Infectious Diseases among Inmate Populations - Article Example

Infectious Diseases among Inmate Populations The prevalence of infectious diseases is much higher among the prison inmate population than the general population. This is a health concern not only for prisoners but because more than 11 million are released every year, the public outside prison walls are affected as well. The prison population is growing every year which continually adds to a widespread health crisis that has yet to be properly addressed by corrections officials, law enforcement or the justice system. The proliferation of infectious diseases such as AIDS, Tuberculosis and Hepatitis by ex-convicts to the general public is a concern of increasing proportion. As this problem escalates, the monetary costs to society continues to rise and are much greater than if the diseases were discovered and treated at an earlier time, in the prison system prior to release. Prisons are in a unique position to treat inmates while the infectious condition is still in its earliest stages thus ultimately less costly to taxpayers. Though considerable economic, logistical and political barriers must be overcome to genuinely improve health care in the prison system, there are methods by which to begin solving this worsening health crisis in the prisons and wider community. The U.S. prison system has undergone a transformation over the past quarter century as a result of and a response to extensive studies that have been conducted to determine the consequences of the rising inmate population. In just 20 years, the number of persons held in U.S. prisons jumped substantially. The nation’s ‘war on drugs’ included mandatory sentencing guidelines which were principally responsible for the increase of 216,000 total prisoners in 1974 to 2004’s figure of 1.4 million. During this period, in just a 10-year span, the percentage of prisoners convicted of drug offenses nearly tripled. “In 1985, only 38,900, 8.6 percent, of State prison inmates were serving time for drug offenses as their most serious crime committed. By 1995, that number had increased almost six-fold to 224,900, 22.7 percent of all inmates” (Skolnik, 1994). Today, the U.S. houses nearly two million inmates. In 1978, the number of persons in the entire penal system, those in prisons, jails and on probation or parole totaled 1.5 million. In 2004 this number stood at almost seven million. The overall correctional population, including persons in prison, jail, and on parole and probation, has jumped from 1.5 million in 1978 to nearly 7 million in 2004 (“Ethical”, 2006). Approximately one in 30 American adults are currently under some type of supervision within the correctional system. This compares to about one in 90 persons just a quarter century ago. A much higher number of prisoners, who are at an elevated risk of having an infectious disease, are regularly released into society. The increased amount of substance abusers entering prisons contributed to the explosion of infectious diseases such as HIV/AIDS, tuberculosis and hepatitis. Those who use some of the harder drugs such as heroin and amphetamines, the ones more likely to affect a physical dependence, often share hypodermic needles to administer the drug which transmits communicable diseases to others. The heightened instances of diseases in prisons are further exacerbated because the average age of prisoners is rising. Older prisoners are more inclined to have other health issues such as hypertension and diabetes which present a more complex set of circumstances for diagnosis and treatment of infectious diseases (“Health Status” 2003). A statistic that illustrates the growing problem is the amount of AIDS patients in prisons. “Twelve to 18 percent of the HIV-positive population of the United States pass through the country’s jails and prisons every year” (Brown, 2002). Despite the numerous studies and reports conducted over the past 25 years that have clearly demonstrated the general health concerns due to the growing number of prisoners with infectious diseases, only a minority of prisons have put comprehensive AIDS prevention policies and programs into action at their respective facilities. On average, fewer than 25 percent of prison inmates have been tested for sexually transmitted diseases. Some prisons have tested less than five percent of it inmates. Sex among inmates is at least somewhat prevalent and is well documented. Since it is unpractical to believe this practice can be stopped, regular testing for sexually transmitted diseases including AIDS seems a logical starting place in finding solutions in the management of this situation. The vast majority of Federal and State prisons, 90 percent, test for tuberculosis and isolate those inflicted with the disease. However, many do not test the air quality in the cell once occupied by the quarantined prisoner. “Most prisons and jails report that they isolate inmates with suspected or confirmed TB disease in negative pressure rooms. Some facilities, however, do not test the rooms to ensure that the air exchange is working properly, or they continue to use the rooms even when the air exchange is known to be out of order” (“Health Status” 2003). Generally, prison systems across the country have either not understood the severity of this health problem, of infectious prisoners entering the general public, or are willfully ignoring it. A medical intervention program designed to treat diseases while in the early stages is cost-effective. Such a program will ultimately save more money than is required to put the medical service into operation and maintain it. The overall benefits to the prison population and society are worth the expensive price even in the unlikely event that the program is more costly to the prison than the immediate return to the particular prison. It has been estimated that, for example, if at least one percent of prisoners in a facility were afflicted with a sexually transmitted disease such as syphilis, the cost to screen all inmates would be cost effective. “Routine screening of men and women in prisons and jails for gonorrhea and chlamydia would be cost effective. Routine syphilis screening and treatment would save almost $1.6 million for every 10,000 inmates screened” (Kraut, et al. 2000). For prison facilities with a 1.5 percent prevalence of HIV, a prevention program consisting of mandatory testing and optional counseling for those prisoners infected with the disease has proven to be cost effective. If HIV was detected early in just three persons and they received and adhered to counseling directives, an estimated $140,000 would be saved. If 60 percent of inmates in a facility that housed 10,000 agreed to counseling and screening procedures, three would be prevented from contracting the disease. “Counseling and testing 10,000 inmates would cost the prison system about $117,000, or approximately $39,000 per case of HIV prevented” (Varghese et al. 2000). The result of this example assumes a 2.3 percent or greater prevalence of HIV within the prison population which coincides with the national average. Inmates with HIV suffer a higher susceptibility to contract tuberculosis (TB). Universal testing for HIV should include screening for tuberculosis as well which would increase the savings for prisons. “The 989 cases of active TB that would be prevented for every 100,000 inmates tested, with treatment of those inmates found to have latent TB infection, 29 would save $7,174,509, or $7,254 per case prevented” (Hammett, 1999). In addition, testing for diabetes and hypertension is recommended for immediate and future cost savings. Of course, only by utilizing professional medical techniques will a prison realize the cost savings outlined in this paper. Correctional institutions and agencies have the capability to implement scientifically proven practices with regard to testing and treatment themselves without contracting from outside the system. Sexually transmitted diseases can be addressed in prison by establishing educational classes concentrating on safe sexual procedures, testing and treatment for HIV, syphilis, gonorrhea and chlamydia. For inmates who exhibit symptoms related to tuberculosis, prison staff can facilitate the containment of this very contagious disease by providing access to “properly operating negative pressure isolation rooms” (“Health Status” 2003) and by mandating screening for all incoming inmates and annual tests for all prisoners and staff. As with all infectious diseases, the correctional system, specifically the parole department, can extend testing and provide access to treatment and counseling once inmates are released into the community. A systematic surveillance method designed to detect and monitor inmates for signs of infectious diseases can be conceived and implemented by the prison systems. The benefit of a surveillance program is that the information gained is used to develop informed strategies to help avoid obtaining and transmitting infectious diseases. “The information obtained from the surveillance system is used to plan, implement, and evaluate health needs of the inmate population and their anticipated health needs upon release” (“Health Status” 2003). Most of those who enter prison will eventually be released back into the community. Therefore, the community and those agencies responsible for public safety should be very concerned about the numbers of inmates with infectious diseases. The initial costs of implementing testing and counseling programs are minuscule compared to the eventual monetary and health benefits gained by these programs. References Brown, Karl. (October 2002). Health Status Report: Infectious Diseases in Corrections, HEPP Report Vol. 5, N. 10. Accessed November 3, 2007 from “Ethical Considerations for Research Involving Prisoners.” (2006). Committee on Ethical Considerations for Revisions to DHHS Regulations for Protection of Prisoners Involved in Research National Academies Press. Accessed November 3, 2007 from Hammett, T.M., P. Harmon, and L.M. Maruschak. (July 1999). 1996–1997 Update: HIV/AIDS, STDs, and TB in Correctional Facilities, Issues and Practices. Washington, DC: U.S. Department of Justice, National Institute of Justice, NCJ 176344. “The Health Status of Soon to be Released Inmates.” (2002). National Commission on Correctional Health Care. Accessed November 3, 2007 from Kraut, J.R., A.C. Haddix, V. Carande-Kulis, and R.B. Greifinger. (February 2000). “Cost-Effectiveness of Routine Screening for Sexually Transmitted Disease Among Inmates in United States Prisons and Jails.” Paper prepared for the National Commission on Correctional Health Care, Chicago, IL. Skolnik, A. (1994). “‘Collateral Casualties’ Climb in Drug War.” Journal of the American Medical Association. Vol. 271: 1638–1639. Varghese, B., and T.A. Peterman. (February 2000). “Cost-Effectiveness of HIV Counseling and Testing in U.S. Prisons.” Paper prepared for the National Commission on Correctional Health Care, Chicago, IL. Read More