HIV and Viral Hepatitis in Corrections A Public Health Opportunity

Joseph A. Bick

Inmates are disproportionately impacted by communicable diseases such as HIV and viral hepatitis (Hammett et al., 2002, BOJ Statistics, 2002). Once incarcerated, the conditions that exist in most of the world's jails and prisons create an ideal environment for the transmission of contagious diseases. Overcrowded communal living environments, delays in medical treatment, insufficient access to clean laundry, soap, and water, and prohibitions against the use of harm reduction measures such as condoms and needle exchange increase the probability that infectious diseases will be transmitted from one inmate to another. The transient status of inmates who are frequently and often abruptly moved from one location to another complicates the diagnosis of infection, recognition of an outbreak, interruption of transmission, performance of a contact investigation, and eradication of disease.

While incarcerated, inmates interact with over 500,000 correctional employees and millions of annual visitors (Hammett et al., 2002). Most inmates are eventually released and return to their communities (Zack et al., 2000). Once released, former inmates often do not access health care, and frequently fail to continue treatments that have been initiated during their incarceration (Wohl et al., 2004, Springer et al., 2004). Many jails and prisons have insufficient information technology, and linkages between the different jurisdictions and agencies responsible for the care of inmates are often poor. Many correctional systems inadequately communicate with their public health counterparts in the free world, squandering opportunities for continuity of care.

Definitions

Jails: detention centers operated by city and country governments. Jails serve as detention centers for persons who are either awaiting trial or who have been sentenced to less than 1 year of incarceration.

Prisons: detention centers operated by state and federal governments. Prisons serve as detention centers for persons who have been sentenced to more than 1 year of incarceration.

Inmates: residents of jails and prisons

Prisoners: residents of prisons

Further complicating the appropriate management of contagious illnesses among the incarcerated is the high prevalence of comorbidities such as mental illness and substance abuse. Many inmates are distrustful of authority and reluctant to cooperate with health care providers. Fearful of adverse publicity, some jails and prisons have been slow to ask for assistance from outside agencies when faced with infectious disease outbreaks. Furthermore, published guidelines for diagnosis and treatment of communicable diseases are not always readily applicable to the correctional setting. All of these factors contribute to lost opportunities for diagnosis, treatment, prevention, immunization, and harm reduction education. Consequences include the development of preventable complications of untreated illness and missed opportunities for interrupting transmission of infection to the larger community.

In this chapter, I will explore the disproportionate impact of infectious diseases in jails and prisons on the health of the society at large, discuss some of the unique challenges and opportunities that exist in correctional public health, review the importance of enhanced interjurisdictional cooperation, and advocate for the creation of a more seamless system of health care for individuals as they move throughout the criminal justice system and return to the free world. Furthermore, I will address the importance of linking correctional health care with public health and community health providers, and argue for the importance of correctional settings as frontlines in our national strategies to reduce the prevalence of preventable diseases. These issues will be explored by discussing two illustrative diseases that significantly impact on the incarcerated: HIV and viral hepatitis.

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