Dr. Karla Thornton noticed a troubling pattern.
Starting in 2004, Thornton, an infectious disease expert at the University of New Mexico Health Sciences Center, was tasked with helping train medical providers working in the state’s prisons to treat hepatitis C, a blood-borne liver disease that can cause serious damage if left untreated.
But new infections kept popping up among the providers’ incarcerated patients.
“I think we need to get some hepatitis C education into the prison system — because there is so much hepatitis C in there,” Thornton remembered thinking.
The New Mexico Peer Education Project was created to do that.
Operated through Project ECHO — a program at the University of New Mexico Health Sciences Center that improves clinicians’ skills on particular subjects through regular collaboration — the Peer Education Project trains incarcerated people to share information with fellow inmates to promote healthy habits and reduce risky behavior that can lead to hepatitis C infections.
Since its start in 2009, the Peer Education Project has trained 1,150 peer educators, who in turn have instructed thousands of people incarcerated in New Mexico prisons. Using New Mexico as a model, similar programs now exist in a handful of other states and in the Dominican Republic, said Thornton, who is now the executive director of Project ECHO.
But the reach of the project isn’t limited by prison walls. Peer educators become public health leaders, sharing what they’ve learned about infectious diseases with others — including loved ones outside of prison. The role often has a “profound effect” on the educators, Thornton said, as they develop leadership and public speaking skills.
It shows participants: “They can do something for their community — in prison and outside,” she said.
‘Key partners’
Like education and family reunification, health is a key building block to a better life after prison, said Haven Scogin, deputy director of reentry at the New Mexico Corrections Department.
“How do you expect people to be compliant with supervision conditions, to be able to get a job, to be able to support themselves or family without having health?” Scogin said.
Diseases tend to spread inside prisons, where relatively large populations share confined spaces. The coronavirus pandemic — during which outbreaks of COVID-19 rapidly spread among people in jails and prisons — demonstrated that, Thornton said: “When people are living in communal settings where they’re very close to each other all the time, there’s more infectious diseases that are spread.”
About 30% of people infected with hepatitis C in the U.S. have spent at least part of the year in a correctional facility, according to data from the U.S. Centers for Disease Control and Prevention. The virus spreads when blood from an infected person enters another person’s body, Thornton said, meaning sharing needles during intravenous drug use or tattooing — both common in prisons — can transmit the disease.
Though curable with proper treatment, hepatitis C is uniquely common in New Mexico prisons. A study published in 2023 shows just over a third, 34.2% of people incarcerated in New Mexico prisons have been infected with the virus — the second highest rate of any U.S. state.
But that number is starting to come down, said New Mexico Corrections Department Health Services Administrator Wence Asonganyi. Since 2020, the state’s prisons have seen a decrease of about 20% in incoming hepatitis C cases.
Asonganyi said peer educators are “key partners” in the hepatitis C treatment program.
“They help educate peers by packaging the necessary information in ways that only those with lived experience can,” he said.
‘A privilege’
Kyle Merrell, who is incarcerated at the Central New Mexico Correctional Facility in Los Lunas, became a peer educator as part of a larger effort.
“My goal, from the very beginning of my sentence, was to utilize this time as best as I could, to be positive and productive and to not have it be dead time,” said Merrell, who court records show is in prison on drug-related charges.
So when he saw a sign-up sheet for a 10-hour Peer Education Project workshop, Merrell decided to participate. After his first session, he kept coming back.
“I was just floored by the wealth of knowledge that these educators had about so many different communicable diseases,” Merrell said.
When an opportunity arose about two years ago for Merrell to become a peer educator himself, he interviewed for the role. And he got it.
Peer educators like Merrell go through 40 hours of in-person training. During that time, Thornton said, they’re schooled in hepatitis C — as well as HIV, addiction and other public health subjects — as well as how to teach others through effective facilitation and public speaking skills.
Then, peer educators share what they’ve learned with those incarcerated alongside them in a series of workshops, with a 10-hour public health workshop serving as the “bread and butter” of peer educators’ work, Merrell said.
Still, each workshop ends up looking a little different as the educators modify to meet participants’ needs and interests.
“Even if it’s the same 10-hour workshop every weekend, not a single one is alike because we have different participants,” Merrell said. “So there’s so much room for us to focus.”
Educators branch out to other subject matter in shorter workshops. Thornton gave the example of a group of prisoners in Otero County who developed a financial literacy curriculum.
“I really look forward to even more of that — that was something that they feel like is really essential for them to learn and creating curricula,” she said.
Merrell, who also facilitates sessions on financial literacy, has been working on workshops centered around what he called “footworks” — or ensure people have the most up-to-date information about resources on the outside ahead of their release.
“What we’re trying to do is equip these guys to do their own footwork, to give them the direction in order to find whatever resources are available when they get out,” he said.
Merrell said stepping into the role of a peer educator and becoming a trusted resource for others in his situation has been “a privilege.”
“It really, really is so humbling when I’m just out on the compound and somebody pulls me to the side and asks for more information or asks if they can just confide in me,” he said.
Merrell continued, “It is one of the most gratifying experiences that I’ve had in my life — and I’m not just talking about in prison, I’m talking about in my life.”