Hepatitis C Virus Infection
among Incarcerated Women
GRACE E. MACALINO
Given the overlap of hepatitis C-infected and incarcerated populations, it is difficult to discuss either one without mention of the other. The inmate population is distinct in that it consists of individuals with greater risk factors for contracting blood-borne infections such as the hepatitis C virus (HCV) compared to the general population. Such characteristics include drug use, and in particular injection drug use, as well as commercial sex work (Butler, Spencer, et al. 1999). Although female inmates comprise a much smaller segment of the incarcerated population compared to males, they may actually represent an incarcerated population with higher risk of contracting HCV. Courts have traditionally been relatively lenient on women for their early criminal offenses; when women reach the point of detention, they are often incarcerated for much more serious crimes and usually represent a higher-risk population as compared to men.
It is estimated that in 1997, 29 to 43 percent of inmates in the United States were infected with HCV (Hammett, Harmon, and Rhodes 2002). Thus, not only do jails and prisons house individuals with high-risk behaviors for HCV, they are also a reservoir of infection, primarily attributed to risk behaviors that occurred before incarceration (Anda et al. 1985).
This chapter will provide HCV prevalence and incidence estimates among correctional and community populations, an overview of HCV natural history, and methods for the screening, diagnosis, treatment, and prevention of HCV among correctional populations. In addition, it will highlight reasons why this is a pressing health concern for incarcerated individuals, particularly among women.
Hepatitis C is primarily transmitted parenterally—through percutaneous exposure to HCV-contaminated blood. The primary mode of HCV transmission in the