Prisons Plagued with Hepatitis C in Massachusetts

By Michelle Hillman / News Staff Writer
Monday, August 25, 2003

http://www.metrowestdailynews.com/arts_lifestyle/health/prisons08252003.htm
NATAP - www.natap.org

Note from Jules Levin: State prison systems are reporting similar rates of
hepatitis C infection and lack of treatment access as reported below in
Massachusetts. This reflects similar problems outside prisons. 3 million people in the
USA are infected with hepatitis C, about 180 million worldwide. It's estimated
that in the USA 60% to 80% of individuals infected with HIV through injection
drug use have Hepatitis C Virus; 30% of all HIV-infected have Hepatitis C Virus, that is 300,000 Hepatitis C Virus/HIV
co-infected individuals. Cornell Hospital HIV Clinic, Johns Hopkins HIV Clinic
and other such clinics, cities, and states report 85% of individuals infected
with HIV by IDU have Hepatitis C Virus. The same numbers plague Western Europe.
Nonetheless, there are few official Hepatitis C Virus testing and counseling programs at HIV Testing
and Counseling Sites. Community based HIV/AIDS organizations who provide HIV
testing and counseling are not providing programs for Hepatitis C Virus testing and counseling,
Hepatitis C Virus education, prevention, and medical referrals. A number of studies suggest
that the hepatitis C virus and hepatitis B virus are now the leading cause of
death in HIV. Treatment for Hepatitis C Virus is cost-effective, it is not expensive. Hepatitis C Virus
treatment is time-limited (12 months) so although the price for one year of
therapy is high the overall cost of treatment is less than that for HIV. The cost
of not providing care and treatment for Hepatitis C Virus is greater than the cost of
providing care and treatment. Access to care and treatment for Hepatitis C Virus is limited for
many Hepatitis C Virus/HIV co-infected individuals. Patient education is also limited. Costs
associated with progression of Hepatitis C Virus are great and outsrtip the cost of care and
treatment.  Expensive hospitalization and potential for liver transplantation
are major costs. The moral imperative of proving HIV treatment to save lives
without adequately addressing Hepatitis C Virus is not understandable. It costs about
$15,000 per year to provide a HAART regimen for HIV. Over 10 years the cost amounts
to $150,000. One year of Pegasys plus Copegus (ribavirin 800/mg/day)
combination therapy is $25,000. There was a time when such a situation in HIV was
unacceptable.

While the rate of HIV infection among prison inmates has remained steady
since 1999, a surge in inmates with deadly Hepatitis C has caught the state
system off guard. Hepatitis C, a deadly liver disease which can be contracted
through intravenous drug use, is being called the new HIV/AIDS epidemic, challenging
corrections officials in Massachusetts and nationally to treat and manage the
virus with slim budgets.

"Right now, to treat everyone would be unaffordable to  most state prison
systems," said Edward Harrison, president of the National  Commission on
Correctional Health Care in Chicago. "The legislatures aren't  appropriating the
dollars, the taxpayers aren't interested in pursuing it.

"There are more inmates in the state prison system with Hepatitis C or a
combination  of Hepatitis C and HIV/AIDS than there is treatment available, said health
advocates who work in the prisons.

"It's an increasing caseload of people to get  into a very small system of
care," said Kathy Blumenthal of Great Brook Valley  Health Center in Worcester,
who oversees a program for inmates at  MCI-Framingham. Susan Martin, director
of health services for the Massachusetts Department  of Correction, said
inmates with HIV are living longer because of drug  "cocktails," but are succumbing to complications from co-infection with  Hepatitis  C. According to data from the Department of Correction, the number of  AIDS-related  deaths dropped from a high of 19 in 1994 to two in 2002. Dr. Alfred DeMaria,
assistant commissioner of the Bureau of Communicable Disease Control at the
Department of Public Health, said that of the 10,000 inmates in the state
prison system, 300 are HIV positive. About 3 percent of the male inmate population
and 5 percent of the female population have the virus.

In addition to those with  HIV, there are 3,000 inmates in state prisons
infected with Hepatitis C, or  about 30 percent of the male population and 40
percent of the female population, said DeMaria. "Obviously they're both significant problems we need to deal with," said DeMaria. About 70 percent of the 300 inmates with HIV are
co-infected with Hepatitis C, and 10 percent of the 3,000 inmates with Hepatitis C are
co-infected with HIV, he said.

Carol Walsh-Boldstead, senior assessment coordinator at Span Inc., which runs
the Transitional Integration Project, or TIP,  serving inmates in Waltham,
Framingham and Lowell, said Hepatitis C is a growing  problem. A project
initiated by the federal government, TIP was designed to stop
the spread of HIV/AIDS in prisons -- an effort complicated by rising numbers
of inmates with both HIV and Hepatitis C.Walsh-Boldstead said a high
percentage  of inmates are co-infected. In 2002, she said, at least five died from 
complications of Hepatitis C prior to their release from state prisons and county
 jails.

There is still little data available to gauge the extent of the problem, 
Walsh-Boldstead said. "There's a big concern about people who are co-infected 
because it complicates their HIV," she said. Hepatitis C is the most common 
blood-borne virus in the United States and is the leading cause of liver
transplants. It can lead to cirrhosis, liver failure, liver cancer and death. It is more
 contagious than HIV because it requires much less exposure to contaminated
blood.

Like HIV, Hepatitis C can be contracted through intravenous drug use, and 
symptoms can take years to appear. Treatment for Hepatitis C consists of 
expensive drugs called Interferon and Ribavirin and costs up to $25,000 a person for
one year, said DeMaria. Since the treatment is so costly, only 50 to 60 of the
3,000 state inmates with Hepatitis C can be treated at one time, said
DeMaria. Not everyone qualifies for the treatment, which cures 50 percent of
patients." For some people the treatment is worse than the disease," said
DeMaria.

Testing in the state corrections system is voluntary. Once an inmate tests
positive, they are referred to a specialist. Inmates wait up to a year for
treatment, said DeMaria.  Because of tight budgets, providers must weigh criteria
such as the likelihood the person will comply with the painful treatment and
whether treatment will be successful.

Rachel Wilson, director of policy and advocacy at  the Massachusetts Public
Health Association, a private, nonprofit group, said  Hepatitis C is an
epidemic that has not fully emerged in the prisons. Many of  those infected are moving
through the corrections system unaware they are
living with the deadly virus, she said. Hepatitis C can take up to 20 years
to  reveal symptoms, and it is most effectively treated before it rapidly 
progresses.

Department of Correction health director Martin said the department has
developed a treatment program in conjunction with the Department of Public Health
and the Lemuel Shattuck Hospital in Jamaica Plain. Educating and treating peop
le in prison is the best opportunity to prevent Hepatitis C transmission and
re-infection once inmates are released, Wilson said. Michelle Hillman can be
reached at 508-626-4447 or mhillman@cnc.com) Hepatitis C numbers. From August
1999 to May 2003 the number of inmates with HIV who also tested  positive for
Hepatitis C from ranged from 50 to 69 percent of prisoners.

Hepatitis C Epidemiology in Massachusetts Prisons

From August 1999 to May 2003 the number of inmates with HIV who also tested
positive for Hepatitis C from ranged from 50 to 69 percent of prisoners.

The lowest rate of co-infection in the state prison system was recorded in
November 2000 with 20.2 percent of inmates with HIV also testing positive for
Hepatitis C.

At MCI-Framingham, an all-women's prison, from August 1999 to May 2003, the
number of inmates with HIV who also tested positive for Hepatitis C ranged
from 50 to 85 percent.


In May 2003, the most current statistics available, 66.6 percent of those
with HIV at MCI-Framingham tested positive for Hepatitis C.
SOURCE: The Massachusetts Department of Corrections