Fighting HCV with Justice Reform

A number of advancements in health education and condom accessibility have likely contributed to New York City’s overall decline in reported Hepatitis C (HCV) transmissions since 2007. Preventative initiatives, for instance, like the city’s longstanding free condoms program and the New York City Department of Correction’s prison condom distribution program (active since 1987), have proved of paramount importance to the fight.   

However, while these efforts are essential to the city’s overall progress in public health, the prevalence of HCV has stayed largely the same due to lack of diagnosis and treatment. Most disturbingly, HCV–related deaths remain on the rise, with an increase of 38% between 1999 and 2014. Individuals detained in jails and prisons are at the greatest risk.  

The national statistic is staggering. In the United States, 1 in 3 people in jails and prisons have HCV, compared to 1 in every 100 (3.2 million people) nationwide. This disproportionality is mirrored in New York City, where on Rikers Island the rate of newly reported HCV diagnoses is nearly three times greater than the highest rates reported elsewhere in the Metropolitan area.  

On 2017 World Hepatitis Day, we are calling attention to this crisis. If we are to end the HCV epidemic, we’ll need to change the way we care for people experiencing incarceration.  

A key first step is addressing social stigmas, which are obstacles to wellness. As Laura Whitehorn, a formerly incarcerated organizer, said about her experience, “We were often met with distrust or abusive responses when we reported symptoms… One Physician’s [Assistant] told me that in his training to come to the jail, he was told… ‘Don’t believe what they say.” Discrimination as a result of stigma may also extend beyond detention. In one study, 4 in 10 men recently released from state prisons reported experiencing discrimination by medical professionals on the basis of their criminal record.   

Prejudices perpetuated by medical professionals can augment the consequences of any health crisis by making those subject to discrimination less likely to seek care. That is why Fortune, through programs staffed by individuals like health advocate and educator Vincent Chambers, is helping clinicians develop practices that are sensitive to the needs of patients with justice histories.    

Vincent first came to The Fortune Society as a participant in our Employment Services program. Soon after, he began working as a co-facilitator of workshops through our Reentry Education Program (REP), a program that supports healthcare providers in integrating culturally responsive and sensitive best practices into HIV and HCV prevention, treatment, and care delivery to patients who are justice-involved and living within underserved neighborhoods. Through REP, Vincent helps health practitioners disband prejudices and take a trauma–informed approach to clinical care. “When I speak to members of the medical community,” Vincent says, “I encourage them to treat formerly incarcerated people with a little kindness and human dignity to help break the barriers that being incarcerated created.”  

Indeed, prison can be a traumatic place. Consequently, the physical contact intrinsic to treatment can make even the best clinical care triggering for individuals with a history of abuse. It is thus important for physicians to know how to recognize signs of trauma when working with justice-involved patients. By building trust in the relationship between physician and patient, we can ensure that our city’s incarcerated population receives the care they need and deserve. 

This World Hepatitis Day, we commemorate the dedication of Fortune staff members like Vincent, who are working to bridge the divide between justice and wellness. By helping clinicians strengthen the quality of their care, we are taking an important step in the fight against HCV.

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Article written by Aya Abdelaziz

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