Inmates in this country represent a large reservoir of individuals at risk for vaccine-preventable diseases. Vaccinations are one of the most cost-effective interventions available, with the potential for decreasing morbidity and mortality by preventing or modifying life-threatening disease.
Almost exactly two years ago, HEPP Report published an article discussing HIV+ inmates' constitutional rights to medical care in light of two divergent cases recently decided at the federal appellate court level. This month's article re-examines those cases and looks at what has happened since then to guide correctional medical providers through this murky area of the law.
"3% of Americans incarcerated...12 million released from jails and prisons every year... 35% of all cases of active tuberculosis identified among current/recent inmates...500,000 individuals with STDs and 500,000 with latent tuberculosis released every year...30% of all Americans with hepatitis C and 12-18% of those with HIV pass through our nation's jails and prisons every year..."
The management of Hepatitis C infection (HCV) was the subject of an expert "consensus panel" discussion at the National Institutes of Health this past June.
Since the publication of a review of Antiretroviral Resistance Testing in the September 2000 HEPP News,1 resistance testing has become an important component of standard care for HIV -infected patients. This is largely due to the widespread availability of genotypic testing, as well as increased access to both the virtual and standard phenotype tests.
Bill Gates, founder of Microsoft, opened the 9th Conference on Retroviruses and Opportunistic Infections (9th CROI) as keynote speaker by comparing the AIDS epidemic in Africa to the sinking of the Titanic. This analogy is extremely apt, for not only is it proving difficult to gauge the severity of the epidemic by examining the tips of the icebergs (those known to be infected), but it also appears that the number of lifeboats on board (available treatments) is inadequate to ensure the safety of all the passengers. Although Bill Gates did not elaborate further, he clearly implied that passengers in steerage may not be aware of existing disparities between their chances of survival compared to passengers holding a higher class of ticket.
Nationally, hepatitis C virus (HCV) outstrips HIV by about 10 to 1 in sheer numbers of inmates infected. Even so, controversy and confusion surround the management of HCV in correctional settings, while HIV testing and treatment is now relatively routine. This controversy stems from debate about the "best time" to treat HCV, and whether HCV treatment should begin to be included in the correctional health care budget or whether the cost should be borne by the public health sector.
In the United States, the number of cases of TB disease has been falling since the beginning of the century. The availability of highly effective treatment accelerated this decline, and by 1970 the Advisory Council for the Elimination of Tuberculosis (ACET) committed to the goal of eliminating TB in the United States by the year 2010. Elimination was defined as less than one case per one million persons per year.
A tabloid worker dies in Florida. Two postal workers die in Washington, D.C. A homebound retiree dies in Connecticut. An envelope packed with a white substance raises alarm when it is opened for routine screening at a US correctional facility. The common link? Spores from Bacillus anthracis. Fortunately, the white powder at the correctional facility did not contain anthrax spores, and moreover, correctional officials recognized the potential anthrax threat, deposited the envelope in a secure receptacle, quarantined the area and alerted the authorities.
The factors associated with the development of lower genital tract neoplasia (cancers) are directly related to lifestyle, poverty, sexual risk taking behaviors, and access to health care. Historically it has been observed that women who have multiple sexual partners or have a partner who has had multiple sexual partners are at highest risk for the development of cervical cancer. Human papillomavirus (HPV) is the most important etiological agent in neoplastic change. In the past two decades, HIV and HPV co-infection has been associated with more rapid development of cervical cancer. Most incarcerated women are at very high risk for cervical cancer due to their lifestyles and to the high rate of HIV co-infection in this population. This paper reviews the present knowledge of this viral infection and the management of HPV infection in incarcerated populations.
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This information is designed to support, not replace, the relationship that exists between you and your doctor.