How a Prison in Rural Australia Found a Way to Eradicate Hep C

Last year, Queensland's Lotus Glen Correctional Centre became the first prison in Australia to eradicate hepatitis C. By employing a health officer to specifically train prison staff in how to curb transmissions and by boosting access to new medications, they eliminated the disease within 18 months.

This is amazing because on average 30 percent of the male inmate population have hep C. But with some simple measures Lotus Glen was able to drop that number to zero.

Hep C is a blood-borne virus, typically spread through intravenous drug use, sex, and tattoos. The infection dubbed is “the silent killer” as it inflames the liver, eventually leading to cancer.

The difference between Lotus Glen's treatment is that they provided treatment to all inmates seeking help, regardless of the duration of their sentence. The nurses provided a follow-up test to ensure there was no re-infection, even after inmates had been released back into the community. This is in stark contrast with other prisons, where care is only provided to inmates facing sentences that exceed six months.

So the question remains, if we can reduce the spread of hep C from within the prison system, why aren’t all custodial programs following suit?

VICE spoke to Infection researcher Dr Sofia Bartlett, from the University of NSW, who assisted with the program at Lotus Glen. Sofia's father was infected with hep C in prison, and she explains how this experience formed her motivation.

VICE: Hey Sofia, tell me about why you decided to research hep C?
Dr Sofia Bartlett: My personal experience with the prison system and hep C began with my dad Jack, who lived with hep C for over 30 years and served two sentences in prison. Dad isn't sure how he got hep C, but he probably became infected while he was in jail in the 70s or 80s. Dad ticked almost all the boxes for hep C risk factors—prison tattoos, getting stabbed, and injecting drugs.

Dad was able to end his dependence on heroin before my brother and I were born. Then years later, he found out he had this virus that was branded a "junkie disease," which affected his ability to work. I think there's a double burden of prison and hep C, because it doesn't just affect individuals, it also affects their families. Dad had treatment for his hep C in 2015 and cleared the infection successfully, which was awesome.

Is that why you chose to dedicate your life to hep C reform?
I didn't set out to become a scientist and study hep C, but one thing led to another, and eventually I did a PhD studying transmission patterns of hep C among people who inject drugs, both in prison and in the community. Dad was shocked when I first started doing hep C research, but I think he's proud of me.

Why is the hep C issue so important within the prison system?
My research, and that of others, has shown that hep C transmission crosses between the incarcerated population and the rest of the community. Approximately 50,000 people flow through corrections each year. So without treating hep C among people who are in prison, there's no way it can be eliminated from the rest of Australia.

How are the inmates responding to counselling?
The hep C treatment program I evaluated at Lotus Glen originally held clinics during lock down on Wednesday afternoons, so that they could try and provide anonymity to the people coming to the clinic to get treatment. Pretty quickly, people started telling each other that they were on treatment, and they were proud of it. They wouldn’t share drugs with anyone who wasn’t on treatment because they didn’t want to get reinfected, so it’s like positive peer pressure was encouraging people to get treated.

Other centres aren’t having such an easy time. Changing really ingrained perceptions and systems that have existed for decades is very hard. But still, the perception that people who inject drugs don’t care about their health is not correct. They do care, but it’s hard to do when a part of your life is illegal.

What is it about the issue that makes it difficult for corrections to address?
It’s definitely the fact that hep C is spread by things that are supposed to not be happening in prison- injecting drugs primarily, and tattoos. By acknowledging hep C, you have to acknowledge all these other things, and that’s hard for both the people who are incarcerated and for the people working in and running these facilities. Until we change our laws and attitude to drugs, it’s going to remain pretty difficult for corrections to address significant health issues like hep C.

How difficult were some of the hep C cases in prison?
There was a guy in a medium security facility in NSW who had been there for a while. He knew he was infected with hep C, but he didn't get any treatment or monitoring. There was actually a treatment trial running in that facility at the time though, so he would have been able to get treatment, but he incorrectly believed that just by having a healthy diet, abstaining from drugs and alcohol, and by getting some exercise, he would remain healthy in the long term, living with hep C. He didn't know that long term infection with hep C causes progressive damage to the liver, resulting in either liver failure or liver cancer. He had developed ascites, which is fluid accumulating in the abdomen, and is caused by severe liver damage. It wasn't until his stomach was so swollen that he was unable to leave his cell that he actually asked for medical attention, and it was almost too late for him.

Many people living with hep C in prison aren't aware that the new treatment is really effective, and it only has mild side effects. Many are also unaware that if they don't get treated early enough, there is the possibility of long term liver damage that is potentially fatal and irreversible. There is a big gap in the knowledge and awareness of hep C among people in prison, both the staff and the people who are incarcerated.

Is there a strategy to get rid of hep C around the country?
I think we can eliminate hep C from all correctional centres if we increase access and uptake of treatment to a sufficient level. If we treat enough people and do it quickly enough, we can stop the cycle of transmission. Research at the moment suggests that increasing access to Opioid Substitution Therapy (OST) and creating Needle and Syringe Exchange Programs inside prisons would make it cheaper and faster to eliminate hep C from prisons. But this still relies on eliminating hep C from the general community at the same time, which is probably an even bigger task.

I definitely support increasing access to OST in prisons throughout Australia, Queensland in particular. I’m not naive enough to ignore the fact that OST is abused in prison a lot. Dad has told me stories about this, and I know people who vomit up their methadone or buep in to milk or juice bottles to sell. But the fact remains that there is strong evidence to support the use of OST in prisons to help people avoid injecting, and that is a good way to not get infected or re-infected from hep C.

Dr. Sofia Bartlett's views don't necessarily reflect opinions or policy of UNSW, Queensland Health, or Queensland Corrective Services.

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