PRISONS HIT HARD BY HEPATITIS C

As prison officials struggle to treat an infection growing to epidemic
levels in prisons here and across the country, a state battle is growing
over who's going to pay the bill. The hepatitis C virus, which infects
about 170 million people worldwide and more than 4 million nationally,
disproportionately affects prisoners, whose lifestyles are prime incubators
for the virus.

The blood-borne disease can destroy a person's liver and lead to death.
Shooting up drugs with tainted needles, snorting drugs with contaminated
straws, tattooing and body piercing with shared equipment, and to a certain
extent, having unprotected sex with multiple partners are high-risk
activities that doctors say contribute to the virus' spreading.

An estimated 1.4 million hepatitis C-infected prisoners pass through the
nation's correctional facilities each year. Of Arizona's 26,800 inmates in
the prison system, an estimated 6,000 have hepatitis C. Of those, an
estimated 700 to 1,000 meet criteria making them eligible for treatment,
according to prison doctors. And the testing, monitoring and treatment for
hepatitis C will cost a lot of money.

The Arizona Department of Corrections asked the state for $10 million for
fiscal 2002 and $5.9 million for fiscal 2003. Gov. Jane Hull settled on $5
million for fiscal 2003 and included that money in her proposed budget. But
Senate Appropriations Chairwoman Ruth Solomon, D-Tucson, said the
Legislature will not include that money in its budget, although she
acknowledges that the prisoners must still receive treatment. "The fact is,
we have a lot of health care needs in the state," Solomon said. "And we
believe they (Corrections Department) have a somewhat generous budget, and
they can use that to treat the inmates." Dr. Thomas Lutz, deputy director
of health services for the department, disagrees. "We don't have the money
within the Arizona Department of Corrections to have ongoing treatment,"
Lutz said. If the department doesn't get the money from the state, it will
have to pull the money from some other place, such as the department's
operating budget, he said. "Prison care overall is not a cheap affair,"
Lutz said. Hepatitis C treatments cost the department anywhere from $8,700
to $16,200 per eligible inmate.

Texas estimated that if it were to treat all of its 15,000 inmates infected
with the virus, the cost would surpass the correctional system's entire
health care budget. Francie Noyes, the governor's spokeswoman, said the
governor intends to defend her request for the $5 million for treatment.
Hepatitis C infections are multiplying in prisons beyond the United States.
In Australia, 40 percent of the inmates entering the system have the
disease, and a third of Russia's prisoners suffer from it. Other U.S.
states report high rates of infected prisoners: Texas, almost 30 percent;
California, 41 percent; Connecticut, 32 percent; Virginia, 30 to 40
percent; Maryland 38 percent. Few other states have appropriated money for
treating the virus, although more are discussing the virus and its cost.
But eventually, the states may end up paying to treat the disease, whether
they want to or not. The Centers for Disease Control and Prevention in
Atlanta plans this spring to begin developing recommendations for
guidelines to manage the virus in correctional settings. Although the most
common method of acquiring the virus until 1992 was blood transfusions,
today 60 percent of the hepatitis C infections are attributed to injecting
drugs. Tattooing or body piercing persists, despite prison rules, Lutz
said. Prisoners "make their own tattoo apparatus and do their own
tattooing, and there is nowhere for them to sterilize it, so they end up
sharing the same needle," he said. He said hypodermic needles are smuggled
into prisons and are shared by some inmates, thus adding to the numbers of
infected inmates.

Sharing razors and toothbrushes also can spread the virus. Treatment isn't
assured.

Some people who acquire the virus may never know it. Lutz said the prison
system doesn't test everybody for hepatitis C. Those whose blood tests show
abnormal liver functions are tested for the virus, and every prisoner in
the system receives a blood screening test at some time, Lutz said.
Prisoners who use of drugs or alcohol are excluded from treatment. Lutz
said some patients decline treatment because of the side effects of the
medicine.

Some people get better with no intervention by doctors. Donna Hamm,
director of Tempe-based Middle Ground Prison Reform, a prison rights
advocacy organization, said prisons should take stronger steps to prevent
the spread of the disease. "If they (prison officials) don't acknowledge
the needles need to be cleaned or clean needles passed out, it is a way of
pretending there is no problem," she said. Hamm said she has gotten letters
from inmates who have been diagnosed with the hepatitis C virus and worry
they will not receive treatment until the disease progresses. Other
prisoners have expressed concern about catching the disease from cellmates
who have advanced cases of the virus. Dr. Thomas Boyer, director of the
University of Arizona Liver Research Institute, said hepatitis C is not a
rapidly spreading disease. Although he understands budgetary restraints, he
said the state is in a pay-now or pay-later situation.

Hepatitis C has become the major reason people need liver transplants, he
said. "What happens to these people when they get out of jail and get sick
and come into the health care system?" Boyer asked. "Someone has to take
care of them." That someone will likely be the government, Boyer said.