HIV and HCV in U.S. Prisons: Debunking the Myths
Prisoners in the U.S. are much more likely to be living with HIV and hepatitis C virus (HCV) than the general public. Though this may not be surprising, there is a widespread false belief that most inmates living with HIV and HCV were infected while in prison. Most inmates living with HIV or HCV, however, were infected before they started serving their current term in prison.
There are limited data on HIV infection in prison settings. The most complete set of data comes from a 2006 study by the Georgia Department of Corrections, which found that the majority of inmates with HIV had been infected before being incarcerated. From July 1988 to February 2005, all Georgia prisoners were required to be tested for HIV when entering prison. Of all the Georgia prisoners who tested HIV-positive during that time, 90% were already living with HIV when they entered prison. Only 88 inmates tested negative when they entered prison and later tested positive. This study covered only Georgia prisons, but it is the most thorough study of its kind in the country and could suggest how the epidemic exists in other prison systems as well.
A 2008 Washington Post article offers an explanation for this trend. The article points out the fact that communities of color with high incarceration rates, usually in inner cities, are the most affected by HIV of any communities in the U.S. Prisons play a very large role in the spread of HIV, but in more hidden ways. When members of a community are constantly being taken to and returned from prison, their partners are more likely to have other relationships. As people in this community have multiple sexual partners at the same time, sexually transmitted infections like HIV spread very quickly.
These communities also tend to have limited access to health care, so members might be less likely to know their own status or how to protect themselves from HIV and HCV. In fact, prison is often the first place these individuals will have access to health care, or the first time they will be tested. Members of these communities make up a large percentage of people in prisons, so the rates of HIV in prisons are likely to be much higher as a result.
The Need for Treatment
HCV rates are also significantly higher in prisons and jails than among the general public. According to the CDC, one in three prisoners is living with HCV. In 2005, 39% of people with HCV in the U.S. had a history of serving time in prison or jail, and a 2000 study found that 79% of all state prisons (which house 94% of inmates in the U.S.) offered HCV testing at some point during a prisoner's stay. But while prisons may sometimes be a good place to get tested, they rarely offer inmates the treatment they need. Between July 1, 1999, and June 30, 2000, only 7% to 27% of inmates who tested positive for HCV were being treated. The majority of HCV-positive prisoners weren't receiving treatment for reasons such as substance use, length of stay, and mental illness.
Many inmates have other health concerns that need more immediate attention, so medical staff prioritize those conditions over the HCV infection. Some medical staff aren't well trained to treat HCV, or don't want to start treatment on someone with a short sentence. Since standards of care vary between prisons, it's often difficult to maintain treatment when a prisoner is moved. Treatment is complex and sometimes painful, and only works about half the time.
But the most common reason given for the lack of HCV treatment in prisons is its cost. Treatment costs almost $10,000 per inmate per year, and many prisons and jails claim they don't have those resources. Some inmates file lawsuits against the prisons that deny them care, but many die during the fight, and a recent Montana Supreme Court decision ruled in favor of the prison system. Despite the fact that prisons have some of the highest rates of HCV infections, they have some of the worst care standards.
This article was provided by ACRIA and GMHC. It is a part of the publication Achieve. Visit ACRIA's website and GMHC's website to find out more about their activities, publications and services.
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