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High HIV and Hepatitis C Rates in Massachusetts Prisons, reports the Boston Globe
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Commentary by Jules Levin: This article from the Boston Globe reports on the conditions in Massachusetts prisons, but reflects a nationwide condition. As I travel throughout the USA holding hepatitis C and HCV/HIV co-infection educational workshops and forums for diverse communities, I find the same situation as reported in the Boston Globe article. The rates for hepatitis C infection in prisons ranges about 50%, but data is uncertain because testing is not always performed. Rates of HCV-infection appears higher among women than men. It is easily misunderstood that prisoners with HIV and HCv or HCV/HIV co-infection do return to communities outside prison where they can transmit HIV and HCV to others. The risks for sexual transmission of HCV is not well appreciated as there is a myth that HCV is not easily transmitted by sex. This controversial topic has not been very well studied. Studies report about a 4% risk for sexual transmission of HCV which is low, but what you don’t hear about is that published studies report that under certain conditions the risk for sexual transmission increases: when STDs including HIV are present, anal sex increases transmission, sex with women during menstruation, multiple sex partners increases risk. People infected with HIV often have higher HCV viral load which may increase the risk for sexual transmission.
The attention HCV gets in general, outside prisons, is not much better. There is little attention focused on HCV throughout the USA. There are none or few public awareness campaigns, prevention programs, education for patients, and programs to provide supportive services important for care and treatment. There is a wholly inadequate care system. If everyone with HCV were identified there is no way the care system could absorb them. For individuals co-infected with HCV and HIV the problem is more serious. HIV accelerates progression of HCV at least 1.5 to 2 times faster. Therefore, co-infected patients are at risk for progressing to cirrhosis or liver cancer much more quickly. On average it may take as long as 30 years for HCV to progress to a serious condition and become life threatening. Of course it varies by individual. Co-infected individuals are at risk for progressing in 15 to 20 years to serious complications. The leading cause of HCV transmission is injection drug use. Often, substance abusers infected with HCV receive inadequate care. They may not be tested for HCV and they may not receive access to quality care. One day these individuals may wakeup with cirrhosis and liver cancer.
What can we do about this? Programs are needed for: (1) public awareness; (2) testing and counseling; (3) a system of referrals for care and treatment; (4) an expanded medical infrastructure system; (5) education for patients, service providers, and medical care providers; (6) a prevention program; (7) a program to provide support services for care and treatment.
You can join your local Hepatitis C Coalition or task force. Task forces or local coalitions are sprouting up. We have one in New York City, and others are starting in LA and Arizona. A national coalition for HCV/HIV co-infection has started and you can get information about it by contacting Michaela Leslie-Rule at NATAP (212 219-0106, 888-26-NATAP).
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Disease rates high in Mass. Prisons
Rate of HIV infections is 7th-highest in US
By Stephen Smith, Boston Globe, 10/19/2003
Massachusetts prisoners suffer some of the highest rates of infectious disease in the nation, with hepatitis C, HIV, and other chronic conditions so prevalent that measures must be adopted to reduce prospects that prisoners will spread illness once they are freed, according to a sweeping report on inmate health scheduled to be released next week.
Inmates incarcerated by the state had the seventh-highest rate of HIV infections in the nation, a study from the Massachusetts Public Health Association found. While the report does not specifically address why conditions such as HIV are more common among prisoners in Massachusetts, disease specialists speculated that the wider use of injectable drugs in the Northeast probably bears much of the blame.
The rate of hepatitis C in jails and prisons is equally alarming: 27 percent of the men and 44 percent of the women entering Massachusetts prisons were diagnosed with the potentially lethal ailment most often spread through the sharing of tainted drug needles. Female prisoners were 24 times more likely to be stricken with hepatitis C than women in the general population.
Researchers said the high disease rates can make jails and prisons incubators of illnesses that, in turn, threaten the health of the disadvantaged communities that many prisoners return to when they finish their sentences. Public health advocates called for improvements in medical care for parolees, and a state senator has filed a bill to give them instant access to the state's health plan for the poor.
"People coming out of prison are going to be our neighbors -- they're our friends, our mothers and fathers and sisters and brothers," said Lyn Levy, executive director of Span, an organization devoted to reintegrating freed inmates into the community. "You just can't take a group of people and segregate them off to a no man's land when you know within a period of time they're coming back. So it behooves us to provide prisoners when they're in custody and when they get out with consistent treatment."
The experiences of former prisoners such as Anne Flaherty, who spent six years locked up in the women's prison in Framingham for running an escort service, graphically illustrate the challenges in containing infectious disease in prison. During her time in custody, Flaherty said, she shared her cell with 20 women. All 20, she said, were stricken with hepatitis C, although most were loath at first to confide details of their medical conditions. And many of them did not know the basics of containing its spread, including thorough hand-washing. That left Flaherty fearful that she, too, would contract the disease.
"I would tell them about following better hygiene practices, and it did end up in some fights because as soon as you tell someone they're not doing something right, they're going to slug you," said Flaherty, who remained free of hepatitis C. "It's no summer camp in there."
Prisoners frequently show up at county jails and state prisons already suffering from a variety of illnesses, a reflection both of lives on the fringes of society and of the limited access to health care that poor communities generally suffer. The higher reported rates of HIV, hepatitis C, and other conditions might also indicate that prison health services in Massachusetts do a better job of testing inmates than elsewhere in the country.
"Substance abuse is clearly the predominant risk factor," said Dr. Alfred DeMaria, the state's director of communicable disease control. "And if you look at the pattern of imprisonment in this country over the years, drug crimes are drawing longer and longer sentences."
Prisoner advocates said that the quality of health services in county jails varies sharply and that although the state system has improved during the past decade, it could still do a better job of addressing inmate health needs. Specifically, inmates sometimes face treatment delays that compromise their health, said Alex Sugerman-Brozan, coordinator of the Prison Health Law Project, which monitors the quality of correctional health care in Massachusetts.
A spokesman for the Department of Correction, Justin Latini, said the agency has moved aggressively in recent years to upgrade care, but acknowledged "we could always improve any system."
But even if inmates receive treatment while imprisoned, that care will be for naught unless systems are in place to assure their care continues outside prison walls, said Rachel Wilson, author of the study from the Massachusetts Public Health Association, which represents state and local public health officials. "The continuity of care when people come out is of the utmost importance," Wilson said. "The fact that you've spent the money on them while they're incarcerated, you might as well throw that money in the trash if you're not going to continue that commitment to care."
To that end, state Senator Richard T. Moore, chairman of the Joint Committee on Health Care, has introduced legislation that would mandate that inmates become immediately eligible for the state's medical plan for the poor. Now, they can wait weeks or even months to gain access to MassHealth Essential.
Guaranteeing that care remains constant is at the heart of an initiative in Western Massachusetts hailed as a national model.
Inmates entering one of the facilities run by the Hampden County Correctional Center are linked with a medical team that comes directly from a community health center in the prisoner's neighborhood. That medical team oversees inmates' care throughout their sentence -- and when they are released.
Studies by the Hampden corrections system, headquartered in Springfield, show that 80 percent of former inmates with chronic conditions continue to get treatment from their neighborhood health center once they're freed.
"Mr. and Mrs. Middle Class America say, `This sounds soft; it sounds touchy-feely.' And they want to get a bang for their buck," said Sheriff Michael J. Ashe, who spends about 10 percent of his $52.7 million budget on health care. "But I can honestly say to you, `Mr. and Mrs. Middle Class Massachusetts, you are getting one hell of a bang for your dollar with this.' "
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