Picture of Jermaine Archer, a former PACE peer educator at Sing Sing Correctional Facility in Ossining, NY. Photo courtesy of Jermaine Archer.
By Ilyssa Daly and Chantelle Lee
At the peak of the HIV/AIDS crisis in the 1980s, New York state prisons were filled with fear. Nobody knew what HIV was yet or how it was transmitted and developed into a full-scale, inevitably fatal disease. In many prisons, that illness was known simply as “The Monster.”
“It was horrible,” said Richard Rivera, who was incarcerated for nearly 40 years and was released in 2019. “It was a stigma that marked the person as someone to be attacked, someone to be feared.”
But the New York State Department of Corrections and Community Supervision, or DOCCS, offered little when it came to education and preventative treatment for incarcerated people. That vacuum left incarcerated people to step up, advocate and teach their own.
In the late 1980s, people who were incarcerated created peer-led educational programs to de-stigmatize HIV/AIDS. The programs — AIDS Counseling and Education, or ACE, Prisoners for AIDS Counseling and Education, or PACE and Counseling, AIDS, Resource, and Education, or CARE — taught individuals how the virus works, how to mitigate its spread and how to maintain one’s health if one receives an HIV diagnosis.
“We decided what the students needed to learn, what we needed to learn,” said Jermaine Archer, a former PACE peer educator at Sing Sing Correctional Facility. “It was for us, by us.”
HIV/AIDS continues to have a disproportionate impact on people who are incarcerated. People in prison are 7.2 times more likely to be living with HIV than those who are not incarcerated, according to a June 2021 report by the Joint United Nations Programme on HIV/AIDS, or UNAIDS, which leads the global response to HIV/AIDS. In the United States, New York state had the highest rate of HIV among its incarcerated population, as reported by the U.S. Department of Justice in 2015. HIV risk factors for people who are incarcerated include the unavailability of condoms, the increased risk of sexual assault and the usage of contaminated needles when using drugs or tattooing, as stated by Avert, an HIV and sexual health education resource.
In women’s correctional facilities, HIV risk factors can include sexual violence perpetrated by male prison staff and needle-sharing, according to UNAIDS. Dr. Kimberly Collica-Cox, who teaches criminal justice at Pace University and has studied HIV peer-education programs in women’s correctional facilities, said it was possible but rare that exposure to HIV could occur through sexual transmission between two women — either through vaginal fluid or menstrual blood.
DOCCS spokesperson Thomas Mailey said in an email that the New York State Department of Health began providing education, counseling and testing services in correctional facilities during the peak of the AIDS epidemic, in the late 1980s and early 1990s. He added that all facilities have an office and resource center where people who are incarcerated can access community-based resources.
Peer-education programs also receive help from the Department of Health, AIDS Institute as part of its Criminal Justice Initiative, according to department spokesperson Jeffrey Hammond. Before the COVID-19 pandemic, 32 of the 50 New York state correctional facilities offered peer-run HIV/AIDS education programming, according to DOCCS.
At the start of the pandemic, DOCCS paused programming and visitation in its correctional facilities. But HIV/AIDS education programs were among the first volunteer programs to resume after the state lockdown was lifted. As of Nov. 16, 17 facilities have resumed peer-run HIV/AIDS education programming, and eight are in the process of resuming, according to the department. The facilities that have resumed programming are doing so in person, with social distancing and other COVID-related protocols in effect. According to DOCCS, many facilities that don’t have peer-run HIV/AIDS programming offer such education through community or volunteer organizations.
Former peer educators and program coordinators have emphasized how important the programs have been in promoting education and fostering community.
‘The Monster’: The AIDS crisis in prisons
In the 1980s, people were so terrified of getting “The Monster” that they reacted in “primitive ways,” Rivera said. If people suspected that someone was sick — if someone even went to the hospital ward for a few days — other incarcerated people would attack that individual or set his cell on fire, according to people who were incarcerated during the AIDS crisis. Some people were so afraid of physical retaliation that they refused to get tested or seek treatment.
While most people who were incarcerated were trying to avoid those who were sick, Rivera volunteered to work in the hospital wing, first at Green Haven Correctional Facility, and later at other prisons. He looked after men who were HIV-positive by putting lotion on them and playing cards with them.
“When I came to prison, I couldn’t read or write, and a lot of these dudes took me under their wing and helped me out,” Rivera said. “This was my friends. This was the people that took care of me and people that needed help.”
In 1987, The New York Times reported that AIDS was the leading cause of death among people incarcerated in New York state. In 1989, about 60% of all deaths in the state’s prisons were caused by AIDS, according to a report released the following year by the New York State Commission of Correction. Around this time, a group of men at Ulster County’s Eastern Correctional Facility, including Rivera, decided to do something about the crisis: They wanted to learn about HIV/AIDS so they could pass on that knowledge to others in the prison.
“We want to teach the population as much as we could,” said Kevin Bartley, who was a part of the group and was released from prison in 2018. “Not only the prison population,” he continued. “We want to make sure that the nurses knew, the doctors knew, the officers knew, the whole community knew what this thing was.”
Group members tried contacting nonprofit agencies to come and teach them about HIV/AIDS, but some organizations didn’t want to go into prisons, Bartley recalled. Finally, one man from AIDS-Related Community Services — or ARCS, though the organization is now known as Hudson Valley Community Services — agreed to come.
After their training, the group members started on the next step: creating a peer-education program. They were inspired by a program created at Bedford Hills Correctional Facility for Women, called ACE. They even modeled their name after the program, adding the word “Prisoners” to the title and calling the program “PACE” for short.
“The women at Bedford Hills, they were the ones that started it off — they are trailblazers,” Bartley said. “We followed their lead.”
‘Trailblazers’: Creating ACE
The conditions at Bedford Hills during the AIDS crisis were similar to those in the men’s correctional facilities; the stigma was so pervasive that anyone who was sick for any reason was ostracized and people didn’t want to visit hospitals for fear of being shunned. And that stigma was all the more prominent because the Centers for Disease Control and Prevention, or CDC, had yet to officially acknowledge that women could have HIV/AIDS; it wasn’t until 1993 that the agency expanded the criteria of HIV/AIDS to include more of the symptoms that women living with the virus experienced.
“It was really creating a crisis of fear that was divisive,” Judith Clark, who was incarcerated mostly at Bedford Hills for 37 years and co-created ACE, said of the epidemic.
ACE wasn’t Clark’s first foray into organizing. An activist since she was 14, Clark had been involved with the civil rights movement and the anti-Vietnam War movement before her incarceration. Later, she became a member of the radical left-wing groups, the Weather Underground and the May 19th Communist Organization. In 1981, Clark drove the getaway car after her fellow group members stole about $1.6 million from a Brink’s truck outside a mall in Rockland County. During the robbery, two police officers and a guard were killed.
While she was incarcerated for her involvement in the incident, Clark publicly apologized to the victims’ families. She earned two degrees and led various educational programs in prison. Clark said that ACE was one of the ways in which she was able to take “responsibility for the death of the three people who were killed in my crime.”
During the AIDS crisis, prison staff tried to bring in agencies to provide education and counseling for people who were incarcerated, but no one trusted the outsiders. In December 1987, Clark and a few others went to the prison’s superintendent, insisting that they needed to run an education program because their peers would trust them. A few months later, the superintendent agreed.
About 30 women went through a rigorous education and training program with staff from the Bronx’s Montefiore Medical Center, Clark said. Then they started developing their own curriculum for the ACE program that would inform their peers about the virus. Their hope was that the program would save lives, promote prevention and create more humane conditions for people who were living with HIV while incarcerated.
“What we were trying to do was not just teach people facts,” Clark said. “We were really trying to build community because we felt that the answer to fear and stigma and suffering was in our self-empowerment and building of community.”
ACE peer educators held workshops to educate their colleagues about the virus, offering a forum for those personally affected by HIV/AIDS to share their experiences. ACE participants also contributed to the AIDS Memorial Quilt by creating squares to honor women who died of AIDS while incarcerated.
“We tried to fight that whole sort of fear and shame with knowledge and sisterhood,” Clark said.
ACE peer educators “were trusted, credible messengers,” said Collica-Cox, who coordinated HIV peer-education programs at Bedford Hills and Taconic Correctional Facility before she conducted research on them.
Women incarcerated at Taconic, which is located next to Bedford Hills, created their HIV/AIDS peer-education program, CARE, around the same time as the women at Bedford Hills created ACE. Through her research, Collica-Cox found that peer education was so effective because these programs provided a strong sense of community between incarcerated women, though she added that peer-education programs can be effective for any population.
“It was almost like a family was formed,” she said, “and they really worked together to support one another.”
From ACE to PACE
Inspired by the ACE program, Bartley, Rivera and their friends started developing PACE a few years later. PACE’s creators wanted the program to address the ignorance of HIV/AIDS in prison, but also outside of the facility. Creators hoped that people who attended PACE classes would then bring what they learned home to their families.
The original program covered the immune system, the definition of HIV/AIDS, available treatment methods and more. PACE peer educators also counseled incarcerated people who tested positive, Bartley said.
PACE continued to grow, as people at other facilities started looking to the program created at Eastern as a model. And when people were transferred to other facilities during their sentence, they brought PACE with them.
“Every time someone was transferred to another prison, if they didn’t have the PACE program there, they created the PACE program,” Bartley said. “That’s what most of us did, and that’s why it’s still around.”
The program has changed over the years with the leaps in medical advancements and information, Bartley said.
“We just kind of planted the seed,” he said. “You watch your child grow. That’s what it is, watching your child grow up and being better than the parents. I mean, that’s every parent’s goal — is for their children to be better than them.”
The basics of peer education
Even after the 1990s, when antiretroviral drugs to control HIV and reduce AIDS transmission became commonly used outside the prison system, the program remained in demand. Charles Moore, the former chairman of Sing Sing’s program, said that PACE was so popular that the class had a waiting list. “Everybody wanted to learn about HIV and AIDS for whatever reason,” he said. “And we never asked why you took this class.”
Before the COVID-19 pandemic put a pause on PACE, coordinators at each facility ran their program differently. Still, all students began with the basic cycle: a weekly two-hour class offered in the evenings. According to curriculum documents obtained from former peer educators at Sing Sing, the 12-week basic cycle covered all topics related to HIV: prevention, transmission, treatment, nutrition, the immune system and the reproductive system. Around 20 students took the basic class at a time, depending on classroom size, according to peer educators.
While the specific curriculum varied depending on the facility, the basic information covered during the program was the same. PACE also followed the same general schedule across many facilities. For example, PACE students took a quiz halfway through the basic course. During week nine, many students watched “And the Band Played On,” a 1993 film about the AIDS crisis directed by Roger Spottiswoode and based on Randy Shilts’s book.
Former program participants said peer-education programs had a strong impact on people who were incarcerated — they fostered community, promoted education and helped diminish the stigma of HIV/AIDS.
Experts agree. Dr. James Woodall, a professor at Leeds Beckett University in England and the co-director of the Centre for Health Promotion Research, said that peer-education programs in correctional facilities rely on communication that takes place between people who share similar characteristics. They “provide a credible and authentic engagement experience,” he said.
Woodall, who collected international research on the effectiveness of peer education in prisons, said that incarcerated people prefer to be supported by others who are incarcerated, rather than by the healthcare professionals who work in correctional facilities.
PACE largely operated on its own, but did receive some assistance from nonprofit organizations to help train peer educators, facilitate HIV testing and provide supplies. To start a peer-run program, an individual needs to submit a formal request to be reviewed and approved by prison administrators, Mailey said in his email. All peer-run programs are supervised by a facility staff member, he added.
Former peer educators said that the department either approved or rejected the attendance list, as well as requests to use the classroom. Archer said that DOCCS was responsible for generating callouts, which are permission slips that incarcerated people use in order to get to various places within a prison. Archer said that while he was incarcerated at Sing Sing, the facility employed two incarcerated people, including himself, to work as clerks in the PACE office. They were paid around $7.50 a week.
“Considering the impact of HIV and AIDS, and the need for education regarding this important matter, the Department is pleased to aid in offering these meaningful and supportive services,” Mailey said in his email. “Staff advisors, Annual Program Evaluations, as well as regular supervision, monitoring, and feedback are used to measure the impact and success of programs.”
When former peer educator Colin Absolam arrived at Sing Sing in 1999, he was approached by a peer educator to take the basic class. “It blew my mind,” he said. “No one is talking about this information. I didn’t know about this disease, except for what I heard. And what I was hearing wasn’t accurate.”
The information that PACE classes covered was grounded in CDC research, but peer educators got creative in getting the source material across to participants in an engaging way. Archer started presenting the “Transmission” session of his class by comparing HIV transmission to the infamous gang rivalry between the Bloods and Crips. He said this was more effective than simply teaching the science behind transmission, especially since the students enjoyed it.
“They laugh and they have fun,” Archer said, “because essentially, a lot of times there are Bloods and Crips in the classroom with us.”
Peer education is effective in reducing risky health behaviors, Woodall said. He added that these programs empowered not only the students, but also peer educators. Woodall’s research found that giving peer educators the opportunity to help others “builds confidence, self-esteem and gives people a sense of purpose and belonging within a prison system.”
Collica-Cox also said that peer educators she studied at Bedford and Taconic were able to take on new identities that they had never considered before their incarceration. “They were teachers; they were counselors,” she said. “They were looked at as role models by others in the facility, which included staff and the other incarcerated women.”
Even though PACE’s curriculum was robust, peer educators were forced to improvise with one section: prevention. Absolam said that prisons typically don’t readily hand out condoms because sex is prohibited between incarcerated people. The only times condoms are handed out are during conjugal visits.
“We do stress abstinence. But we’re also aware that that is not always the case,” Absolam said. “We share as much information as we possibly can to assist individuals in protecting themselves and others.”
Absolam said that Saran Wrap is occasionally available when there are events with food in the mess hall. “Sometimes individuals get their hands on it,” he said. “And when that happens, that is something that could be used as a barrier.”
Ivette Pagan, a former CARE peer educator at Taconic, said that she knew incarcerated women were engaging in sex and mentioned Saran Wrap’s effectiveness as a method of protection. “That was out in the open,” she said. “At that point, it was like using something is better than nothing.”
CARE program participants were instructed to pay attention to the side of the Saran Wrap that they were using as a barrier. “If they were using one side of the wrap, you have to dispose of it after you use it,” Pagan said. “Or to make sure that they were using the other side.”
In order to indicate the side of the barrier that contained bodily secretions, Pagan said that she would tell women to mark the side they used with a pen or marker. “Sometimes you kind of laid it out and it was the only piece you had,” she added.
When it came to intravenous drug use or tattooing in prisons, Absolam taught abstinence, but he said he still spoke during class about an unconventional method people could use to clean their syringes and needles. The process, which involved water and bleach, would loosen dried blood inside of syringes and sanitize needles.
At the culmination of the basic course, PACE participants took a final exam. Those who scored above 76% were eligible to take the advanced class, which “gave you a better understanding of the information that was presented in the basic class,” Moore said. The advanced class also trained students who wanted to become peer educators for PACE.
After students completed the advanced course, they attended two additional sets of training in order to acquire their teaching certification. The first part was called “completion.” Participants picked one of four topics out of a hat — HIV/AIDS transmission, prevention, testing or basic counseling — and had to give a 15-minute presentation on that topic. Those who passed this part moved on to “proficiency,” where students gave a half-hour presentation on all aspects of HIV education.
Presentations weren’t just scored on their content; students were judged on how effectively they communicated — how they used their voices and how much eye contact they made.
“It had to be accurate. You could not freestyle,” Moore said. “Any information that was not true would cause you not to pass the completion or proficiency. That’s how serious it was, because we know that there’s a lot of misinformation.”
Looking back — and ahead
In an effort to contain the spread of COVID-19, programs in prisons — including HIV/AIDS peer-education programs — halted. Former peer educators expressed disappointment that the program they worked to build had stalled.
“I hope that it gets a restart because as a result of COVID, the facilities have been shut down, and they haven’t been able to have programming,” Moore said. “So I just hope that PACE has a great comeback.”
At first, PACE was only being offered by correspondence or virtually, which participants said severely limits their experience and learning.
When programming paused during the COVID-19 pandemic, the DOH AIDS Institute’s Criminal Justice Initiative remained in contact with incarcerated peer facilitators through mail and DOCCS staff, according to Hammond. “Correspondence courses were also created in a few facilities and virtual trainings were discussed,” he said in an email.
Troy Bolling, a PACE peer educator who is incarcerated at Sing Sing, said in multiple letters through the email service JPay that the correspondence was discouraging for some students since they only received paper packets with course material. Every two weeks, they had to return the packet and complete a test. “Participants are in their cells trying to figure it out themselves,” he said in his message at the time.
According to DOCCS, as of Nov. 16, no peer-run HIV/AIDS education programming is being done virtually or by correspondence.
Clark said the ACE program empowered her and many of her peers to continue their activism after they were released from Bedford Hills. Clark mentioned the advocacy of Katrina Haslip, who was one of the original creators of the program and went on to fight to include women in the definition of HIV/AIDS. She died in 1992 of complications from AIDS, as reported by The Times.
Rivera said that while the stigma of HIV/AIDS is not as pervasive now as it was at the peak of the epidemic, it’s still prevalent. And he said some people have the compounded stigma of living with HIV and being formerly incarcerated as they try to reenter society after they’re released.
“I feel really proud of the program,” Rivera said. “There’s a lot to be proud of, but the problems continue, right? The stigma continues and the fear continues.”
To contact these reporters, email ilyssadaly@gmail.com and cl4144@columbia.edu
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