Should prisons have government-sanctioned tattoo shops?
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Also, as Anne Spaulding of Emory University School of Medicine, notes, most HCV in prisons is imported, not acquired on the premises. One study reported that a third of all people in the United States infected with HCV pass through a correctional facility each year. If that's the case, then clean tattooing in the big house is not going to slice HCV rates either inside or outside penitentiaries.
But legal tattooing could still hold one major advantage: as a steppingstone toward public acceptance of prison needle-exchange programs. As an HCV risk factor, tattooing pales in comparison with injection drug use, which also transmits HIV. Studies report extremely high levels of drug injection in prisons. Many inmates switch from pot to heroin because, with no wafting smoke, it's easier to hide from the guards. But actual needles are a scarce commodity. Inmates will inject themselves with anything—pens, coat hangers, whatever—often with a tattoo chaser to conceal the puncture wounds. When inmates do get their hands on a real needle, sharing is commonplace; they'll even pay to use a dirty one. "About 10 of us used the same needle," says one Canadian prisoner of her first experience injecting drugs, which was while she was incarcerated. "We had to keep sharpening it on a matchstick cover."
Several countries have launched needle and syringe exchange programs within correctional facilities. Swiss prisons have vending machines that provide clean needles upon deposit of a used one. Similar programs are in place in Spain, Germany, Moldova, Kyrgyzstan, and Belarus. Combined with education and methadone treatment for addicts, the efforts have brought HIV prison transmission rates to nearly zero in several countries and have also led to reduced overdosing, increased referral to treatment programs, and increased awareness of infection risk—without increasing drug use.
Still, state and federal prison systems in the United States remain resistant to all of these options. Security concerns regarding increased needle-stick injuries persist, though evidence shows that these programs actually reduce such problems. Politically, the approaches are a hard sell, too. HCV patients are already short on advocates, and prisoners with HCV even more so. A tattoo program could be a small step toward addressing the major public health problem that is HCV—and HIV, for that matter—in prisons.
The future has never looked brighter for HCV sufferers. In 2011, two new drugs with cure rates of up to 75 percent will be approved. New regimens that omit the depression-inducing interferon component are also coming available. The joint is the perfect place to treat people since they are in a fixed place (unlike, say, the homeless population, which also has sky-high hep C rates). As David Thomas of Johns Hopkins Medical Institute, a world-renowned expert on hepatitis, explains, considering that so many HCV carriers end up behind bars, a rigorous, comprehensive prevention and treatment program in prisons could go miles toward eradicating the disease.
Why should taxpayer dollars be used for clean needles and cheap tattoos? This kind of thinking lays its own trap. Most jail sentences are for fewer than three months, and most prison sentences are two to three years. Health problems on the inside will eventually find their way to the outside.
Up to 300 million people are infected with HCV worldwide. With no vaccine available, finding ways to prevent transmission is essential to reining in this epidemic. Preventing just one dirty needle in the haystack could save lives and significant public health care dollars. Installing safer tattooing programs in prisons is a simple, low-cost step in the right direction.
Jessica Wapner, based in New York, writes frequently about health care and biomedical issues.
Photograph of a Filipino inmate by Paula Bronstein/Getty Images.