Hepatitis C Rates in Imprisoned Persons

Hepatitis C virus (HCV) causes liver damage. It spreads through infected blood and is sometimes called a “silent” infection. That is because you can have HCV for years without symptoms. It also means you can spread HCV unknowingly. Treatment is available, but untreated HCV can scar the liver (cirrhosis), and cause liver cancer or liver failure over time.¹

One of the risk factors for HCV is being in prison. Many imprisoned people have HCV. Risky behaviors common in prisons may cause higher rates of HCV. But improving screening for HCV and starting treatment in prison will help lower HCV rates.¹

How many imprisoned people have HCV?

It is hard to get an accurate number. This is due to poor screening practices in correctional facilities. The following HCV rates have been reported:^2-4

• 1990s – between 12 and 35 percent
• 2003 to 2010 – 23.3 percent
• 2015 – 18 percent
• 2009 to 2018 – 15.1 percent

States and correctional facilities have different screening processes. This allows HCV to go undiagnosed. Only 13 states have good screening protocols. Their data shows that between 9.7 and 39.7 percent of imprisoned people have HCV.^2,3

All studies show that imprisoned people have a higher rate of HCV infection than the public. Only 1 to 2 percent of the general public has HCV.^2-4

Why is the HCV rate so high?

Risky behaviors raise the risk of HCV. Injecting drugs raises your risk by 24 times. Other behaviors that raise the risk of getting HCV are:^3,4

• Reusing tattoo needles
• Unprotected sex
• Sex with many partners
• Alcoholism

Do correctional facilities treat HCV?

A survey of correctional facility directors in 41 states found that only 949 out of 106,266 people (0.89 percent) with HCV were treated. Many reasons have been given as to why this number is low.⁵

HCV treatment in jail

Jails house people for an average of 25 days. HCV antiviral treatment lasts up to 12 weeks, so many people in jail do not get treated. A study of 104 jailed people – 62 on treatment when they entered jail and 42 who started treatment while in jail – found that over 90 percent of the people had undetectable viral loads upon follow-up. This shows that jail-initiated HCV treatment can work.⁵

HCV treatment in prison

The average prison stay is over one year. HCV treatment can be completed in prison. Yet, many people do not get or complete treatment. Reasons include:^2,3,5

• Poor screening – HCV cannot be identified or treated without consistent screening.
• The course of the disease – Because HCV progresses slowly, prisons may defer treatment if the person is close to release.
• Medical history – Prisons prioritize those with bad liver problems. Those with mild HCV or a history of injecting drugs may not get treated.
• Staffing – Shortages of trained medical staff hinder treatment.
• Cost – Costly 12-week antivirals hinder treatment.
• Transfers and releases – A study showed HVC cure rates fell 15 percent if prisoners were transferred and 29 percent if they were released.
• Refusal – Many prisoners decline treatment.

Delays in treatment can be harmful. If an untreated person gets cirrhosis, it can cause complications or death.²

In-house treatment can work

Completing a full course of antiviral drugs has been shown to reach a 90 percent cure rate. The structure of prison routine and strict monitoring will raise the likelihood of treatment completion if it is started in-house. Since 95 percent of prisoners are released, treatment while imprisoned, would lower community spread.³

You can get reinfected with HCV. Released prisoners who inject drugs are at risk. Providing education and resources for released prisoners to help them stay drug-free would lessen the chance of reinfection.²

Changes in screening could raise treatment rates

Using opt-out screening could help find and treat HCV cases in prisoners. Opt-out screening means that everyone entering prison would be tested unless they declined. A computer simulation showed that opt-out screening in prisons could stop:³

• 11,700 liver-related deaths
• 7,300 cases of cirrhosis
• 900 liver transplants

Correctional facilities could strengthen screening procedures. This would identify new cases. If treatment is started, that could also lower HCV rates. Correctional facilities and doctors in the community can partner to ensure that released prisoners stay healthy and complete treatment.