Viral Hepatitis and the Criminal Justice System
The unique circumstances of the criminal justice environment create opportunities to reach an underserved population with viral hepatitis prevention and treatment services. However, correctional facilities must grapple with several issues, including uncertainty about who will pay for these services, a lack of screening and treatment guidelines, and a need for staff training.
Viral Hepatitis is an Important Issue Facing the Criminal Justice System
Hepatitis B and C are highly prevalent in correctional facilities.
Although the prevalence of hepatitis B virus (HBV) and hepatitis C virus (Hepatitis C Virus) infections in correctional facilities is not known with certainty, a number of indications point to their being very common:
- Studies of prison populations in California, Virginia, Connecticut, Maryland, and Texas have found evidence of Hepatitis C Virus infection in 29%- 42% of inmates, and national figures for Hepatitis C Virus infection among incarcerated populations estimate that 15%-30% of inmates across the country may be Hepatitis C Virus positive.
- A California survey found that half the incoming women and a third of incoming men tested positive for hepatitis B virus infection.
- Injection drug use is the primary transmission route for Hepatitis C Virus. High-risk sexual behaviors (such as unprotected sex with multiple partners) and injection drug use are the major transmission routes for HBV. A substantial majority of prison and jail inmates – as much as 80% – have serious drug problems, including injection drug use.
Transmission can occur within and beyond the corrections setting.
Many inmates already have chronic HBV or Hepatitis C Virus infection when they enter prison or jail. Because symptoms are often mild or nonexistent, inmates may not know they are infected and can unwittingly transmit the virus to others through injection drug use, consensual sex, rape, and tattooing with contaminated equipment. Transmission can also occur as a result of sharing personal items, such as razors or toothbrushes. There is also a high risk of transmission to the larger community outside of the facility if an inmate continues to practice high-risk drug use and sexual behaviors after release.
The Criminal Justice System Faces Particular Challenges in Responding to Hepatitis B and Hepatitis C
Awareness of viral hepatitis as an important public health issue is growing, but correctional facilities face a number of unique issues as they try to respond:
- Currently, no specific federal guidelines exist for screening or treating inmates who may be at risk or who are already infected with HBV and Hepatitis C Virus, although such guidelines are currently being developed. Such guidelines should provide facilities with assistance in developing and implementing policies for routine screening, immunization, and medical evaluation and management.
- Viral hepatitis prevention measures, including screening, immunization, and treatment can be expensive. States and communities will need to identify sources for funding these services within correctional facilities, as well as develop policies for continuing care (such as completing immunization or therapy) after the inmate’s release.
- Variable length of sentences and constant movement of inmates within and between facilities makes ensuring complete immunization, monitoring chronic infections, and establishing and carrying out treatment regimens difficult.
- Antiviral therapy for chronic hepatitis B and chronic hepatitis C is complicated, has limited effectiveness, and is not appropriate for everybody. Facilities that have instituted viral hepatitis treatment programs have found that periodic training and updates for correctional health and pharmacy staff are needed for successful programs.Successful HIV/AIDS treatment programs in correctional facilities also may provide some useful lessons learned.
- Many inmates have other illnesses and conditions, such as HIV, tuberculosis, diabetes, or mental illness. Treatment of an inmate’s hepatitis B or hepatitis C may not be the highest priority for the correctional health staff if a beneficial outcome is uncertain.
Despite these challenges, the unique circumstances of the correctional environment create an unparalleled opportunity to reach a population that has been resistant to or unreached by education and interventions and to provide them with beneficial prevention and treatment services:
- Vaccines are available for hepatitis A and hepatitis B, providing a real prevention opportunity.
- Many correctional facilities already have education, prevention, and treatment programs focused on HIV, sexually transmitted diseases, and substance abuse. Viral hepatitis prevention, screening, and treatment messages could build on these existing efforts.