Unbeknownst to some, approximately 30 percent of HCV infections in this country are among the prison population. The most common risk factor for HCV in prison inmates is intravenous drug use. However, tattooing, once a seemingly innocuous practice, is revealing itself as a likely mode of transmission.
Several studies have examined the association between tattooing and hepatitis C transmission. One of these studies, published in 2001, and conducted by Robert Haley of the University of Texan Southern Medical Center, identified tattooing in commercial tattoo parlors as a significant risk factor for HCV. Of the 626 patients who were evaluated for spinal problems in 1991 and 1992, 42 tested positive for HCV. The status of these patients had, until then, been unknown. According to the study, "tattooing in commercial tattoo parlors may have been responsible for more HCV infections than injection drug use" [41% to 17% respectively].
There is still dissension in the scientific community about the degree to which hepatitis C is actually spread through tattooing. But while the scientific debate continues, so too does tattooing in prison. What is evident, however, is that the risks associated with tattooing in prison far outweigh those for tattooing in commercial tattoo parlors.
Moreover, the risk factors associated with tattooing are more often ignored or unknown by many of the recipients of tattoos in prison. I make this assessment based on my experience as a peer educator for the Prisoners for AIDS Counseling and Education program (P.A.C.E.), known for its diligence in covering the gambit of risky behaviors and risk reduction. I also conducted an informal poll of dozens of men who received prison tattoos. Not only were many of those polled oblivious to the possibility of blood-borne viral infections being transmitted via tattooing, but several of them had not even heard of hepatitis. Only a few had actually been tested for the disease.
The more conscientious respondents claimed to have eliminated the risk factors by bringing along their own equipment, usually the needle (a sharpened guitar string) and ink (normally melted down checker pieces). They were disconcerted to find out that even providing one's own equipment is not a fool-proof method to remove certain inherent risks, primarily the makeshift tattoo gun itself, whose design makes it difficult to be sterilized reliably. One respondent even admitted that he tested positive for hepatitis C subsequent to receiving a tattoo (he had previously tested negative), and yet was later seen receiving another tatoo.
The perils of tattooing in prison have not gone unheeded, at least by the medical community, health departments, and activists for health-related issues. Prison administrators in the U.S., Canada, Australia, and other countries have been asked by authors of reports on prison tattooing to accept the reality that prisons are playing a key role in the hepatitis C epidemic. Even the Centers for Disease Control and Prevention, in a 2003 report, recommend that "all prisoners be asked about hepatitis C risk factors, and that all prisoners who report hepatitis C risk factors be tested for hepatitis C antibodies."
Recommendations from the CDC are certainly influential, but are prison administrators ready and willing to confront this crisis? Displaying genuine interest in risk factors will, in all likelihood, encourage many prisoners to get tested, thereby removing any uncertainties about their status. This will undoubtedly prove beneficial, as those who are aware of their status are more likely to err on the side of caution, and some who test positive will seek treatment.
According to Dr. Anne S. DeGroot, Editor of HEPP News and author of HCV: The Correctional Conundrum, "Treatment of Hepatitis C (HCV) is emerging as the most controversial subject in correctional health care. Much of the controversy around HCV testing and treatment in corrections is related to delayed recognition of the important role incarcerated individuals play in the transmission of hepatitis in the communities after they are released. State and federal public health officials have been slow to recognize the potential benefits of screening, educating, and where possible, vaccinating incarcerated persons to prevent morbidity and mortality associated with viral hepatitis."
So the question becomes, is it preferable to let sleeping dogs lie because treating a large number of prisoners will be considered by some to entail a financial burden not worth undertaking? No matter what angle you view this problem from, it has to be dealt with sooner or later -- for example, while the person is incarcerated and more apt to adhere to the prescribed medication; or after the person is released and is more inclined to be apathetic to pursuing treatment.
Because tattooing in prison is in vogue, this practice is not likely to be halted. It can be curbed considerably, however, if this quandary is first acknowledged and a practical plan is implemented to increase awareness of the association between risky behaviors and blood-borne diseases. As Dr. DeGroot states further: "The lowest cost intervention for the prevention of hepatitis C infection is education." Or, if the gravity of this matter does not resonate with correctional officials, and with inmates who throw caution to the wind, then hepatitis C and other viral infections will continue to increase in prison -- and more prisoners will return home as potential new sources of disease transmission.
Ronald F. Day is a peer educator for the Prisoners for AIDS Counseling and Education (P.A.C.E.) Program at Eastern Correctional Facility in Napanoch, New York.