Pubdate: Thu, 05 Apr 2001
Source: Reuters
Copyright: 2001 Reuters Limited
Details: http://www.mapinc.org/media/364
Author: Alan Elsner, National Correspondent

HEPATITIS C SPREADS MOSTLY UNCHECKED IN PRISONS

SAN QUENTIN, Calif. (Reuters) - Hepatitis C, a silent killer that attacks 
the liver, is rampant among the almost two million inmates of U.S. prisons 
and jails but authorities are making only half-hearted efforts to combat 
it, medical and prison experts say.

"The prevalence of this disease is believed to be 30 to 40 percent of the 
prison population, depending on the state," said Anne Degroot, a doctor who 
treats AIDS and hepatitis patients in the Connecticut prison system and 
heads a prison health education project at Brown University in Providence, 
Rhode Island.

Hepatitis C is a virus spread through contact with human blood and is 
rarely transmitted sexually. It can lead to life-threatening liver damage 
by scarring the liver (also called cirrhosis), liver cancer or liver 
failure. Fewer than half of those treated are cured. There is no vaccine.

The disease is particularly prevalent among intravenous drug users. For 
example, in Baltimore 90 percent of those seeking treatment for heroin 
addiction are infected.

In total, more than 4 million Americans have been exposed to the disease, 
of whom up to 15 percent can expect to become seriously ill in the next 20 
years, according to David Thomas of Johns Hopkins University Hospital. 
Carriers often have no symptoms.

Most state prison systems do not require testing of inmates. In many 
systems, testing is voluntary and in a few it is non-existent. Prison 
activists charge that prison authorities do not want to know if inmates are 
infected because once they do know they are obliged to offer costly treatment.

Diagnosis may involve giving patients liver biopsies to determine how far 
the disease has progressed. Drug treatment can cost up to $12,000 a year 
for  each patient. In some advanced cases, the only treatment may be liver 
transplants.

"The incarcerated population is the only population in this country that 
has a constitutional right to health care," said Barry Zack of Centerforce 
Inc, a non-profit organization that offers HIV and hepatitis education to 
inmates of California's San Quentin state prison.

"If they find something, they have to treat it at the same standard as that 
which prevails in the outside community. The implications are enormous. 
People used to think that treating prisoners with HIV would break the bank. 
That's nothing compared to what treating hepatitis C would do," he said.

Incidence of HIV among the prison population, although much higher than in 
the community at large, is still relatively low. A 1997 Justice Department 
report estimated that 2.3 percent of state and federal prison inmates -- 
just under 25,000 individuals -- were HIV positive.

For those who are infected with both HIV and hepatitis C, the prospects are 
grim.

Hep C Expensive To Diagnose, Treat

Ted Hammett of Abt Associates, a research and consultancy company in 
Cambridge, Mass, conducted a study for the Texas prison system which 
concluded it would cost $40 million a year to diagnose and treat prisoners 
for hepatitis C in that state.

"A lot of states are really gun shy about the cost issue for pretty obvious 
reasons," he said.

Prisoners are San Quentin are told about AIDS and hepatitis C as they enter 
the prison and are urged not to do things that could put them at risk, 
including tattooing, body piercing, fighting, sharing razors, sharing 
needles and engaging in homosexual sex. Prison rape puts inmates at 
additional risk.

At one briefing for newly admitted prisoners this week, John Romain, a peer 
counselor serving three years for drug possession, did not mince his words.

"Since I've been in this institution, quite a few fellows have died of Hep 
C. Don't share needles, don't do tattoos, don't share needles with nobody, 
don't share cotton balls, don't share water, don't share toothbrushes, 
don't share nothing with no one," he said.

Judy Greenspan of California Prison Focus, a grass-roots advocacy group, 
said San Quentin was the exception in the state prison system. Other 
facilities offered little or no health screening and education to inmates.

"Even if prisoners were tested, they were not always told the results. We 
have people who have gotten sick and gone back to their medical records and 
found they tested positive in prison years ago. By that time, it's too 
late," she said.

Phyllis Beck, director of a hepatitis C awareness project in Oregon, said 
hundreds of inmates within that state's prison system desperately needed 
treatment but only a handful were receiving it.

"We are seeing more and more inmates who are being released with cirrhosis 
or close to cirrhosis due to a lack of follow-up care after a positive 
diagnosis has been made," she said.

Oregon started counseling prisoners about hepatitis C only last year. Of 
the state's 9,600 inmates, 937 requested a test of whom 339 tested 
positive. Four liver biopsies have been conducted and 9 more prisoners are 
in the process of work-ups.

Degroot, who has seen two of her patients die in prison, said treatment 
would be highly cost effective for U.S. society despite the high price tag.

"If we treat these people, nearly all of whom will be returning to the 
community, we can avert public health expenditures down the road to the 
tune of billions of dollars," she said.

"If we aggressively treat in the prison system, we could avoid 30 percent 
of the liver transplants that will otherwise be needed," Degroot said.
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MAP posted-by: Jo-D