Report links prisons and global epidemics

Unhealthy conditions foster diseases, which then enter communities

The cycling of inmates in and out of prisons and jails around the world contributes significantly to the global epidemics of HIV, viral hepatitis and tuberculosis, according to new research from the Johns Hopkins Bloomberg School of Public Health.

Inmates typically suffer from higher rates of those diseases, which spread more readily in crowded correctional facilities and then get passed to others on the outside when the inmates are released, the study found.

The study, “Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees,” was published July 17 in The Lancet as part of a series of studies on HIV and prisoners.

Although the study was global in its focus and did not examine individual nations, let alone cities, the findings could have important implications for Maryland, and particularly Baltimore, which has one of the highest rates of HIV infection among U.S. metro areas. Inmates from Baltimore make up more than a third of the state’s prison population.

Andrea Wirtz, a co-author of the study and assistant scientist at the Bloomberg School of Public Health, said the results were important, considering the racial and economic disparities in the jail and prison population from Baltimore.

“By having this disparity in imprisonment in the city, are we increasing peoples’ risk of HIV and other infectious diseases?” Wirtz said. “We can say this is part of the bigger picture of the HIV epidemic.”

Nearly 32,000 Marylanders were living with the disease in 2013, according to the Centers for Disease Control and Prevention. Many of those reside in Baltimore — 12,435 that same year, according to the Baltimore City Health Department.

In the United States, HIV is a bigger problem among people moving in and out of prison than hepatitis and tuberculosis, said Bruce L. Gilliam, an associate professor of medicine at the University of Maryland School of Medicine.

The study found that of the estimated 10.2 million people incarcerated worldwide on any given day in 2014, 3.8 percent had HIV, 15.1 percent had hepatitis C, 4.8 percent had hepatitis B and 2.8 percent had tuberculosis. In less wealthy countries, between 10 percent and 20 percent of prisoners have HIV.

The authors reached their conclusions by analyzing nearly 300 scientific papers written about prisoners and infectious diseases by scientists around the world during the past 10 years. They also requested research data from United Nations organizations and from prison officials in countries such as China and Russia. Officials in 17 countries turned over their data.

The researchers believe transmission of HIV within U.S. prisons is fairly low due to the availability of antiretroviral drugs there, but the risk of transmission rises once prisoners are released due to difficulties accessing continuing care.

Hepatitis C can spread through prison tattooing, the researchers found, and tuberculosis can thrive in unsanitary conditions in some correctional facilities.

The study authors said corrections officials ought to do more to improve how they combat the spread of infectious diseases, including offering condoms, needle exchanges