Prison outbreak: an epidemic of hepatitis C.

• Author: Wright, Kai

Rodger Anstett's death in 2003 was either sudden nor inevitable. The symptoms started back in 1998: the abdominal pain around his kidneys and liver, the achy joints, the debilitating fatigue. Blood tests later that year showed that his liver enzymes were far above normal--one of them was eight times higher than it should have been. It all pointed to advanced hepatitis C infection, but Anstett's doctor waited another two full years before giving him a test to confirm the presence of the disease. It was another year before the doctors for Oregon's corrections system, where Anstett had been locked up for twelve years, treated him, just a month before his release. At that point, his liver was far too damaged for the drugs to do much good, and he died a year and a half later.

Thousands of hepatitis C-positive prisoners around the country are today facing Anstett's dilemma--barreling towards a preventable death because they are at the mercy of corrections health systems that are refusing to treat them. Moreover, say an increasing number of public health watchers, the unchecked hepatitis C epidemic inside the nation's prisons is undermining efforts to bring it under control in the broader community.

"No matter what you're in prison for," says Rodney Anstett, who watched his brother Rodger wither away from liver failure, "you deserve basic human rights." Rodger was the lead plaintiff in a lawsuit making just that assertion. Two days before his death, Anstett recorded a deposition for a case that would be the first successful class-action challenge to a state prison system's hepatitis C treatment policies. Last year, the state settled the suit, agreeing to open up treatment, and a federal judge is now monitoring its compliance with that settlement.

But Oregon's case is unique only in that the courts have intervened. Hepatitis C infection rates in some incarcerated populations are as high as 42 percent, according to an article in the Clinical Infectious Diseases journal, and anywhere from 15 to 30 percent of all prisoners are believed to carry the blood-borne virus. More precise counts are unavailable because few systems have come up with effective ways to screen for it-indeed, few even tried until federal health officials prodded them into action in recent years.

"Most prison systems are purposely not testing for hep C," charges civil rights lawyer Michelle Burrows, who led the Oregon lawsuit, "so they can say 'we don't know who's got it,' and don't have to treat it."

Science didn't identify hepatitis C until 1989, and it has been overshadowed by its more prominent viral sister, HIV. But the U.S. Centers for Disease Control and Prevention (CDC) estimates at least three million people nationwide now have chronic hepatitis C infections-triple the HIV caseload. Most are injection drug users, since unlike HIV the hepatitis C virus spreads less easily through sex than through direct blood-to-blood contact--which explains the epidemic's intensity among people who cycle through prison.

Hepatitis C is emerging as a leading cause of death in...