Hepatitis C spreads mostly unchecked in prisons

By Alan Elsner, National Correspondent

 
SAN QUENTIN, Calif, April 5 (Reuters) - Hepatitis C, a silent killer that
attacks the liver, is rampant among the almost two million inmates of U.S.
prisons and jails but authorities are making only half-hearted efforts to
combat it, medical and prison experts say.

"The prevalence of this disease is believed to be 30 to 40 percent of the
prison population, depending on the state," said Anne Degroot, a doctor who
treats AIDS and hepatitis patients in the Connecticut prison system and heads
a prison health education project at Brown University in Providence, Rhode
Island.

Hepatitis C is a virus spread through contact with human blood and is rarely
transmitted sexually. It can lead to life-threatening liver damage by
scarring the liver (also called cirrhosis), liver cancer or liver failure.
Fewer than half of those treated are cured. There is no vaccine.

The disease is particularly prevalent among intravenous drug users. For
example, in Baltimore 90 percent of those seeking treatment for heroin
addiction are infected.

In total, more than 4 million Americans have been exposed to the disease, of
whom up to 15 percent can expect to become seriously ill in the next 20
years, according to David Thomas of Johns Hopkins University Hospital.
Carriers often have no symptoms.

Most state prison systems do not require testing of inmates. In many systems,
testing is voluntary and in a few it is non-existent. Prison activists charge
that prison authorities do not want to know if inmates are infected because
once they do know they are obliged to offer costly treatment.

Diagnosis may involve giving patients liver biopsies to determine how far the
disease has progressed. Drug treatment can cost up to $12,000 a year for each
patient. In some advanced cases, the only treatment may be liver transplants.

"The incarcerated population is the only population in this country that has
a constitutional right to health care," said Barry Zack of Centerforce Inc, a
non-profit organization that offers HIV and hepatitis education to inmates of
California's San Quentin state prison.

"If they find something, they have to treat it at the same standard as that
which prevails in the outside community. The implications are enormous.
People used to think that treating prisoners with HIV would break the bank.
That's nothing compared to what treating hepatitis C would do," he said.

Incidence of HIV among the prison population, although much higher than in
the community at large, is still relatively low. A 1997 Justice Department
report estimated that 2.3 percent of state and federal prison inmates -- just
under 25,000 individuals -- were HIV positive.

For those who are infected with both HIV and hepatitis C, the prospects are
grim.

HEP C EXPENSIVE TO DIAGNOSE, TREAT

Ted Hammett of Abt Associates, a research and consultancy company in
Cambridge, Mass, conducted a study for the Texas prison system which
concluded it would cost $40 million a year to diagnose and treat prisoners
for hepatitis C in that state.

"A lot of states are really gun shy about the cost issue for pretty obvious
reasons," he said.

Prisoners are San Quentin are told about AIDS and hepatitis C as they enter
the prison and are urged not to do things that could put them at risk,
including tattooing, body piercing, fighting, sharing razors, sharing needles
and engaging in homosexual sex. Prison rape puts inmates at additional risk.

At one briefing for newly admitted prisoners this week, John Romain, a peer
counselor serving three years for drug possession, did not mince his words.

"Since I've been in this institution, quite a few fellows have died of Hep C.
Don't share needles, don't do tattoos, don't share needles with nobody, don't
share cotton balls, don't share water, don't share toothbrushes, don't share
nothing with no one," he said.

Judy Greenspan of California Prison Focus, a grass-roots

advocacy group, said San Quentin was the exception in the state prison
system. Other facilities offered little or no health screening and education
to inmates.

"Even if prisoners were tested, they were not always told the results. We
have people who have gotten sick and gone back to their medical records and
found they tested positive in prison years ago. By that time, it's too late,"
she said.

Phyllis Beck, director of a hepatitis C awareness project in Oregon, said
hundreds of inmates within that state's prison system desperately needed
treatment but only a handful were receiving it.

"We are seeing more and more inmates who are being released with cirrhosis or
close to cirrhosis due to a lack of follow-up care after a positive diagnosis
has been made," she said.

Oregon started counseling prisoners about hepatitis C only last year. Of the
state's 9,600 inmates, 937 requested a test of whom 339 tested positive. Four
liver biopsies have been conducted and 9 more prisoners are in the process of
work-ups.

Degroot, who has seen two of her patients die in prison, said treatment would
be highly cost effective for U.S. society despite the high price tag.

"If we treat these people, nearly all of whom will be returning to the
community, we can avert public health expenditures down the road to the tune
of billions of dollars," she said.

"If we aggressively treat in the prison system, we could avoid 30 percent of
the liver transplants that will otherwise be needed," Degroot said.