By Abramsky, Sasha | The Nation, July 1, 2002 | Go to article overview
Save to active project


Abramsky, Sasha, The Nation

A report is sitting at the Justice Department, unpublished. It has been there for two years. Titled The Health Status of Soon-to-be-Released Inmates, it was compiled by experts who sat on three panels: one on communicable diseases, one on chronic diseases and a third on mental illness. Their findings are, to say the least, somewhat startling. Estimating that 11.5 million Americans cycle in and out of jail or prison each year (the great majority of them short-term jail inmates), the report suggests that more than 18 percent of hepatitis C virus (HCV) carriers in the country pass through the jail or prison system annually, as do 8 percent of those with HIV and one-third of those with active tuberculosis (TB). Six percent of incoming inmates, according to the report, show evidence of recent syphilis infection, 6 percent have chlamydia and up to 4 percent have gonorrhea. Experts believe that for these diseases, the infection rates (the number of cases per 100,000) among prisoners are upward of ten times those found in the American population as a whole.

"It's clearly a public health issue," says Ted Hammett of the Boston-based research group Abt Associates. "These people find themselves in prisons and jails; therefore there's a tremendous opportunity for intervention."

Intervening would be a smart economic move, too. In tandem with the medical report, economists affiliated with the Centers for Disease Control were commissioned to write three background papers positing economic models for treatment and screening protocols inside prisons. Although their data also remain unpublished, one of the authors, CDC health economist Dr. Beena Varghese, reports that their models predict that for such a disease as HIV, offering screening to an additional 10,000 inmates will likely detect fifty new cases; counseling those who test positive will, their model estimates, prevent the disease from being passed on to four more people than would be the case absent such a program. Since the additional screening and counseling (minus the fixed costs already incurred for starting up a blood-testing program) runs to approximately $125,000, while the cost of treating four more cases of HIV/AIDS over the patients' lifetime is estimated to be $800,000, Varghese's team believes such screening to be extremely cost-effective.

The economists also predicted that universal screening of inmates for STDs and treatment for those who test positive would curb transmission of diseases like syphilis when inmates return to the community and thus save the public health system tens of millions of dollars per year. "You get a bigger bang for the buck," says one doctor involved in compiling the report. "If there's only one in a thousand, it's not very cost-effective" to screen all inmates. "But if you have a prevalence rate of more than one in twenty and you're able to cure the disease, you have tremendous costs saved."

In response to these dramatic statistics, The Health Status of Soon-to-be-Released Inmates, according to those with access to its contents, recommends a massively expanded data collection system that would allow public health authorities to track and treat infectious diseases among this population group (that is, of cons and ex-cons) and their friends and lovers out in the community. It also endorses a policy of universal hepatitis B (HBV) immunization for incoming inmates--as a way to limit the amount of liver disease in an at-risk group already deeply vulnerable to the often-untreatable HCV. And it urges a far greater degree of coordination between correctional health systems and public health authorities, so as to provide continuous medical treatment and adherence to treatment regimens, for patients both inside jail or prison and those recently released.

In interviews, recently released inmates describe a patchwork health system with gaping holes. At the Fortune Society in New York, ex-inmates with HIV gather in peer education groups, where their stories reveal widely varying degrees of access to medical care.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Cite this article

Cited article

Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article



Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?