Strategies to reduce hepatitis C rates among prisoners in Australia are failing, with a new Australian study finding that a third of injecting drug users contract the disease while in prison.
The study, conducted by researchers at the National Drug and Alcohol Research Centre at the University of NSW, found that one third of injecting drug users continued to inject in prison and 90 per cent of these shared needles. A third of these went on to contract hepatitis C while they were full time inmates.
Study Chief Investigator, Associate Professor Kate Dolan said the findings strengthened the case for introducing needle syringe programs in Australian prisons and for considering alternatives to imprisonment for less serious offences because of the health risks.
“We know that the rate of hepatitis C among injecting drug users is high in both the general community and the prison population,” said Associate Professor Dolan. “What we have not been able to say with any certainty until now is just how many of these infections are being acquired in prison.
“Our study is unique in that it is the largest study to date to isolate cases of hepatitis C that were contracted in prison,” said Associate Professor Dolan.
Inmates from 13 prisons across NSW were recruited for the study, from 2005 to 2007, and were eligible if they were an injecting drug user who had tested negative for hepatitis C over the previous 12 months and at least six weeks after their most entry into continuous imprisonment (to exclude those who had contracted HCV immediately prior to entering prison).
Of the 120 who were eligible, 16 were found to be positive for hepatitis C – which translates to 34 new infections for every 100 inmates each year. Further, the study found that while the rate of injecting fell when people entered prison - from 78 per cent in the three months before entering prison to 34 per cent in prison - the rate of sharing needles jumped dramatically from 39 per cent sharing needles before entering prison to 90 per cent sharing needles in prison.
“These findings are alarming,” said Associate Professor Dolan. “They are the highest recorded figures in the literature to date and this is the largest study to date of the injecting drug user prison population.
“NSW has introduced several strategies to reduce hepatitis C transmission but we still have these very high rates of prison acquired infection.
“Together NSW, Victoria and Queensland account for 50 per cent of the Australian population and prevalence rates of Hepatitis C are similar in all three states so the results would apply to at least 50 per cent of Australia.
“One untried strategy in Australia is the distribution of clean needles in prisons,” said Professor Dolan. “A recent report by the National Centre in HIV Epidemiology and Clinical Research found that in Australia since 2000 the distribution of 30 million clean needles and syringes every year in the general community have prevented close to 100,000 cases of hepatitis C and 32,000 cases of HIV infection, saving $1.3 billion in healthcare costs.”
The findings are published in the current issue of the European Journal of Clinical Epidemiology, “Incidence and risk for acute hepatitis C infection during imprisonment in Australia, Dolan et al.”