HEPATITIS C SPREADS MOSTLY UNCHECKED IN PRISONS

SAN QUENTIN, Calif. (Reuters) - Hepatitis C, a silent killer that attacks
the liver, is rampant among the almost two million inmates of U.S. prisons
and jails but authorities are making only half-hearted efforts to combat
it, medical and prison experts say.

"The prevalence of this disease is believed to be 30 to 40 percent of the
prison population, depending on the state," said Anne Degroot, a doctor who
treats AIDS and hepatitis patients in the Connecticut prison system and
heads a prison health education project at Brown University in Providence,
Rhode Island.

Hepatitis C is a virus spread through contact with human blood and is
rarely transmitted sexually. It can lead to life-threatening liver damage
by scarring the liver (also called cirrhosis), liver cancer or liver
failure. Fewer than half of those treated are cured. There is no vaccine.

The disease is particularly prevalent among intravenous drug users. For
example, in Baltimore 90 percent of those seeking treatment for heroin
addiction are infected.

In total, more than 4 million Americans have been exposed to the disease,
of whom up to 15 percent can expect to become seriously ill in the next 20
years, according to David Thomas of Johns Hopkins University Hospital.
Carriers often have no symptoms.

Most state prison systems do not require testing of inmates. In many
systems, testing is voluntary and in a few it is non-existent. Prison
activists charge that prison authorities do not want to know if inmates are
infected because once they do know they are obliged to offer costly treatment.

Diagnosis may involve giving patients liver biopsies to determine how far
the disease has progressed. Drug treatment can cost up to $12,000 a year
for each patient. In some advanced cases, the only treatment may be liver
transplants.

"The incarcerated population is the only population in this country that
has a constitutional right to health care," said Barry Zack of Centerforce
Inc, a non-profit organization that offers HIV and hepatitis education to
inmates of California's San Quentin state prison.

"If they find something, they have to treat it at the same standard as that
which prevails in the outside community. The implications are enormous.
People used to think that treating prisoners with HIV would break the bank.
That's nothing compared to what treating hepatitis C would do," he said.

Incidence of HIV among the prison population, although much higher than in
the community at large, is still relatively low. A 1997 Justice Department
report estimated that 2.3 percent of state and federal prison inmates --
just under 25,000 individuals -- were HIV positive.

For those who are infected with both HIV and hepatitis C, the prospects are
grim.

Hep C Expensive To Diagnose, Treat

Ted Hammett of Abt Associates, a research and consultancy company in
Cambridge, Mass, conducted a study for the Texas prison system which
concluded it would cost $40 million a year to diagnose and treat prisoners
for hepatitis C in that state.

"A lot of states are really gun shy about the cost issue for pretty obvious
reasons," he said.

Prisoners are San Quentin are told about AIDS and hepatitis C as they enter
the prison and are urged not to do things that could put them at risk,
including tattooing, body piercing, fighting, sharing razors, sharing
needles and engaging in homosexual sex. Prison rape puts inmates at
additional risk.

At one briefing for newly admitted prisoners this week, John Romain, a peer
counselor serving three years for drug possession, did not mince his words.

"Since I've been in this institution, quite a few fellows have died of Hep
C. Don't share needles, don't do tattoos, don't share needles with nobody,
don't share cotton balls, don't share water, don't share toothbrushes,
don't share nothing with no one," he said.

Judy Greenspan of California Prison Focus, a grass-roots advocacy group,
said San Quentin was the exception in the state prison system. Other
facilities offered little or no health screening and education to inmates.

"Even if prisoners were tested, they were not always told the results. We
have people who have gotten sick and gone back to their medical records and
found they tested positive in prison years ago. By that time, it's too
late," she said.

Phyllis Beck, director of a hepatitis C awareness project in Oregon, said
hundreds of inmates within that state's prison system desperately needed
treatment but only a handful were receiving it.

"We are seeing more and more inmates who are being released with cirrhosis
or close to cirrhosis due to a lack of follow-up care after a positive
diagnosis has been made," she said.

Oregon started counseling prisoners about hepatitis C only last year. Of
the state's 9,600 inmates, 937 requested a test of whom 339 tested
positive. Four liver biopsies have been conducted and 9 more prisoners are
in the process of work-ups.

Degroot, who has seen two of her patients die in prison, said treatment
would be highly cost effective for U.S. society despite the high price tag.

"If we treat these people, nearly all of whom will be returning to the
community, we can avert public health expenditures down the road to the
tune of billions of dollars," she said.

"If we aggressively treat in the prison system, we could avoid 30 percent
of the liver transplants that will otherwise be needed," Degroot said.