North Dakota Tackles Hepatitis C in Prisons
RENEE MONTAGNE, host:
The virus hepatitis C is often called the silent disease; that's because a large number of infected people don't even know they have it, something especially true in prisons, where the infection is more prevalent. Inmates across the country have filed lawsuits accusing prison systems of failing to treat them. In North Dakota, all new inmates are screened for the disease in what officials call a huge public health initiative.
NPR's Cheryl Corley reports.
CHERYL CORLEY: North Dakota's prison system is small, with more than 1,400 inmates. The prisoners have a nickname for the main facility in Bismarck; it's called Camp Snoopy. There's not a lot of trouble here, but there is overcrowding caused in part by the state's surge in methamphetamine users. Staff physician John Hagan says there are many more drug abusers who may have used infected needles in North Dakota's prisons now, and more Hepatitis C - about 10 to 15 percent of the state's inmate population.
Dr. JOHN HAGAN (North Dakota State Penitentiary): Injection of drugs is far and away the number one way this transmits. And then also here culturally when folks are in prison, there's a lot of body art, a lot of tattooing, a lot of body piercing. And it really is a way to express yourself in a place where you can't express yourself.
WILSON: New inmates here go through a four-week orientation process. One of the activities calls for them to watch a video about how to avoid hepatitis C. Then, every Monday, Nurse Ginny Althoff walks through the prison gates and heads for a clinic area. She's responsible for drawing blood from new arrivals to see if they have HIV or hepatitis C.
Ms. GINNY ALTHOFF (Nurse): I got a list of about 12 guys that I need to draw blood on.
CORLEY: In the clinic, Althoff lines up alcohol swabs, needles, gauze and a small crate of blood collection tubes. Each have the name and birthdates of a prisoner on them.
Ms. ALTHOFF: All right. I think we can have one guy out here...
CORLEY: Some of the men lining up to get their blood drawn are here for violating their probation, some for meth possession. Twenty-one-year-old Sean Barnett(ph) has seven tattoos; one has a cross with a ribbon wrapped around it. He says tattoos were a major topic in the orientation video.
Mr. SEAN BARNETT (Inmate): Yeah, and they give us a big speech to not get tattoos in here.
CORLEY: As Althoff places a Band-Aid on Barnett's arm, she offers a bit of jailhouse advice.
Ms. ALTOFF: You know, you're not supposed to be using anybody else's shave - razor, right?
Mr. BARNETT: Yeah, the razors...
Ms. ALTOFF: Yeah, no jailhouse tats, as they say. Right?
Mr. BARNETT: Toothbrush. What is it, toothbrushes?
Ms. ALTOFF: Toothbrushes too, yeah. You bet.
CORLEY: Hepatitis C can be a chronic disease that affects the liver after many years of infection. National health surveys estimated about three million people suffer from it. Without treatment, close to one in four will get cirrhosis of the liver. Although the infection has declined rapidly in recent years, it often goes undiagnosed because there are no symptoms.
Dr. Cindy Weinbaum with the Centers for Disease Control says as much as 35 percent of the nation's inmate population has the virus. Still, she's not ready to call that a crisis.
Dr. CINDY WEINBAUM (CDC): Hepatitis C doesn't seem to be frequently transmitted within the prison setting. It's more so that individuals who are at risk for hepatitis C, generally through their injection drug use, end up in prison much of the time. So prison is an opportunity for identifying infected people and evaluating them for medical treatment.
CORLEY: Even though the CDC does not recommend that all inmates be tested, and only suggests that states ask its prisoners questions like whether they shoot drugs. Costs for medicine, as high as $40,000, remains a big obstacle to treatment, which takes about a year. There's also controversy over their effectiveness.
Jackie Walker with the ACLU's National Prison Project says very few inmates are treated at all. And lawsuits have been filed against prison systems from New Jersey to Oregon.
Ms. JACKIE WALKER (ACLU): Everything from trying to just get information about their diagnosis to receiving their new diagnosis late, to having problems receiving a liver biopsy to just not being able to have treatment because of their classification level or their length of sentence or, you know, other non-medical factors.
CORLEY: North Dakota's warden, Tim Schuetzle, says states give medicine to inmates who will remain in their custody to make sure they follow the medication regimen, and limits are necessary to control what could become skyrocketing medical cost. Even so, he believes screening inmates for hepatitis C is crucial.
Mr. TIM SCHUETZLE (Warden, North Dakota State Prison): Those people are going to be going out, and if we don't do anything to educate them when they go out and they know they're hep C positive and they're sharing needles anyway, or if they don't and they share needles, that's a real public health risk.
CORLEY: A risk that Schuetzle says North Dakota couldn't afford to ignore.
Cheryl Corley, NPR News.
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