Prisons Plagued with Hepatitis C in Massachusetts

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 people 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.

· 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