Tattooing is ubiquitous behind bars, despite — or perhaps because of — the fact that it is banned.
“It’s just unbelievable how creative they can be,” said Michele Deitch, a prisons expert at the University of Texas at Austin’s LBJ School of Public Affairs. “They can jerry-rig pens to become needles. They use the dyes in paper products.”
But the practice carries with it more than the risk of punishment — it can also spread hepatitis C.
The prison population is particularly prone to this viral disease, which is transmitted largely through infected blood and can lead to liver cirrhosis and cancer.
Not only do inmates have a penchant for illicit tattoos, but they are also likelier than the general population to have engaged in high-risk behavior like intravenous drug use outside of prison. Prison health officials estimate that as many as 50,000 of the state’s more than 150,000 inmates could be infected with hepatitis C.
The cost to treat Texas inmates with hepatitis C is expected to soar by as much as 380 percent next year, a result of the growing prevalence of the disease among inmates and a more effective, but more expensive, treatment protocol. Legislators, already facing a strained budget, will have to find millions more dollars to pay for this care.
Not all inmates are tested for hepatitis C when they enter the prison system. They are tested if they have other clinical indicators, like H.I.V. or a history of intravenous drug use. In a 2007 report, health providers for the Texas Department of Criminal Justice said they had identified and were managing care for about 20,000 inmates with hepatitis C.
Dr. Stephanie Zepeda, the director of pharmacy services for University of Texas Medical Branch Correctional Managed Care, which oversees treatment of inmates, said she provided medication therapy for about 400 hepatitis C patients per month, at a cost to the state of about $2.8 million per year. Not all patients with the disease receive the medication, and the therapy can last from three months to a year.
The current protocol is composed of two drugs, and its cure rate is about 40 percent, Dr. Zepeda said. But new medical guidelines call for the use of a third medication, which can be one of two different drugs. One of them would increase the cost of hepatitis C treatment in prisons to more than $8 million a year, the other to more than $13 million, Dr. Zepeda said.
Dr. Zepeda said that adding a third drug raised the cure rate to 70 percent. But the drugs are not only expensive, they are also complicated to administer.
“It’s great from a humanistic standpoint,” Dr. Zepeda said. “But it’s, practically, a challenge for the correctional system.”