Hepatitis C: The “New Monster” in Corrections
Date:  06-23-2014

Depending on the prison, hepatitis C rates vary from 15 percent to 54 percent
Last month Reentry Central was contacted by the National Black Leadership Commission on AIDS, Inc.(NBLCA) about the National African American Hepatitis C Action Day 2014 which will take place on July 25. On that date the NBLC is encouraging organizations to hold one or more of the following events:

  • One-day Summits – targeting healthcare practitioners, nurses, physicians, pharmacist, public health professionals, social workers and counselors

  • Public Policy Town Hall meetings – to inform community stakeholders and policy makers of the impact of Hepatitis C within the African-American Community

  • HCV Health Literacy - workshops and trainings to educate the community on the impact of Hepatitis C

  • Outreach & Testing events- to as many African-Americans tested for Hep C and if positive linked to care and treatment

    Reentry Central asked NBLCA for information about how the disease is affecting prisoners. We received the following from Access Care and Resources for Health (ARC Health) via NBLCA.

    A New Monster: Hepatitis C is the New Front of Public Health Work in Prisons

    By: Erin E. Bortel, MSW, Director of Prevention Services at ACR Health

    As a provider rooted in the harm reduction approach, I’m often challenged to defend the “why” of our work. Most people understand the point of prevention services...until they realize our services target high risk groups like injection drug users, sex workers and incarcerated people. The stigma that these groups experience on a daily basis is precisely what makes these groups “high risk”. Without judgment, we seek these disenfranchised and marginalized populations to tackle public health issues across the state and region. A contract with NYS Department of Health AIDS Institute, the Criminal Justice Initiative, allows ACR Health to provide inmates rapid testing for HIV, group behavioral health education about sexually transmitted infections, HIV and viral hepatitis, individual risk counseling, peer training, and re-entry planning for HIV-positive inmates in 8 NYS correctional facilities.

    NYS Department of Corrections & Community Supervision, or NYS DOCCS, houses almost 55,000 individuals in 58 facilities. The state shares 15% of the HIV-burden among all US correctional (state and federal) facilities according to a 2012 Bureau of Justice Statistics report. In correctional facilities across the country, HIV is known as “The Monster”. With more people dying of hepatitis C than HIV in the U.S., it is time to tackle the newest challenge of health among the incarcerated, a New Monster. Also known as the “silent disease”, there is no reason cases should progress to becoming chronic health conditions with the treatment options available. This imminent and costly threat presents both challenges and opportunities to providers and the prison system.

    Myth: Hepatitis C in prisons is a prison problem, not a community problem. About 90% of people currently incarcerated will eventually be released and will return to their communities. The incarcerated population does not exist in a bubble. Their health issues are our health issues because there is no “us” and “them”. We are one, fluid population. Providing pro-active prevention education and awareness about hepatitis C in prisons will help prevent the spread of the virus in all communities.

    According to the New England Journal of Medicine (May 2014), more than a million people could die from HCV by 2060. If one in three HCV-infected Americans ends up locked up for at least a little time in their lives (Orenstein, May 2014), putting resources into providing access to testing and treatment options among inmates will help the U.S. get a handle on this health crisis. The strategy could save taxpayers billions in preventable medical costs caused by the complications of chronic hepatitis C, not to mention prevent the loss of life. Myth: All inmates are screened for communicable diseases, like hepatitis C, upon entry to a correctional facility.

    In a perfect world, state and federal corrections systems could have structured processes in place to efficiently screen and identify new cases of HIV, hepatitis C, and tuberculosis by testing every inmate who enters their facilities. The truth is, these systems vary and are not consistently implemented. According to a 2013 report from the New York State Correctional Association, a high prevalence of hepatitis C exists in all NYS DOCCS facilities and less than 75% those infected are known to the facilities. 45% of the impacted group is co-infected with HIV. Testing provided by the department only identified a limited number of newly diagnosed HCV-infected inmates. About 10% of men and 17% of women in NYS DOCCS facilities are suspected to have hepatitis C, yet only 17,700 (2011) received HCV-testing in the facility. Out of those tested, only 487 were found to be HCV-positive, representing about 2.7% of the total inmate population. Stigma, fear or denial about the individual’s risk, or a lack of understanding that they may be at risk, are key factors that impede inmate’s willingness to seek testing. It is clear that we have a lot of work left to do to overcome these barriers.

    Myth: An inmate with medical needs must be offered treatment. According to HCV Advocate, the US rates for hepatitis infection in prisons range from 13% to 54%, depending on the specific prison system. There are many reasons that people do not seek medical care while they are in prison. Like HIV, there are many inmates who are living with HCV but are undiagnosed, or, those who are aware of their infection and choose not to disclose their status to the facility. The reasons behind these decisions are complex, but are chiefly driven through an inherent distrust of the institution and a pervasive stigma that is experienced by marginalized groups, such as injection drug users. Stigma in a correctional setting can threaten an individual’s confidentiality, access to care, and personal safety.

    NYS is at the forefront of trying new treatment options for inmates who meet established diagnostic criteria. However, the cost of current hepatitis C treatment regimens can discourage systems from investing in care. Those eligible for treatment can run up a bill from $18,000 to $84,000 (Reuters 5/28/2014) depending on the specific medications used and length of the regimen. The significant costs create barriers to care whether an individual is incarcerated or not. At the high end, it could cost the United States more than $33 billion to treat every HCV-infected inmate in our country, or about as much as the entire federal Energy and Water budget appropriations for FY2014.

    Myth: There are no solutions to this complex problem. Yes there is. It is called hope. Treatment advances coupled with innovative approaches to testing may present viable options for HCV-infected inmates. It is incumbent on the institution, the staff working at facilities, and private contractors such as ourselves to offer a hopeful perspective to inmates. In the next six months, we will see groundbreaking advancements in the pharmaceutical industry. This fall we are being promised a cure for hepatitis C by taking one pill a day for less than 12 weeks. Gone are the days of interferon alpha-2b regimens, a 24-48 week treatment that can most closely be associated to chemotherapy. NYS is already negotiating with manufacturers to reduce drug costs to treat the incarcerated, and the federal correctional system already has deals in place, offering more accessibility to the HCV-infected inmate and more affordability to the state. With affordable care in place we have every reason to encourage access to testing among the incarcerated.

    The good news in all of this is that people are mobilizing: advocates are citing the need for change, facilities are receiving public pressure to respond to testing and treatment initiatives, and New York State, at least, has made very public recommendations about how to improve access to care among the incarcerated. Furthermore, national organizations are investing time and resources to bring attention to this issue. Most notably, the http://acrhealth.org/) is coordinating a public health campaign to increase awareness about hepatitis C, increasing access to testing and advocating accessing to treatment for those impacted. With support from other nonprofits such as the Harm Reduction Coalition, the Coalition on Positive Health Empowerment (C.O.P.E.), and now ACR Health, local events and advertising are being coordinated to lead up to the Second Annual African-American Hepatitis C Action Day on July 25, 2014.

    By building public-private partnerships and fostering a commitment to working together, we have an opportunity to address one of the most critical public health crises of our generation, but we cannot allow the health of the incarcerated to take a back seat to bureaucracy or politics. It’s time to act. Will you join us?

    To learn more about National Black Leadership Commission on AIDS, Inc. click here. or for more information on ACR Health click here.