. Your girlfriend works on the street and is making enough money to supply you both with drugs. It is a long time since you were last dope sick. One night, she suddenly says that she wants to use condoms with you. You are surprised because you feel condoms are only for clients. You refuse.”
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Exploring different value systems *7
Although HIV and hepatitis transmission routes are discussed quite frequently, uncertainties and doubts still remain (see chapter 2, 3.2).
Objective:    1. Exploring different value systems
2. Enable participants to clarify what is acceptable and unacceptable for themselves
3. Providing a basis for negotiating safer sex Duration:    45 - 60 minutes
No. of participants: Minimum 6, maximum 20
Material needed: Ccopies of the statement cards and 3 header cards (see following pages: ‘This is OK for me’, ‘This is OK for others’, ‘This is not OK’)
Exercise outline:
-    Fix the three header cards on the wall/flipchart where everybody can see them and put the smaller cards with questions in a pile that everybody can reach.
-    Ask participants to choose a card, one at a time, and place it under the heading that best fits their views. Ask them to comment on their choice.
-    If a person picks a statement card which they do not want to declare their views on, they can place it back in the pile and either take another or return to their seat.
-    Once all the statement cards have been placed in a line, tell participants that they can move any card under another header card, if they disagree with where it is
currently placed. Each person can only move a particular card once.
-    Participants may like to say why they are placing the statements cards under particular headers, or they may choose to do so silently.
-    Ask participants if they were surprised at any of their own responses or those of others.
-    Ask participants what they learned from the exercise.
*7
This exercise has been adapted from Brian Murtagh: Peer education (book 3). See references.
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Exploring different value systems - Statements
¨ Having more than one partner
¨ Being paid to have sex
¨    Working as a prostitute
¨ Always insisting on a condom when working as a prostitute
¨    Using a vibrator
¨    Getting drugs for sex
¨    Giving drugs for sex
¨    Talking about other inmates having sexual contacts
with each other
¨ Sex between two women
¨    Vaginal intercourse without a condom in private
heterosexual relations
¨ Women who drink
¨ Pornography
¨    Put pressure (bullying and intimidation) on others to
have sex
¨ Have sex to prove you love someone
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EXPLORING DIFFERENT VALUE SYSTEMS
(1/3)
For ME
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EXPLORING DIFFERENT VALUE SYSTEMS
(2/3)
For Others
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EXPLORING DIFFERENT VALUE SYSTEMS
(3/3)
t OK
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Safer Sex in relationships, sex work as risk exposure
HIV and STD’s are frequently discussed in professional sex relations. Risks in private sexual relationships are often neglected. Risks are often connected. More awareness should be raised on the connections between risks.
Objective:    1. Explore risks and everyday beliefs in het-
erosexual relationships.
2. Provide an opportunity to practice negotiation and decision making skills, so that the inmate is better able to make positive choices in social and (hetero)sexual relationships.
3. Discuss the necessity of communication about risky behaviour.
Duration:    60 minutes
No.of participants: Minimum 6, maximum 20
Material needed:    Copies of the scenario (following page),
flipchart
Exercise outline:
u    Divide the group into couples and let them discuss the
scenario (10-15 minutes)
u    Collect the solutions (helping arguments) and
discuss them
u    Write down the list of possible solutions on the flipchart
u    Make it clear that this scenario is only one example
of how to start with female sex work and that there are
many other ways which often include violence, having no other choices etc.
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SAFER SEX IN RELATIONSHIPS - SCENARIO
Maureen and Paul have been together for about six months, both have been using drugs for quite a while. Financing the drug for both is getting more and more difficult. After Paul was caught by the police, he is not allowed to enter certain supermarkets and warehouses anymore (to steal things). Seeing no other solution, Maureen started to work as a street prostitute. For both Paul and Maureen, it was clear that Maureen should insist on the use of condoms, but initially, she didn’t always succeed in persuading her clients. It was often impossible, especially when she needed the money urgently because she was turkeying. Most of the clients wanted oral sex in their car but others wanted vaginal sex. The first time she did it, she thought that oral sex wasn’t a cause of infections, but after having done it more often she felt depressed about her situation. Although her clients looked very clean and it seemed impossible to her they could be infected, she still felt highly uncomfortable with unprotected sex. The problem was that she couldn’t find a way to discuss her problem with Paul. Although they hadn’t had sex since she went out on the street, she didn’t want to infect him.
Can you find some arguments to help Maureen?
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Respond to persuasion in a positive way *8
In many situations, any suggestion of condom use is rejected by the male partner. A condom is often associated with mistrust, feeling uncomfortable, being too complicated to organise etc. Here are some statements in response to which challenging statements are requested.
Objective:    1. To provide inmates with an opportunity to
respond to persuasion in a positive way by challenging the persuader and asserting themselves and their own ideas.
2. To discuss different strategies for finding solutions in conflict situations based on individual experiences and knowledge
Duration:    60 minutes
No. of participants: Minimum 6, maximum 20
Material needed: Beep Beep Suggestion Sheet (below)
Exercise outline:
u    Clear the room of any chairs or objects;
u Ask the group to form a line side by side at one side of the room;
u    Tell the group you will read out a statement from the sheet;
u Each statement tries to persuade someone to have sex without condoms either in professional or in private relationships;
u Anyone who can come up with a challenging statement in response must shout “Beep Beep”! The trainer calls this person’s name, and they will then make their challenge and take a step forward. The rest of the group stays where they are;
u This procedure is then repeated. When the end of the room is reached by one of the group, reposition everyone back in the starting place. Proceed until all statements are gone.
u    Discuss the participant’s responses. Are they realistic?
Are they being applied? What is the explicitly ‘positive’ value here? Can participants think of applying these statements in the future?
*8
This exercise has been adapted from Brian Mailagh: Peer education on (book 3), see references.
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*9
This exercise has been adapted from Brian Murtagh: Peer education (book 3). See references.
Exploring the facts about HIV/AIDS *9
Although HIV and hepatitis transmission routes are talked about quite frequently, people still have uncertainties and doubts especially about transmission in everyday life (see chapter 2.3.2.6.).
Objective:    1. Explore the facts about HIV/AIDS and
hepatitis
Duration:    45 - 60 minutes
No. of participants: Minimum 6, maximum 20
Material needed: Pens, questionnaires and answer sheets for clarification
Exercise outline:
u    Circulate the questionnaire to participants
u Discuss answers on completion
Variations:
u Have three large sheets of paper. One marked AGREE, the second DISAGREE and the third UNSURE.
u Place AGREE and DISAGREE on walls at opposite ends of the room, and UNSURE in the middle.
u    Read out a statement. If people agree with it they should
go to the AGREE end or stand at whichever card they think best suits their viewpoint.
u    Encourage discussion between participants on their sug-
gested answers. Some statements have clear correct answers, while others are deliberately ambiguous to generate discussion and to encourage participants to think about different situations. Clarify the correct information at the end of each section.
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RESPOND TO PERSUASION IN A POSITIVE WAY - “BEEP BEEP”STATEMENTS -
1.    If you really loved me you would do it
2.    Do you think I have a disease or something?
3.    It’s because I love you that I want us to do it.
4.    I want to be very close to you - not even with latex between us
5.    I will withdraw before I come
6.    I won’t tell anyone
7.    AIDS is a gay disease - people like us don’t get it
8.    Condoms spoil my pleasure
9.    Look into my eyes - do they look yellow or something? I don’t have hepatitis or AIDS, you would see it if I did.
10. If you are using the pill, nothing will happen.
11. If you get pregnant, you could use the ‘morning-after’ pill.
12. I’d feel so rejected if we couldn’t do it here and right now
13. I will pay you 5 pounds more
14. Look at this car, my suit - do you think I could have all this with an infectious disease?
15. If you do it orally, nothing will happen at all!
16. I’m not the one who is at risk but you. I should be scared of getting infected by you.
17. I can’t father a child - I’ve been sterilised!
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STATEMENTS ON HIV/AIDS
1/2
Do you think HIV can be found in ....    Agree    Disagree    Unsure
Air?           
Blood?           
Food?           
Men’s semen?           
Women’s vaginal fluids?           
Breast milk?           
Saliva?           
Sweat?           
Tears?           
Urine?           
Skin contact?           
Do you think you can get HIV from....    Agree    Disagree    Unsure
Oral sex (women with women)?           
Insect or animal bites?           
Getting a tattoo?           
Being sneezed on by someone who is infected with HIV?           
Sharing a toothbrush?           
Mixing blood?           
Sharing needles?           
Wet kisses?           
Sharing a dildo?           
Ear Piercing?           
Mouth to mouth resuscitation?           
Cleaning up someone else’s blood?           
Blood transfusion?           
Shaking hands?           
Which of the following do you think would help you to avoid getting HIV...    Agree    Disagree    Unsure
Not sharing a cell with an HIV-positive woman?           
Using the contraceptive pill?           
Stopping oral sex before the man comes?           
Stopping vaginal sex before the man comes?           
Not borrowing a toothbrush?           
Always using condoms during professional sex contacts?           
Not sharing cups and towels with your cell mate?           
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ANSWERE SHEET TO EXPLORING THE FACTS
2/2
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Air?    no    HIV is not an airborne virus. Therefore there is no risk from being in the same room or being near somebody who is infected
Blood?    yes    HIV is present in large quantities in the blood of an infected person to allow transmission to occur
Food    no    HIV is transmitted only via body fluids. There is no danger from eating food which has been handled by someone who is HIV positive.
Men’s semen?    yes    If the semen from an infected person enters the body of another person, e.g. during unprotected sexual intercourse
Women’s vaginal fluids    yes    HIV can be found in vaginal fluid and transmission can occur
Breast milk?    yes    The breast milk of an infected woman does contain HIV and it is possible for the mother to infect her baby during breastfeeding
Saliva?    yes    All the body fluids of an HIV infected person contain the virus in varying quantities. Saliva does not contain enough of the virus to facilitate transmission
Sweat?    yes    See above
Tears?    yes    See above
Urine?    yes    See above
Skin contact?    no   
Oral sex (women with women)?    yes    HIV can be found in vaginal fluid and transmission can occur
Insect or animal bites?    no    Mosquitoes, for example, cannot infect people with HIV
Getting a tattoo?    yes    The risk associated with tattoos relates to the use of ‘dirty’ needles, which might have been used on an HIV-infected person
Being sneezed on by someone who is infected with HIV?    no   
Sharing a toothbrush?    yes    Very low risk
Mixing blood?    yes    Very low risk
Sharing needles?    yes    Very high risk
Wet kisses?    no    Although theoretically possible it is highly improbable. The amount of virus present in the saliva is usually very small.
Sharing a dildo?    yes    HIV can be found in vaginal fluid and transmission can occur through sharing a dildo
Ear Piercing?    yes    But very low risk through contaminated needles
Mouth to mouth resuscitation    yes    Theoretically possible. If there is blood in the mouth of the person who is dying then there is a slight risk, but no single case of infection is known.
Cleaning up someone else’s blood?    yes    If the blood is infected and the person who is cleaning up has cuts or open wounds on the hands and is not wearing gloves
Blood transfusion?    yes    An number of people have been infected this way in the past before testing of blood started
Shaking hands?    no    No risk
Not sharing a cell with an HIV-positive woman?    no    Infection will only occur through sex, shared needles and syringes, or bloodto-blood contact
Using the contraceptive pill?    no    The pill offers no protection against HIV or other blood-borne diseases
Stopping oral sex before the man comes?    no    Often this method is not successfully applied within the dynamic of sexual intercourse
Stopping vaginal sex before the man comes?    no    See above
Not borrowing a toothbrush?    yes    Although minimal risk (see above)
Always using condoms during professional sex contacts?    yes    Condoms are a successful means of preventing infected semen from reaching your blood
Not sharing cups and towels with your cell mate?    no    Infection will only occur through sex, shared needles and syringes, or bloodto-blood contact
Which of the following do you think would help you to avoid getting HIV...
Do you think HIV can be found in ....
Do you think you can get HIV from....
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8.3    Exercises for prison staff only
We suggest starting any training for staff members by talking about drugs in a more general and basic way: effects, patterns and prevalence of use, associated risks, and myths. It may be useful to begin with the quiz ‘What do you know about drugs?’ (see chapter 2, 2.1). This form seems appropriate and helpful in initiating discussions about drugs and their impact in our society. Avoid making a competition out of the quiz, as participants might feel embarrassed when making mistakes. Use the questions as starters for further discussion. The quiz can be filled in by participants individually, without making the answers known to other participants. It then works as a check of the level of knowledge of individual participants, showing that people might need to have a more thorough knowledge of the issues.
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Legal and illegal drugs
Discussions with staff members about the topics ‘drugs’ and ‘infectious diseases’ should start and be structured by the specific prison circumstances and the needs of the staff. The following exercise might be useful as a starting point:
This exercise uses chapter 2, 2 of the manual.
Objectives:    1. Introducing the effects and risks of drugs.
2. Showing differences and similarities of legal and illegal drugs
Duration:    60 - 80 minutes
No.of participants: Minimum 4, maximum 20
Material needed:    Flipchart, (photocopies of chapter 2, 2 can
be used as ‘give aways’)
Exercise outline:
u    Participants are asked to list legal and illegal drugs; write
these down on the flipchart in two columns
(legal and illegal)
Ask for the effects of the most widespread drugs and list them on the flipchart. Generally, the focus will be on negative effects. Ask explicitly what the positive effects might be (‘Why do people feel attracted to or use this substance?’, e.g. pleasure, pain relief).
What are the differences and similarities between the different substances (legal, illegal and pharmaceutical drugs)?
Variation:
u    Ask the participants to split up in two groups, one
will discuss the pros and one the cons of the prohibition of alcohol. Each group selects a speaker who will then present the arguments to the whole group after 30 minutes.
u    ‘In Italy every prisoner is allowed to buy 1^2 litre of wine
every day’ - discuss the impact of that: Would you agree/ disagree with this measure?
Remarks:
The trainer needs to be well-informed about drugs and drug use.
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Cannabis use by inmates - what do you think about it?
The attitude of society towards drugs, especially towards cannabis is changing in many countries. Cannabis use is seen as less problematic than in former days. In different countries the law’s approach towards use, possession (and in some cases even small-scale selling) is changing towards less harsh measures. Cannabis seems to be the main drug used by inmates. Cannabis is often regarded as serving a useful function or helping to alleviate the experience of incarceration. Some directors of penal institutions have realised that they cannot avoid adapting to this new situation: in some prisons (for example, in North Germany) urine tests do not include testing for cannabis consumption anymore. Some prison managers in Scotland confirm the view that the use of some drugs in prison doesn’t vary considerably from that outside. “We do still accept that prisoners who use cannabis are breaking the law and they will be treated accordingly, but we are reflecting the way the world is outside prisons” (The Scotsman 13/5/98). The Howard League for Penal Reform in the UK recently recommended depenalization of cannabis in prisons in its ‘Submission to the Home Affairs Select Committee’.
Objectives:    1. Introducing the purpose of drug use
2. Sensitisation to cultural changes, values and judgements about cannabis (use). Duration:    60 - 80 minutes
No. of participants: Minimum 4, maximum 20
Material needed: Photocopy of the sheet below
Exercise outline:
u    Ask participants to split up into groups of 4 and discuss the
following questions alongside the photocopied text:
w Have you had any previous contact with cannabis use/ usage in prison?
w How widespread do you think the use of cannabis is in prison?
w What do you think about cannabis use in general? w What do you think about cannabis use in prison? w Have there been any changes in your opinion
toward cannabis since you started working in prison?
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u    Focus on changes in personal views, the meaning of drug
use for inmates and the possible toleration by the prison system.
Points of attention in the discussion can be:
u    What effects of cannabis fit into the prison system, and
which drugs are not suitable (stimulants)?
u Would there be more violence among inmates without cannabis?
u    Urine tests: is it still necessary to detect cannabis in drug
testing?
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Abstinence and/or risk reduction - what are the goals?
Objectives:    1. Identifying health objectives for drug-using
inmates
2. Understanding the differences between drug services (abstinence, methadone maintenance, risk reduction)
3. Understanding the principle of equivalence of health care inside and outside the prison
4. Identifying prejudices against risk reduction (‘Second hand service’) or negative connotations
5. Raising awareness of risk reduction providing a bridge function
Duration:    80 - 100 minutes
No. of participants: Minimum 4, maximum 20 Material needed:    Flipchart, pens
Exercise outline:
u    Ask participants to split up into groups of 4 and discuss the
following questions (every group should appoint a note taker to write down the results on the flipchart):
w What are realistic short-term and long-term health objectives?
w What drug and health services are needed to realise these objectives?
w What drug and health services are available in the community?
w Can these services be transferred into the prison setting?
u    Discuss the different answers in the plenary, and try to
sort them from long-term, maximum objectives on top (e.g. abstinence) and the short-term objectives below
(e.g. risk reduction). Discuss the hierarchy of goals.
Variation:
u    Discuss abstinence vs. risk reduction in the context of
sexuality in prisons.
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Health risks for staff
Objectives:    1. Identifying health risks for staff members
2. Raise risk awareness for communicable diseases
3. Discussing prevention measures
Duration:    60 - 80 minutes
No. of participants: Minimum 4, maximum 20
Material needed:    flipchart, pens
Exercise outline:
u    Ask participants to recall situations in their everyday routine
when they thought they were ‘at risk’
w Note these reports of situation
(e.g. cell/body/visitors search)
w Try to cluster these reports
w Let the participants identify the risks of communicable diseases: which ones constituted serious risk,which ones probable risk, which ones no risk?
w Ask participants about their knowledge of and experience with vaccination (e.g. Hep. A+B)
w Are the participants aware of post-exposure-prophylaxis? Do they know what to do immediately after a needle stick injury? Give information.
u    Collect all the answers and risk situations and make an
assessment of what is needed in future in terms of training, provision of technical means of prevention, in-depth discussions with unions, prison doctor and governor.
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Prevention of communicable diseases in prison
In about 19 prisons in Switzerland, Germany and Spain, needle exchange programs have been introduced. Interesting findings from the evaluation of these interventions have included: a decrease in needle-sharing among the participants was found; the number of abscesses dropped dramatically; the amount of drugs found and seized did not rise. This can be seen as an indication that ears that an increase in the availability of clean needles would result in increased drug use have not been confirmed. No scenario of using a syringe to threaten someone has appeared in any of the 19 prisons running needle exchange schemes so far. None of these prison have witnessed attacks on staff or fellow inmates by prisoners using needles as a weapon.
Objectives:    1. Raising awareness of effective measures
of prevention of infectious diseases
2. Debating the pros and cons of needle exchange projects in prisons
3. Discussing a hierarchy with alternative measures for the prevention of
communicable diseases
Duration:    60 - 80 minutes
No. of participants: Minimum 4, maximum 20
Material needed:    Flipchart, pens,
Exercise outline:
u    Present reasons for models and the results of needle
exchange in prison
u    Ask participants to split up in two groups (‘Pro’ and ‘Con’
groups). Give all participants a photocopy of the text above.
w For 30 minutes, the two groups should collect arguments on the pros and cons of a needle exchange project in their prison
w Collect the arguments on a flipchart in the plenary. Look at how the needs of the staff are addressed and what priority they gain in the arguments.
w Discuss the backgrounds of arguments pro (advantages for inmates and staff, etc.) and con (contradiction of general prison policy, fears of needle sticks, etc.) of needle exchange in prisons.
Variation:
u Ask one of the two groups to write a proposal for a needle exchange project in their prison. The other group should
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develop a bleach project
w Who should be participating in the planning phase?
w What kind of mode of distribution should be preferred, and why?
w Ask each group to react to the proposals of the other
8.4 Exercises for prison staff and inmates Talking about drugs
In prison, most staff members and inmates smoke tobacco. Is tobacco a drug?
Objectives:    1. Raising awareness about the fact that
drugs and drug use are a widespread phenomenon in our society (see 2.2.);
2. Raising awareness that tobacco is an addictive drug comparable to illegal substances like opiates.
3. Discussing tobacco as a common and widely accepted drug.
Duration:    45 - 60 minutes
No. of participants: Minimum 4, maximum 20
Material needed: Copies of cards (see next pages)
Exercise outline:
u Ask the participants which of them smokes
u    Discuss briefly the facts about tobacco (using the informa-
tion in chapter 2, 2.1 to be included)
u    Split up in small groups of four (two staff members, two
inmates). Half of the couples get a copy of card A (‘My first cigarette’) and the other half a copy of card B (‘Running out of cigarettes/stopping).
u    Couples with cards A are asked to recount the circum-
stances of ‘My first cigarette’, couples with cards B are asked for ‘Running out of cigarettes/stopping’?
u    After twenty minutes, the participants discuss their results:
one member of each group will present the results.
u  When discussing the results, compare them to the general perception of illegal substances. Use terms and concepts that apply to the use of illegal drugs (cold turkey, seduction into drug use by peers, just say no, addiction, relapse, moral weakness, etc.) Ask questions that are usually asked with regard to the use of illegal drugs. (Weren’t you strong enough to stop? Have you been motivated enough?)
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TALKING ABOUT DRUGS
(1/2)
CARDS A
‘My first cigarette’
and how it went on ...
Give the reasons why you took your first cigarette?
Were there peers or other people involved who invited you to
smoke that first cigarette?
What did you feel after your first cigarette?
Why did you go on smoking?
When did you feel you could not stop?
How do you feel, now you are confronted with more and more
areas where smoking is forbidden?
Is stopping smoking a voluntary decision? What does smoking
mean to you?
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TALKING ABOUT DRUGS
(2/2)
CARDS B
Running out of cigarettes/stopping
What do you think or do when it’s late at night, you are at home
(or on holiday abroad) and you have no cigarettes available
because the shops have closed?
Have you tried to stop and did you succeed?
How did it feel when you stopped?
Did you start again?
What made you start again?
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atter of hygiene
Objectives:    1. Discussing hygiene in prison as a
common topic
2. Speaking about fears of infections
3. Looking for ways to deal with these fears Duration:    90 minutes
No. of participants: Minimum 4, maximum 20
Material needed:    flipchart
Exercise outline:
u    Ask people about their fears of infection in prison
(door handles, toilets, surfaces, kitchen, barber, cell changes, needles). Discuss (on the basis of chapter 2, 3) any possible genuine risks of infections and write the results in a flipchart (using the following structure)
Place, situation, object    Hep. A    Hep. B    Hep. C    HIV etc.
u    Split up into small groups of four (two staff members, two
inmates)
u    Divide the results on the flipchart and give an equal amount
of places, situations and objects to each of the small groups
u    Ask the groups to discuss realistic and effective measures
to reduce and prevent the infection risks involved in their part of the flipchart and work with a note taker;
u    Ask the note takers to report back their plans for risk reduc-
tion measures
u    Discuss the plans briefly
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toilet seat
door handle
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