Rotting Away

Thousands of New York inmates have hepatitis C. Only a few hundred get treatment.

It's hard to imagine how a doctor could miss Jimi Hammerstein's primary health risk. The graying Brooklyn native spent most of the last 10 years upstate for slinging dope in Park Slope—back when the neighborhood was still in transition. "I remember when this neighborhood wasn't nothing like this," he says, laughing as he sits in a drop-in center for ex-offenders on Fourth Avenue, the Slope's still-gritty border with Downtown Brooklyn. "This was like, dope land!"

Dope land's geography extended into the prison compounds Hammerstein bounced between. His habit continued once he was inside, and just as intensely. Most inmates snort heroin rather than inject it, but as Hammerstein describes the scene, "You got the die-hard dope fiends like I was, where there's only one way to fly. If you're going to do any kind of substance, you might as well shoot it."

Hammerstein's commitment to the needle made him a textbook candidate for two of the modern era's most aggressive communicable diseases: HIV and hepatitis C—a deadly virus that, when left untreated, slowly devours your liver. He tested positive for HIV back in 1989, before he entered prison. He says he copped to the infection at the beginning of his two bids, but he'd never heard of hep C and claims no one— certainly not corrections health officials—ever asked him about it.

Only after his release last year did the questions begin. "People used to say to me, 'Oh, you're HIV; are you hep C too?' " Hammerstein remembers. "I'd say no. And they'd say, 'Oh, that's unusual.' " He'd shrug the idea off. "I'd been taking tests up north for years, and no one mentioned anything about hep C." His doc on the outside finally insisted he get tested, and in what should have been no surprise, he was positive.

Like Hammerstein, thousands of prisoners around the country are slowly dying from a wholly treatable disease because corrections officials are doing everything possible to avoid caring for them. New York is among the worst offenders, as by most estimates it boasts more inmates living with hep C than any other state. But after years of advocates and inmates fruitlessly lobbying for change, a series of recent lawsuits, including a class action case now pending in federal court, appears to have finally forced the state's hand.

Over the last three decades, hep C has been a stealthy but virulent sidekick to its celebrity sister HIV. Nearly 3 million people nationwide now have chronic infections—triple the HIV caseload. They are uniquely concentrated in prisons: At least 14 percent of New York's inmates are known to have hep C. And as these legions barrel toward the disease's end stage, in which the inflamed liver turns cirrhotic, they promise to collapse the teetering liver-transplant market. Already, hep C is the number one reason for swapping out a liver; the waiting list for transplants is 17,000 people deep and growing. The sooner you start treatment, the less likely you'll need one.

In response to growing awareness about the epidemic—and its concentration among drug users who cycle in and out of incarceration—the state corrections department says it now offers tests to all incoming prisoners whose profiles raise red flags, as Hammerstein's should have. But even for those who get screened, learning you've got the disease is where, for most, the process ends. According to a Justice Department census, as of 2000, only about 300 of the state's estimated 10,000 hep C–positive inmates were being treated.

Prison health advocates charge this dismal rate is no accident. Coincidentally or not, treating hep C is one of the more expensive tasks in medicine. The multi-drug regimen can cost as much as $35,000 per patient. Corrections already spends almost $23 million a year on AIDS meds, nearly 40 percent of its whole pharmacy budget.

Until mid October, when the department began revising its policies in response to ongoing litigation, any inmate needing hep C treatment who had a history of using drugs—as does almost everyone with the virus—was required to first enroll in a six-month class for users. The official approach, which has been slowly shifting over the last couple of years, originally forced inmates to complete the course before getting treatment. It was expansive and unbending: If you'd ever done drugs or alcohol in your life, you had to take the class.

"You got guys that been in the system eight, nine, 10 years," scoffs Rahiem (not his real name), a hep C–positive lifer at the medium-security facility in Auburn who refused to take the drug class and so hasn't gotten treatment. "They don't have no record of drug use from disciplinary actions. But they're denied treatment." Rahiem wears long gray dreadlocks and stares with measured intensity when insisting that he last got high in 1973. But his old girlfriend once got charged with smuggling whiskey into the visiting room, he says, so now he's stuck with a user label.

"These rules are barriers that they set up," complains Romeo Sanchez, a hep C–positive ex-offender who organizes prison activism at the New York City AIDS Housing Network, "because they don't want to pay for it."

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