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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

The silent killer doing time

What does a person do when a prescribed eight-year prison term turns into a life sentence?

By: Sean Guillemette
Hepatitis C Virus in prisons. (Article)

What does a person do when a prescribed eight-year prison term turns into a life sentence? State corrections departments are fielding this question throughout the country in dealing with the growing epidemic of hepatitis C (Hepatitis C Virus) in their correctional facilities

The growing problem of Hepatitis C Virus in our states? prison populations is one just now coming into focus. Very few states have conducted thorough seroprevalence studies of Hepatitis C Virus in their inmate population. The few states that have report alarmingly high rates of infection.

In 1998 a California Department of Corrections (DOC) study found a 39.4 percent Hepatitis C Virus seroprevalence in incarcerated males. A 1999 report issued by the Texas Department of Criminal Justice estimates that 40,000, or 28.8 percent of its prisoners, carry the hepatitis C virus. Virginia estimates range between 30 and 40 percent.

A national study of 36 states by Dr. Anne Spaulding and researchers from Brown Medical School and Miriam Hospital in Rhode Island established that only one state, Colorado, performs any sort of routine screening for Hepatitis C Virus. Their seroprevalence was found to be 30 percent. Nevertheless, it is believed that 30 to 40 percent of the nation?s inmate population is infected with hepatitis C.

Why so high?

There are many possible reasons for the high rate of infection in our inmate population. The link between IV drug use, hepatitis C infection and incarceration is an obvious culprit.

Prison itself, however, poses unique risk factors to inmates. The sharing of personal care items such as electric razors and razor blades can be common in prison situations. Something as mundane as getting a haircut becomes a risk factor in a prison setting when the barber does not sterilize shears between cuttings. Tattooing and body piercing take place with needles that have not been sterilized. IV drugs and the snorting of drugs also take place within prison walls. The blood-to-blood contact men can have when fighting is another concern, explains Phyllis Beck, director of the Hepatitis C Awareness Project and co-founder of the Hepatitis C Prison Coalition.

"Even though hepatitis C isn?t that easily spread sexually, with traumatic sex and anal sex [which sometimes takes place in prison], it can be spread a lot easier," says Beck. All of these risk factors multiply exponentially when they are confined to a small space with crowded conditions such as a prison.

"In essence, our state prisons have become a state-sponsored incubator for Hepatitis C Virus, by default."

The cost of treatment

With such a high rate of Hepatitis C Virus in state prison populations, the cost of treatment obviously can be intimidating. According to Texas prison health officials, a year?s worth of treatment costs about $10,000 per inmate. (Other states? estimates range as high as $18,000 per inmate.) These officials estimate an initial cost of $64 million to treat current inmates, which is almost a quarter of the $280 million total health care spending for prisoners in 1999.

Government bureaucracy and cost have caused departments of corrections nationally to move slowly on this problem, Beck explains. "This has kind of been a bomb that?s been dropped right on the DOCs and they are [justifiably]scared of the cost and the responsibility of treating inmates."

Cost is a thorny issue to government agencies wary of losing their annual health care budget to a single problem. Unwieldy as it first appears, researchers are finding that cost is not as big a factor as it seems.

"I think that what a lot of people don?t understand is that not everyone is a candidate for therapy," Beck says. "Not everyone will be treated." For most states, the cost becomes far more reasonable when coupled with the reality of who is a good candidate for drug therapy.

According to the Spaulding study, using the treatment guidelines the authors laid out, only 31 inmates out of the 3,000 infected in the Rhode Island prison system would actually benefit from treatment.

Factors disqualifying treatment include the length of time an inmate will remain in prison, contraindications such as active drug or alcohol abuse and depressive illness.

Studies have also shown that it is cheaper over a lifetime to treat now rather than wait for potential problems. Dr. John B. Wong of the New England Medical Center in Boston and his colleagues published findings in the November 7, 2000 issue of Annals of Medicine that supported the cost-effectiveness of immediate treatment as opposed to monitoring liver biopsies every three years and then determining if therapy was needed.

The costs to society for not treating hepatitis C in the prison population go beyond their stay in prison, as well. "You don?t want these people entering back into the community sicker than when they went in," Beck continues. The majority of inmates rely on public health outside of prison. In the long run, the cost of biopsies, transplants and other complications to the public outweigh the initial treatment costs.

While difficult to calculate, cost also goes beyond dollars and cents into the realm of public health risk. Obviously the vast majority of inmates are not serving life sentences. In Florida, the average prison term is eight years. The prison system, which has acted as an incubator for the virus just as its inmates have, releases these infected individuals out into the public after their time is served.

With only one state performing routine testing, most inmates are unaware that they are infected. Even when they are tested, Beck says that prisoners are sometimes not even notified that they are infected. After their sentences are over, the released inmates, who may or may not know that they are infected, are then free to spread the virus.

"From a public health policy perspective, this is a serious issue," Beck continued. "You have inmates who are released into the community on a daily basis. They may have no clue that they have Hepatitis C Virus, or have any understanding of how it is contracted. Therefore, they continue the cycle and spread it to someone else in the community."

What can the public do?

Advocacy is the most important thing people can do to help the prison population, Beck believes.

Education should be an advocate?s primary goal. "I think that is the number one priority."

Educating inmates has a number of positive benefits. Education helps inmates help themselves to reduce the spread of Hepatitis C Virus within prison and also helps them with their personal health treatment.

Not only is educating inmates about their disease important, but educating your state?s department of corrections and public health departments is a good idea. Education promotes the idea of formalized treatment plans to state agencies. State legislatures also need education regarding the scope of the problem. "If we start educating them now, then when we come to them with these problems and present them with what?s going on, they?ll have a base [of knowledge]," counsels Beck.

a handful of states have programs that even begin to deal with the epidemic. While the Centers for Disease Control (CDC) are currently working on them, the CDC have yet to publish specific guidelines for preventing viral hepatitis in correctional settings. Education can go a long way in spurring states to look at the issue and act on it.

In dealing with hepatitis C and the prison issue, it is often easy to dismiss inmates? problems as those that are of their own making. In doing so, however, we must remember that we place the community at greater risk. In this case, helping the prison population also helps the community at large. "It?s a win-win situation for everyone," says Beck. Hm

National Hepatitis C Prison Coalition (NHCPC)

The National Hepatitis C Prison Coalition was formed to bring together organizations and individuals interested in working to support and raise awareness among prisoners who are suffering from hepatitis and HIV/Hepatitis C Virus coinfection.

Their goal is to help educate prisoners and advocate for better testing, diagnosis, treatment and prevention of these diseases. To accomplish this mission, they offer seminars and support groups both inside and outside of correctional facilities. They distribute their news-letter to anyone who is interested, and advocate for better and more humane treatment of incarcerated persons living with hepatitis C.

If people inside or outside of prison would like to receive more information or the Hepatitis C Prison Coalition?s free newsletter contact:

Hepatitis C Prison Coalition
PO Box 41803
Eugene, OR 97404
(541) 607-5725