HOW TO MAKE CONTACT WITH DRUG-USING INMATES *2

There is one basic problem in reaching drug users in prison. A prerequisite for discussing safer behaviour is that generally inmates would have to ‘out’ themselves as former, current, actual or potential drug users. The only exception to this is when distributing general information, e.g. on a leaflet handed out to all individuals on entering prison. Outing oneself as a drug user, however, is not easy in an institution that punishes this behaviour severely (through loss of privileges etc.). So methods of making contact have to be developed that protect drug users by making sure that no disadvantages result from participating in a training seminar or other risk reduction activity. One option might be to find - through discussion with the prison management - ways of allowing confidential counselling or less public ways of organising risk reduction seminars, e.g. by using rooms in the general education unit so that the purpose of the training is not apparent.

Aside from this basic problem, making contact can be regarded as a task on its own, even if it doesn’t immediately result in other risk reduction activities. To reach the target group of drug-using inmates, one needs to have a network of contacts among the general inmate population in order to be able to reach those who are difficult-to-reach or ‘unreached’. One problem here is that while the ‘unreached’ is a popular term, it is not very specific. Therefore, before going into detail about how to make contact it is worthwhile to define what is generally meant by the term. This can be helpful in the process of establishing the types of people who constitute the target group.

Among those considered to be ‘unreached’ we would include:

Inmates who have never had any significant contact with an HIV or drug counselling service either outside or within the prison.

Inmates who have so far avoided any contact with prison health services about their drug use.

Inmates who do have contact with health services in prison but are not being reached by risk reduction measures.

Inmates who are not being successfully reached by risk reduction measures and drug counselling.

> Either due to incomplete or inadequate information

> Or due to an inadequate approach

> Or due to factors or problems on the client’s side: motivation, attitude, social norms, lack of resources, etc.

In general, one can say that the more repressive the prison setting is, the more difficult it will be to approach drug-using inmates. Peer support, i.e. drug-using inmates contacting other drug-using inmates, can be helpful here, firstly as a first step to risk reduction by peer support, and secondly as a means of facilitating risk reduction activities by prison or community service staff. The latter might have an advantage over prison staff, by being independent from the prison system and thus possibly being more trusted by inmates. However, prison administration differs widely in every European country, as do the conditions under which ‘outsiders’ are allowed access to prisons. There are countries where good co-operations between community drug and health services exist. However, in other countries this is far from being the case.

Another factor that may impede the process of making contact might be that the drug-using population is not homogenous. There are differences regarding drugs of preference, methods of administrating drugs, ethnic backgrounds, sexual preferences, etc. These sort of differences can make developing contacts even more complex. This problem can, to some extent, be addressed by selecting peers or staff of the same gender or ethnic background as the people targeted when seeking to engage in risk reduction activities.

5.1 The first steps

Before actually making contact, one has to at least have a vague idea of who it is that one wants to reach and what one wants to achieve. Starting from our general notion of target groups and aims, we can then begin to take the first steps and start to explore the situation. Important things we need to know will be:
What is the situation of drug users in prison?
What are their specific needs?
What drugs are used, how are they used and what health risks are involved?
What is the situation concerning the spread of infectious diseases and drug-related diseases?
What is the extent of sexual contacts and what health risks do they imply?
How widespread is tattooing and what disinfection techniques are applied?
What are the risk reduction resources of the institution?
How can risk reduction activities be implemented and institutionalised?

Important sources of information for answering these questions will be found through discussions with key persons, staff members and colleagues and probably inmates or ex-inmates. Though one will generally only get rough estimates and anecdotal information about risk behaviour, combining and triangulating this information from different sources will provide some valuable indications of what is going on. Additionally it will be important to get a picture of how justice authorities, prison governor, middle management and prison medical service officials view the problem, what they want to do about it and what they expect from risk reduction activities.

This information will serve as the basis for redefining and choosing the target group (criteria, priorities, etc.). Then making contact - the first step in any risk reduction activities - can be started. Of course, the process of collecting this information will have already resulted in us making some contacts.

The process of making contact includes:
u    Visiting the prisons and getting in touch with inmates (the
first step for community service workers);
u    Communicating the aims of the risk reduction activities;
u    getting a conversation started; generally this start will tend
to be a casual chat, just to get on speaking terms and create a basis for further talks about risk reduction, and finally;
u        Introducing oneself (again, this is especially important for
community service staff), i.e.
w Explaining what one’s task or aim is
w Telling people what organisation/group you are
working for (you can leave a business card)
w Describing what you stand for
w Explaining what you can do for the target group, etc. u    Establishing credibility and a trusted relationship with the
target group(s), for instance by
w Proving that you are aiming at improvements in their situation
w Always being honest (about what you are, what you can and cannot offer)
w Offering support for those with problems, being care ful to only offer what you can actually deliver.
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5.2 Getting in touch
In the attempt to really make contact, the start of the process can be a long-term, frustrating enterprise, especially if one has to begin from scratch in a prison. One has to decide:
u    Where to make contact (in a cell, in the corridor, in a com
munity room, etc.)
u When to make contact (which is the right moment, do people have time, are they in the mood for a talk, etc.)
u    Which person to contact first (generally, one should con
sider starting with informal leaders of the inmate commu nity)
u    What is the right way to handle it (a direct or less direct
approach)
u What can you offer
u    When to stop (temporarily, at least), when is it time to take
a break and leave
For clarity’s sake, two ways of getting in contact can be distinguished:
u    Doing it on your own, or
u Getting introduced by someone
Making a new contact on your own
When you intend to make a new contact on your own, you have the choice between:
u    An indirect approach, e.g. by starting some casual chat
(about soccer, etc.). Such a chat often will develop into a more personal talk, at which point you can introduce your self, or may be asked to introduce yourself (‘what the ... do you want from me?’).
u    Or a direct introduction of yourself as (community) health
worker,
w explaining what your task is
w what you stand for
w what you can do for the target group, etc.
The most difficult approach, without doubt, is how to start on your own. For prison staff it is possible to just walk around in the prison, starting a casual conversation as a prelude for counselling or getting people involved in a training seminar. Moreover, they generally know or are known by the inmates. Inmates will be aware of their role as social or health workers. For people working in community
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rvices though, this might be more difficult. However, there are eful tools that
can make things easier. Risk reduction activities ounselling, seminars and services) can be announced through:
u    Prison staff, during educational and recreational activities
and in working places. One also can consider whether to organise recreational activities, such as sport, music, etc. which are focused on paying attention to health issues.
u        A poster. The poster should be presented in a ‘safe’ place,
where people can read it without being seen, e.g. in toilets.
u A leaflet. To avoid the problem that inmates receiving or having the leaflet are seen as admitting their drug use one can consider to hand out the leaflet to all inmates or to have it available at a ‘safe’ place.
u A newsletter or magazine. In some prisons a prison news letter or magazine is produced. An announcement on risk reduction activities can easily be included in this. One also can consider the possibility of producing a risk reduction/health promotion magazine, and including an announcement of services available in this.
u    An inquiry using a questionnaire, seeking to determine what
the health needs and problems of the target groups are. u    Giving out condoms/bleach/syringes.
Using these devices as supportive measures for making contact has proved to be quite useful in the past. They can facilitate the start of a personal discussion or the participation in training seminars. All these options will be discussed in more detail below (9 and 10).
Being introduced by someone
As soon as prison or community service staff have some contact with people from the target group or groups, things begin to get easier. Making new contacts can then be achieved by being introduced by those people that one already knows. It may even be possible that the initiative for making contact is taken by one of these people. If people trust the staffmembers they might introduce their friends to them. This latter situation is, of course, the easy way, and is what many people employed in this function often dream of.
However, even making the first contacts can be a relatively easy job. If you, as a prison or community service worker, are in a community room with some members of the target group where you already know some people and want to make contact with others:
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u You can join a group with some people you know and start a conversation. By doing so, you will generally get introduced or get the chance to introduce yourself to those people you do not yet know.
u    Alternatively, you can explicitly ask one of the people you
know (do this beforehand) to introduce you to people you want to make contact with. You also can ask if people know others who could benefit from information on risk reduction activities, etc.
Here again, success depends on an appropriate assessment of the situation. It can be helpful to visit informal meeting places (the corridor, TV room, sports facilities) on a regular basis, on the same day, at the same time. This makes it easier for the target group to find the staff involved in risk reduction activities, either for their own sake or for introducing or referring a friend to them. ‘If you go to this place on Friday at 10 o’clock you can meet them’).
As a community service worker involved in risk reduction activities in prison you can also consider getting introduced through people in positions of trust (such as the social worker, priest, medical personnel). However, you should also bear in mind the inmates’ privacy. You should never ask for names of inmates to speak to. The only thing you can ask is that these trusted individuals inform inmates about your work, refer them to you. It is then up to them to turn to you.
Here, too, the process of building up contacts can be facilitated by handing out some form of literature (see 5.2, 9 and 10 in this chapter).

(Based on Trautmann / Barendrecht "European Peer Support Manual, See References)