Hepatitis C and HIV One of the few states to openly acknowledge this pending financial disaster, and to do something about it, is North Dakota. State medical director Kathleen Bachmeier instituted 100% HCV screening after a methamphetamine epidemic tripled her state's prison population and brought with it high rates of HCV infection. As a public health initiative, North Dakota seeks out and treats those who are deemed medically treatable and who agree to stop using drugs. At least ten states, including Texas, have implemented mandatory HIV screening for all prisoners. [See: PLN, March 2007, p.40]. Alabama and Missouri test prisoners when they both enter and exit the prison system. A federal bill, the “Stop AIDS in Prison Act” (H.R. 1943), introduced by Rep. Maxine Waters in April 2007, would require mandatory HIV testing for federal prisoners. The bill is presently in a subcommittee where hearings were held on May 22. Still, treatment for infected prisoners, as opposed to testing, remains the exception rather than the rule. Fewer than 10% of prisoners who know they have HCV receive treatment. In many states where litigation has forced treatment programs, the combination of waiting lists, delays in liver biopsies, onerous “pre-conditions” (e.g., attending drug counselling for one year first) and minimum remaining-length-of-stay restrictions have effectively denied treatment to most HCV-afflicted prisoners, or have delayed it until they are released on parole or are too sick to respond to treatment. The latter result is doubly damning, because treatment is denied until the patient is sicker and then released back into the community with an advanced stage of the disease. Most prisoners have no private health insurance, and the public healthcare budget can't handle the burden that results from thousands of infected ex-cons. Other countries faced with HCV prison epidemics have taken a strong position in favor of treatment. In June 2007, the High Court of Sindh in Pakistan directed the superintendent of the Central Prison Khairpur to expedite the medical treatment of over 100 prisoners with Hepatitis B and C. The Pakistani high court noted that “a prisoner does not shed his basic rights at the prison gate and as long as he is in custody, his health and well being are the responsibility of the state.” Few prison authorities in the United States seem to share the same view in regard to HCV treatment. The future looks bleak. HCV is already the most common disease of its type in America, and is becoming more entrenched as intravenous drug use grows. The place to interdict this disease with aggressive treatment is in the nation's jails and prisons, where it can be readily screened, since fewer than half of those who carry HCV even know they are infected. While one in five people with HCV will clear the disease out of their system naturally, the other four will go on “if untreated” to develop terminal liver disease within 20 years. 13,000 people died of HCV in 2000 and 39,000 with the disease are predicted to die in 2030. 375,000 HCV victims will suffer disabling cirrhosis of the liver by 2015. Although $1 billion is spent annually treating HCV in the United States, that is a miniscule amount compared to the future costs if containment of HCV in prisons and jails is not implemented nationwide. In some recent cases litigation has forced prison officials to address the issue of HCV treatment. On June 4, 2007, the Supreme Court ordered the reconsideration of a lawsuit filed by Colorado prisoner William Erickson after his HCV treatment protocol was stopped by prison officials due to a disciplinary matter related to a missing syringe. The Court did not address Erickson's treatment claim on the merits, but remanded the case on procedural grounds after finding that he had alleged sufficient injury (the termination of his HCV treatment) to sustain the suit. See: Erickson v. Pardus, 127 S.Ct. 2197 (2007). The previous month, in March 2007, Delaware prisoner Richard Mark Turner won a pro se lawsuit “on a summary judgment motion” against Correctional Medical Services (CMS), in which he alleged deficient medical care related to his HCV treatment. Turner claimed that CMS employees had failed to properly train him to inject himself with Interferon, an HCV medication; the judge found that he had received “obviously inadequate” care and ruled in his favor. The issue of damages has not yet been decided. See: Turner v. CMS, USDC DE, Case No. 1:03-cv-00048-SLR. And on February 27, 2007, New Jersey's Supreme Court ordered the Department of Corrections to notify prisoners of any serious medical conditions requiring treatment, to allow prisoners access to their medical records, and to enact regulations that addressed the Department's responsibility for prisoners' health. The ruling resulted from a lawsuit filed by a prisoner identified only as “J.D.A.” who had HCV but whose prison medical records incorrectly indicated he had tested negative for the disease. It took four years for the records to be corrected, during which time he received no treatment. This delay and incompetence led the Court to criticize the DOC's “refusal to acknowledge until the eleventh hour its ultimate responsibility for inmate medical care and record keeping “. See: J.D.A. v. New Jersey DOC, 189 N.J. 413, 915 A.2d 1041 (N.J. 2007). The American Friends Service Committee has an aggressive on-going HCV education program for prisoners, but public health money is sorely needed to treat those already infected. Advocacy and educational materials regarding Hepatitis C are available from the National HCV Prison Coalition, P.O. Box 41803, Eugene, OR 87404; (541) 607-5725, www.hcvinprison.org. Information about HIV treatment and related issues in a prison setting is available at The Body website: www.thebody.com/index/whatis/prison.html and PLN also distributes the book Hepatitis and Liver Disease: What You Need to Know, details in the book order section of this issue.