Hepatitis C is Common in Prisons, but Treatment Is Rare

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From The Body: The Complete HIV/AIDS Resource:

For many years, people with HIV and their advocates fought to increase HIV testing and treatment for prisoners. Over time, access to testing and treatment has improved, though problems remain. For example, very few jails or prisons make condoms available as an HIV-prevention tool.

Although U.S. prisons now offer routine screenings for HIV, they do not for hepatitis C, meaning that people may unknowingly live with, spread or be exposed to the virus for years. Similar to their historical neglect of HIV treatment, prison officials often balk at treating hepatitis C. Given that the new HCV drugs cost six to eight times more than interferon, the likelihood of prisoners receiving effective treatment has become even more elusive.

In Oklahoma, which has the nation’s highest female incarceration rate, Gillian (not her real name) was excited to learn that prisons were administering the new HCV treatment. Her hopes were dashed, however, when the prison’s doctor told her that she was ineligible. “I’m not surprised because the new treatment is very expensive,” she wrote. In California, only 146 (less than 1%) of the 17,405 state prisoners diagnosed with hepatitis C are receiving the new treatment.

Abu-Jamal is not the only person heading to court to gain access to medical care. In May 2015, the International Humanitarian Law Institute filed suit on behalf of two men incarcerated in Minnesota, claiming that the prison’s denial of HCV treatment is “in deliberate indifference to their serious medical needs.” Minnesota prisons offer routine screenings for HIV, but not for HCV. Furthermore, its prisons offer no hepatitis C treatment until a person displays symptoms of fibrosis, cirrhosis or liver failure. Once symptoms manifest, the only treatment available is the 48-week, less-effective interferon-based regimen. The suit is seeking class-action status, which could affect the approximately 1,350 prisoners already diagnosed with HCV, as well as those who are infected but were never tested or were never told the results of their tests.

In June 2015, Prisoners’ Legal Services filed a lawsuit on behalf of two Massachusetts prisoners who have been denied treatment. Of the state’s more than 1500 prisoners with hepatitis C, only three are currently receiving treatment. That same month, three Pennsylvania prisoners filed a class-action lawsuit, charging that denial of HCV treatment violates their Eighth Amendment rights.

Despite the high cost of HCV treatment, some prison systems are offering the new drugs to a limited number of people. The Bureau of Prisons (BOP), which oversees the federal prison system and its over 200,000 people, is receiving a 44% discount on the new drugs, enabling it to make treatment available for some. However, the BOP does not automatically test new arrivals for HCV; instead, its policy guidelines recommend testing for sentenced prisoners with HCV risk factors, all prisoners with certain clinical conditions and those who request testing.

New York State is also approving the new drugs in certain cases. In 2009, New York passed legislation requiring the Department of Health to annually review HIV and hepatitis C care in state prisons, publicly report its findings and mandate improvements so that prison health care mirrors community standards. According to Jack Beck of the Correctional Association of New York, which monitors prison conditions, New York offers treatment at a much higher rate than other states. However, he notes that screenings are limited to people born between 1945 and 1965 and those who meet certain risk factors. “But being in prison is a risk factor,” he points out. “If you already know that 17 percent of the population has Hepatitis C, you should test everyone.”

Read the full article by Vikki Law here.