Hepatitis C spreads mostly unchecked in prisons
By Alan Elsner, National Correspondent
SAN QUENTIN, Calif, April 5 (Reuters) - Hepatitis C, a silent
attacks the liver, is rampant among the almost two million
inmates of U.S.
prisons and jails but authorities are making only half-hearted
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
Hepatitis C is a virus spread through contact with human blood
and is rarely
transmitted sexually. It can lead to life-threatening liver
scarring the liver (also called cirrhosis), liver cancer or
Fewer than half of those treated are cured. There is no
The disease is particularly prevalent among intravenous drug
example, in Baltimore 90 percent of those seeking treatment
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
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
that prison authorities do not want to know if inmates are
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
"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
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
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
HEP C EXPENSIVE TO DIAGNOSE, TREAT
Ted Hammett of Abt Associates, a research and consultancy
Cambridge, Mass, conducted a study for the Texas prison system
concluded it would cost $40 million a year to diagnose and
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
including tattooing, body piercing, fighting, sharing razors,
and engaging in homosexual sex. Prison rape puts inmates at
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
system. Other facilities offered little or no health screening
"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,"
Phyllis Beck, director of a hepatitis C awareness project in
hundreds of inmates within that state's prison system
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
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
liver biopsies have been conducted and 9 more prisoners are in
the process of
Degroot, who has seen two of her patients die in prison, said
be highly cost effective for U.S. society despite the high
"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,"