Researchers found that a significant number of men get the hepatitis B virus behind bars

Inmates entering Rhode Island prisons have high rates of HIV and hepatitis, according to new Brown University research, which presents a “significant community health issue.” Once in prison, researchers found, male prisoners pass on the hepatitis B virus at alarming rates.

That’s why the research team, led by Grace Macalino, assistant professor of community health, is calling for hepatitis B vaccinations for all prisoners. Their findings and recommendations appear in the current issue of the American Journal of Public Health, a leading journal for public health research and policy.

“We have a unique opportunity to access a hidden, high-risk population,” Macalino said. “We can do a lot of prevention work to make sure inmates are healthier. Because these men don’t stay inside. They come back to the community.”

The Brown study is the first of its kind in Rhode Island and one of the few investigations of blood-borne infection rates in prisons in the United States.

To conduct the study, Macalino and her team analyzed blood from mandatory, consensual tests taken when inmates entered the Adult Correctional Institute in Cranston. Researchers gathered test results on 4,269 men sentenced between 1998 and 2000.

Their major finding: high prevalence of life-threatening, contagious infections.

Nearly 2 percent of incoming inmates tested positive for HIV, while HIV can be found in 0.33 percent of the general U.S. population. Twenty percent had hepatitis B and 23 percent had hepatitis C. For comparison, 5 percent of the general public has hepatitis B and 2 percent has hepatitis C.

To see if inmates were spreading disease in prison, researchers retested 446 men who were still serving time at least one year later. This netted some good news: None of the subjects contracted HIV while in prison, and less than 1 percent of inmates contracted hepatitis C.

“Prisons don’t appear to be the dangerous incubators we thought they were,” Macalino said. “It’s not that prisons are doing a good job of prevention. It’s just that conditions in lock-down are a lot more prohibitive than they would be out in the community.”

Transmission of the hepatitis B virus inside the Cranston prison, however, was alarming. In one years’ time, almost 3 percent of inmates contracted the virus – a rate higher than indicated in previous prison research and exponentially higher than the national average.

Macalino and her colleagues said the spread of hepatitis B – which is preventable – is cause for concern. Infants and toddlers are routinely vaccinated to protect them against the disease, which attacks the liver and causes cirrhosis, cancer, even death. Researchers recommend that the Adult Correctional Institute, and all prisons, give inmates the vaccine.

While a recent U.S. prison survey found that only two facilities routinely give hepatitis B shots, Macalino said the investment would be wise. Inmates, on average, serve a two- to three-year sentence. Vaccines would prevent inmates from passing on the virus to the public once they’re freed. Teaching prisoners how to steer clear of injection drug use – a main avenue of transmission – once they’re released would also improve community health, Macalino said.

Macalino’s research team from Brown Medical School included Josiah Rich, M.D., associate professor of medicine; staff members Stephanie Sanford-Colby and Christopher Salas; and student Sarju Patel. David Vlavhov from the New York Academy of Medicine and Keith Sabin from the University of Georgia–Athens also assisted in the research and writing.

Funding came from the Centers for Disease Control and Prevention.