R.I. prisoners transmit hepatitis B at alarming rate, Brown researcher finds

by Wendy Y. Lawton

In 1996, AIDS was a full-blown public health crisis. America was also in the midst of a prison-building boom. This got Grace Macalino thinking. A lot of prisoners have a history of injection drug use and often engage in unprotected sex - key avenues of HIV transmission. Behind the prison walls, was the virus spreading fast?

The question made sense coming from Macalino. She was earning her doctorate in infectious disease epidemiology from the Johns Hopkins School of Public Health. So the 29-year-old wrote an ambitious grant proposal: Find out how many prisoners were coming into Maryland prisons with HIV and hepatitis, another life-threatening bloodborne disease. And find out how many prisoners were contracting these viruses behind bars.

The enterprising scientist got her wish. The Centers for Disease Control and Prevention gave her $1 million to pay for the project.

But Macalino hit a snag. "In Maryland, the people in corrections changed their minds," she said. "They got leery. What if we did find something?"

Macalino made the move to Brown to teach - and brought her grant money with her. In Rhode Island, she found prison officials much more willing to let scientists into the system, regardless of what they might find.

The research that followed is now a capstone of Macalino's career. After two years of study, the assistant professor of community health and her research team found that inmates entering Rhode Island prisons have high rates of HIV and hepatitis. Once in prison, male prisoners pass on the hepatitis B virus at alarming rates.

The Brown study is the first of its kind in Rhode Island and one of the few investigations of bloodborne infection rates in prison in the United States. And the results are getting attention. The study has landed in the current issue of the American Journal of Public Health, the nation's premier journal for public health research and policy.

To conduct the experiment, Macalino and her team analyzed blood from mandatory, consensual tests taken when inmates entered the Adult Correctional Institutions 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 .33 percent of the general U.S. population. Twenty percent had hepatitis B and 23 percent had hepatitis C. Comparitively, 5 percent of the general public has hepatitis B while 2 percent have hepatitis C.

To see whether inmates were spreading disease in prison, researchers retested 446 men that were still serving time at least one year later. This netted some good news: None of the subjects contracted HIV while in prison. And fewer 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.Ó

Transmission of the hepatitis B virus inside the Cranston prison, however, was alarming. In one year's 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 said prison officials have a powerful tool to stop the spread of hepatitis B: a safe and effective vaccine. Infants and toddlers are routinely vaccinated to protect them against the disease, which attacks the liver and causes cirrhosis, cancer, even death. That's why Brown researchers recommend that the Adult Correctional Institute, and all prisons, give inmates the shots.

A recent U.S. prison survey found that only two facilities routinely give hepatitis B shots. Macalino said it's mainly a matter of money: Prisons don't have enough to give all prisoners the three doses needed for full protection. But she believes that the money - and the vaccines - will come some day.

"The question," she said, "is who will step up and make it happen."