Contemporary Issues: Infectious Diseases among Inmate Populations

Infectious disease is any disease that is able to spread among our public and contained population, thus being called infectious. An infectious disease travels through the environment, as it passes from one person to another through means of airborne, droplets, contaminated water, clothes, bedding, utensils or anything that has come in contact with an infected person. Diseases spread as the result of direct personal contact with bacteria. The most pressing issue that our prisons face when dealing with communicable disease is population density.

Inmates are living most of their days in eight by eight cells that would normally accommodate one person, and are sharing it with two or more additional inmates. This creates an environment where a disease can easily be transmitted from one person to another in a short period of time. With the prison systems revolving door of inmates every year, it is not easy to provide a detailed medical screen for every intake. The amount of inmates coming in and their lack of screening together creates an enviroment through which disease can be introduced into the population.

Many inmates didn’t have or could not afford health insurance, and were unaware they had a disease, or were unable to afford treatment. So many inmates come through intake, and are unaware that they carry HIV, Hepatitis C, and other diseases, and are under the assumption that their initial health screen will detect the disease. This is simply a lack of knowledge, and lack of personal care before becoming incarcerated. Inmates think that they are in a disease screened environment, and still other will unknowingly carry the disease and possibly spread it because they are unaware they had it.

Initial screenings may only test for diseases such as hepatitis C, and only certain diseases such as HIV will require a follow up visit, others just assume no news is good news and think everything came out fine. Prisons and houses of incarceration were developed and then combined in the 18th century in England and France. The penitentiary system was then developed in the 19th century in America. Prisons became a breeding ground for epidemical diseases that decimated the inmates. Because

people were uneducated about communicable diseases and the make-up of microbial etiologies of transmissible diseases, the epidemic of these diseases served to reinforce the idea that the ill-health of prison inmates was somehow self-inflicted or divinely inspired. “From the 18th century on into the 20th century, few observers identified the degree to which deaths and disease among inmates were determined by the physical design, population density, administration, and the conditions of the prisons” (Greifinger, 2007).

The history of disease in prison systems was affected by several issues; overcrowding, already infected person’s entering the prison systems, lack of medical care, treatment of diseases, violence, abuse, and many other contributing factors, thus plaguing the prison systems without having any protocols in place to reduce the spread of infectious diseases. “As of December 31, 2007, of the 2,319,258 incarcerated Americans, 31 percent (723,131) were locked up in jails.

While figures vary widely by state, the operating costs per inmate averaged almost $ 24,000, and capital expenses per bed averaged $ 65,000 in 2006. Healthcare costs are the fastest growing category of prison operations, currently accounting for 8 to 12 percent of total prison budgets” (Awofeso, 2008. ) The present circumstances surrounding the spread of infectious diseases among inmate populations continues to grow at a rapid rate due to the lack of financial funds available to the prisons.

Provision of good quality healthcare is necessary to facilitating physical rehabilitation of incarcerated individuals. Due to the increases of prison population this has become nearly impossible to achieve. Improving the quality of care, monitoring of diseases, and evaluating healthcare must remain on the same priority levels as security and emergency situations within the prison itself. In the prison facilities today infectious diseases such as HIV, Hepatitis C, and Sexually Transmitted Diseases are much higher than in the general community.

Inmates who engage in sexual and drug related behaviors are at a higher risk level in contracting these infectious diseases. “A study released last year by the U. S. Centers for Disease Control and Prevention documented 88 men who became infected after entering Georgia state prisons, most of them through consensual sex. Because prisons only rarely test for HIV, infected ex-cons frequently go on to have unprotected sex and spread the disease to their unknowing wives or girlfriends. The resulting damage has been most

devastating to minority communities. Because two-thirds of prisoners are black or Latino men, and one out of three black men will serve time behind bars in their lifetime, minority HIV rates have skyrocketed, especially among female partners of ex-cons. In 2003, African Americans and Latinas accounted for 83% of all new AIDS cases among women in the United States according to federal statistics” (Los Angeles Times, 2005). The Future of prison health care lies in the hands of our lawmakers.

With the recent passing of Government run healthcare system, prison systems may suffer the financial burden in providing quality healthcare and service to inmates. Inmates need to be seen as patients and not only inmates. Inmates require the same healthcare services that the general population requires to improve healthy living. Furthermore, the elderly populations in prisons are becoming the fastest growing sector. “The continuing boom of prison populations, the rising number of inmates is living longer” (Keith, 2001, p1).

The body of an inmate will age much faster than the body of someone who is not in prison. The inmates, who committed crimes during their golden years, are now at ages that are in failing health, which requires more complicated medical care. Prisons are becoming more of a hospice care facility than a prison. “Some states such as Virginia and Pennsylvania have built geriatric prison facilities that resemble mini-hospitals, equipped with medical devices and oxygen tanks. Prisons are being licensed as acute-care settings with a crew of Registered nurses, correctional health experts say” (Chen, 2009).

Issues surrounding how healthcare services can help reduce the spread of infectious diseases relies on the Correctional Officers Health and safety Act, of 1998, “which requires the United States Attorney General and Secretary of Health and Human Services to provide guidelines for the prevention of infectious diseases, detection, and treatment of inmates and correctional employees who face exposure to infectious diseases in correctional facilities” ( (Health, 2005). “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 Health Status of Soon-to-be Released Inmates 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, an 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 general population” (Health, 2005). The challenge of providing healthcare service within the correctional setting requires special skill combining the task of providing quality medical care within the environmental constraints of the prison systems. Therefore it is necessary to implement plans of prevention, policy and procedures so inmates receive quality healthcare and follow-up care when they are discharged from the prison system.

Policies that are developed for treatment will address prevention, screening, testing, and education designed to prevent and control infectious diseases in the prison systems. Additionally the policies should be guided by federal and state regulations, laws, and accreditation and correctional health care standards such as those issued through National Commission on Correctional Healthcare (NCCHO). Recommendations for Infectious Disease Management: * State and local agencies- develop policies that advocate infectious disease programs.

* Develop program objectives for management of clinical staff, prevention, control, surveillance of infectious diseases. * Educate staff and inmates on preventative measures and treatment of infectious diseases. * Develop safety protocols and procedures in handling infected inmates and or staff. * Meet the recommended standards of patient care * Isolate infected inmates when they are contagious with infectious diseases. * Provide Personal Protective Equipment (PPE), when staff or inmates are subjected to exposure.

* Require a minimum of six weeks in training on infectious diseases to new hires and staff. * Comply with state and local laws * Develop policies regarding patient privacy and HIPPA. “The Federal Bureau of Prisons clinical guidelines are in the form of a technical reference manual known as Infectious Disease Management, TRM 6100. 02, which is continually updated. The TRM guides the medical healthcare provider in the assessment, evaluation, clinical care, and treatment of infectious diseases found in inmates.

Diseases that are significant among inmate populations are, viral hepatitis (A, B, C. and D), HIV, tuberculosis disease, tuberculosis chemoprohylasis, sexually transmitted diseases, endocarditis prophylaxis, and varicella” ( (Health, 2005) Although healthcare is a service that will always have change whether for quality improvement, policies and procedures, diagnosis, treatment, and follow-up care, we must continually strive for infectious disease prevention.

Not only will the prevention of infectious diseases allow inmates and staff to be healthy, but also will provide the financial assistance that our prison systems so desperately need to continue the preventative healthcare, treatment, and follow-up care of inmates during the time of incarceration and when they are released. Dating back to the early 1600s’, Healthcare has improved greatly, but continues to strive for better developed levels of care.

Infectious diseases continue to plague the prison systems, with the longevity of overcrowded prisons, lack of healthcare resources, medical staff, and budgets. By implementing programs that will provide the education, prevention, diagnosis, and treatment of infectious diseases, prison systems will have decreased numbers of ill-health inmates. Continuing to produce quality Healthcare and quality training will be beneficial to the future of inmates, staff, and authorities.

References Abramsky, S. (2002, July 12). The Nation. Retrieved April 10, 2010, from www.thenation. com: http://www. thenation. com/doc/20020701/abramsky Awfeso, N. (2008). Making Prison Healthcare more Efficient. BMJ , 331:248-249. Chen, S. (2009, Nov 12). CNN. Retrieved April 10, 2010, from www. cnn. com: http://www. cnn. com Greifinger, R. (2007). Public Health Behind Bars. New York: Springer Science + Business Media. Health, A. J. (2005). American Journal of Public Health. American Journal of Public Health , 95 (10), 1685-1688. Keith, R. (2001, March). IPO. Retrieved April 11, 2010, from IPO: http://www. lib. niu. edu/2001/ii010323. html.

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