Nationally, the prevalence of HIV, hepatitis C virus, and HIV-HCV coinfection is disproportionately higher within the confines of prisons and correctional facilities than it is 'on the streets,' as prisoners say. But what is being done to educate and treat this largely forgotten people who were sentenced to lose their freedoms but not their access to health care? Unfortunately, not nearly enough. [Also see 'Help for Hep C?' in this issue.]
Too often people adopt an 'out of sight, out of mind' attitude toward people serving time. And yet it is estimated that at least 85% of prisoners will eventually return to their communities. Because harm reduction methods such as access to sterile syringes, bleach, and even condoms is prohibited in all but a few correctional facilities, prisons can be a breeding ground for infectious diseases. Without proper education and treatment we run the risk of releasing a huge number of infected individuals back into the world. Thus the out-of-sight, out-of-mind attitude has become a community health issue that must be addressed where medical services are available.
Worse yet is the attitude of 'they don't deserve treatment.' Surprisingly enough, this has proved to be the mind-set of far too many prison health care providers and members of prison administrations.
Lack of funding complicates these issues, forcing some prison health care workers to make difficult decisions regarding which illnesses will be treated and which must be ignored. Prisoners entering the system already diagnosed with HIV, hepatitis C, or both often find that their treatment regimens are changed to antiquated, less expensive therapies or are discontinued altogether. Prisoners at a high risk of infection who request to be tested are blatantly ignored. And because of a lack of education, many infected prisoners do not have the knowledge to recognize their risk factors and seek out counseling and testing.
The horror stories are many within the walls of our prisons. Denied access to even the most basic anti-HIV medications, my friend Tony was left to die in the prison infirmary, shunned by staff and peers. Tony wasn't even allowed an extra pillow to keep him comfortable, and this was his only request. A compassionate-release petition for terminally ill prisoners was denied, even though Tony had only eight months left to serve.
In Oregon and elsewhere, grassroots organizations like the Hepatitis C Awareness Project are working hard to put an end to such horror stories. Acting as a voice for this overlooked and often ignored population, volunteers at HCAP raise awareness about the growing HIV-HCV epidemic inside our nation's prisons in a variety of ways. Giving testimony to lawmakers, working with prison officials, and even going into the prisons to offer support are but a few of the ways in which individuals like Phyllis Beck, founder and director of HCAP, have already made significant changes in the prison health care system.
But we must educate the incarcerated as well, through efforts such as HCAP's bimonthly newsletter, sent to more than 4,000 prisoners nationwide. By giving prisoners the knowledge they need to have an active voice in their own health care, we can start to make fundamental changes in the way diseases like hepatitis and HIV are treated'and prevented'in our prison systems. As these incarcerated men and women eventually return to their communities, these changes will ultimately benefit us all.
White, who is HIV- and HCV-positive, used to be an inmate at the Oregon State Penitentiary and is currently a prisoner advocate for HCAP. He also is executive director of HIV+ Hope Behind Bars, a Salem, Ore.-based organization that provides a bimonthly treatment information newsletter to HIV-positive prisoners.
