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Prisoners, Infectious Diseases and

Prisoners experience some of the same health-related conditions as the general population. However, the prevalence and incidence of certain infectious diseases are markedly higher among institutionalized offender populations. With the U.S. prison population now surpassing 2.2 million, the control and management of infectious disease has become a dominant concern for groups both inside prisons and in the community. This concern is driven by the fact that an overwhelming number of those incarcerated are from minority groups. Additionally, the National Commission on Correctional Health Care has identified communicable diseases and chronic diseases as priorities for correctional health care. Communicable diseases are diseases that can be transferred from one individual to another via direct or indirect contact. The communicable diseases of greatest concern for correctional populations are HIV/ AIDS, hepatitis B, hepatitis C, and tuberculosis.

HIV/AIDS

Human immunodeficiency virus (HIV) is the agent that causes acquired immunodeficiency syndrome (AIDS). HIV destroys white blood cells and attacks the immune system. According to the National Minority Aids Council, the incarceration of people of color has “created one of the major challenges in the HIV/AIDS epidemic for minority communities in the United States.” A quick glance at the national picture reveals that Blacks represent 49% and Hispanics/Latinos 18% of new HIV/AIDS cases. The Centers for Disease Control and Prevention also report that Black and Hispanic males are more likely to catch the virus through sexual contact with other men, injection drug use, and high-risk heterosexual conduct. Transmission of the virus to Black and Hispanic women often is a result of engaging in high-risk heterosexual contact and drug use.

While there is some variation in the percentages of people incarcerated who are positive for HIV/ AIDS, the data reveal that prisons are places where HIV/AIDS cases are highly concentrated. For example, according to Theodore Hammett and colleagues, 22% to 31% of people with HIV and 16% of those with AIDS have been incarcerated in state or local correctional facilities. Similarly, Cindy Weinbaum and colleagues report that 20% to 26% of HIV carriers have spent some time in a correctional facility. Nationally among the prison population, 51 out of every 10,000 inmates have been predicted to be HIV positive. Although the majority of inmates who test positive acquired the infection before being imprisoned, prison sex is an undeniable part of institutional life, and as a result inmates are at increased risk for acquiring the disease.

Hepatitis

Hepatitis is a viral infection that attacks the liver and often causes inflammation. Two types of hepatitis are common in correctional settings: hepatitis B (HBV) and hepatitis C (HCV). HBV, which is transmitted via high-risk behaviors such as intravenous drug use, tattooing, and sexual contact, causes lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. HCV is found in the blood of infected individuals and is transmitted via contact with the blood of an infected person. Whereas a vaccine is available to prevent HBV, there is no known cure for HCV. In states that test inmates for HCV, at least a third of the inmates test positive. Some estimates suggest that U.S. prisoners' rates of HCV are 9 to 10 times higher than among the general population. According to the National Commission on Correctional Health Care, approximately 2% of the inmate population is infected with HBV. Hammett and colleagues report that an estimated 29% to 43% of individuals diagnosed with HCV were incarcerated in the past year. In a related study, Weinbaum and colleagues report that approximately 12% to 15% of Americans diagnosed with chronic HBV infection and 39% of those with HCV infection can be found in correctional facilities.

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