Invisible Disease

Hep Talk by Larry Buhl

Organizations shine a light on HCV in jails and prisons

The percentage of people chronically infected with hepatitis C (HCV) in jails, prisons, and other correctional facilities is between fifteen and thirty percent, according to latest estimates—now more than ten years old—by the CDC. Why the wide window? Because testing among this population is sporadic, underscoring a larger problem: HCV, the silent killer, is doubly silent in prisons and jails where stigma about the disease, lack of education and outreach, and nonexistent national funding have driven the disease underground.

Even if the true percentage of inmates carrying the hepatitis C virus is at the low end of the CDC range, it’s still more than five times higher than the rate of HCV in the general population. That’s a problem for the general population, too: When these prisoners are released, they will be carriers and can present an expensive burden on the healthcare system.

“It’s a given that HCV in prisons and jails is widespread, but from the facilities’ point of view, there’s no point testing inmates, because if they’re positive, there’s no money to pay for treatment,” says Cajetan Luna, executive director of the Center for Health Justice, an organization that educates imprisoned people in the Los Angeles County Jail System about healthier lifestyle choices.

Whereas HIV education and outreach is well-funded, thanks to national programs, the available money for similar HCV outreach, prevention and treatment is minuscule by comparison. “There’s no national program for hepatitis, no ADAP to get hep C drugs and treatment covered,” says Luna, whose organization piggybacks its HCV outreach efforts on its HIV program.

Not only is money a problem in educating this population, it’s also a problem in treating it. When there is funding for treatment, assuming an inmate has been tested, the facility will make a cost-benefit analysis to determine who gets the meds, according to Rich Feffer, a program coordinator who runs an outreach program for those in prisons and jails, at the Seattle-based Hepatitis Education Project. “They won’t treat those who will be released before treatment is through, and they generally won’t treat inmates unless the disease has progressed to the point where it’s already damaging the liver,” Feffer says.

Through a grant from the state of Washington, the Project has been teaching classes on HCV prevention and treatment options for almost ten years. Washington is an anomaly in setting aside money for statewide education and outreach. There’s no national policy for testing and treatment of HCV in prisons, so the decisions are left to the states on how to deal with the problem—and, more often, individual counties and the public and private correctional facilities—creating a haphazard quilt of care, with huge holes. As a result, up to eighty percent of those with chronic HCV infection in prisons and jails are undiagnosed, Feffer estimates. There’s no clear consensus on when to test in prisons, and whether to test, or on when to start treatment, or whether to start treatment, and in most cases, there’s little or no money for any of it.

The Hepatitis Education Project and the Center for Health Justice are two of a dozen organizations that have joined to form a national network to find ways of increasing access and availability of HCV information for prisoners and families. The network is so new it doesn’t yet have a name. Feffer says that, though the network has the potential of sharing valuable information and maximizing limited resources, it won’t be enough to fully address the problem.

For more information about these two organizations, visit: and

Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His young adult novel, The Genius of Little Things, debuted in January 2013. His comic mystery novel, We’re Here to Help, will be available later in 2013.

Read the article in the April 2013 digital issue by clicking here.