(MintPress) – In the hollow corridors of prisons across the United State, there’s a buzz. It’s not the echoing voices of inmates, but rather the sound of a homemade tattoo gun at work. With over half of all prison inmates in the United States receiving at least one tattoo during their stay, the illegal act is still commonplace in correctional facilities across the country.
But without a health code or proper tools and ink, body art behind bars carries a myriad of risks, the biggest of which may be the hepatitis C virus. In a study of growing concerns with the link between prisons and hepatitis C, the Bureau of Justice Statistics says as many as one-third of America’s two million inmates could be infected.
After their release, those who served time become a public health threat, as they pose a risk of infecting others. The hepatitis C virus causes swelling of the liver that can increase the chances of severe liver disease. It also has a common link to liver cancer, increasing its fatality rate. With needle exchange programs aimed at reducing the rate of infection among drug users in some U.S. prisons, is it time for the federal government to subsidize safe tattoo practices in America’s prisons?
Prison tattooing, or “scratch art” as it is commonly referred to as because of its often low quality, has been a mainstay in American prisons often used to convey gang affiliation, a symbol for a crime committed and many other motifs. As previously mentioned, tattooing in prisons is against the law, meaning that prison tattooists have to fabricate tattoo guns and ink. Convicted Artist, a media outlet consisting of writers and artists, focuses on fringe art, including tattoos. The publication notes that tattoo guns in prisons are often made with parts from radios or video game consoles because they make use of a rudimentary motor. Without tattoo ink in prisons, shampoo or Styrofoam is often burned until it becomes a black liquid.
“Tattooing in prison represents a unique combination of risk factors for blood borne virus (BBV) transmission because it is illicitly performed by untrained operators with homemade, unsterile, and frequently-shared equipment,” says Australia’s Centre for Epidemiology and Population Health Research. “It occurs in a setting where a high proportion of people are already infected with hepatitis C virus and other BBVs.”
Governments take action
Without new tools at their disposal, prison tattooists use the same needles on multiple people. And with no sanitary practices like those seen in licensed tattoo shops – such as an autoclave – the risk of spreading infection grows significantly. Health researchers at the University of British Columbia say the makeshift practice can also push toxins into the bloodstream, infecting kidneys, lungs and lymph nodes because of the carbon found in much of the improvised ink.
Rates of hepatitis C are 10 to 20 times higher among inmates who receive a tattoo in prison than the general population. In Canada, as much as one-quarter of the individuals who are tattooed in prison are linked to hepatitis C. That prompted the Canadian government to run a test program from 2005-2006 that offered sanitary tattooing tools to inmates and education on blood-borne illnesses to prison tattooists. The program was scrapped after one year, but showed tangible savings for the prison system should it be renewed. Canada paid $913,000 to launch the program and found that it cost less to prevent hepatitis C in its inmates that it did to provide the health care needed for a prisoner with the virus.
Lorry Schoenly is a veteran nurse who specializes in correctional health care. She said pilot programs such as the one implemented in Canada could be critical to reducing blood borne illnesses in prisons, which can cost states thousands of extra dollars to treat. She noted that it is equally important for governments to consider the ethics of subsidizing gang-related tattooing, however.
“These programs ensure that proper hygiene is maintained and sterilized equipment is used in the tattooing process, but at what cost?” Schoenly wrote. “Are the benefits of sanctioned tattooing (decreases in BBP transmission and the trade in contraband tattoo equipment) outweighed by the costs (perpetuation of tattoo and gang culture)?”
Dr. Joseph Bick, chief medical officer at the California Medical Facility, brought up two important factors about hepatitis C treatment in prisons in an interview with MSNBC: He noted that the government may be wary of pushing tax dollars toward such a potentially unpopular program and that the health care debate plays an influential role because many people struggle to find access to affordable care. He concluded, however, that investments in preventative care far outweigh the cost of treatment.
“It’s a hard sell to convince taxpayers why additional resources should be spent on the health care of the incarcerated when there are a lot of people who aren’t incarcerated who don’t have adequate health care,” Bick said. “It’s a tremendous opportunity for us to have an impact on the larger health of the community.”
Growth of needle sharing exchange
Blood borne illnesses in America’s prisons took off after the rise of smuggled drug use among inmates. Drugs injected into the bloodstream resulted in inmates sharing any needles they could get their hands on, causing outbreaks in hepatitis C and HIV. As a result, various authorities instituted needle exchange programs (NSPs) where inmates would be given sterile needs and supplies for their drug injections. When the supplies were returned, the inmate would be given a new set of sterile supplies.
In 2011, 221 exchange programs existed in among U.S. prisons. Nearly 40 percent of those programs were managed by local health authorities and after lifting the ban in 2009, federal funding was allowed to be allocated to such programs. Many states also provide funding for exchanges, as 35 states have legal exchange programs as of this year. The World Health Organization (WHO) claimed that its studies suggest intravenous drug use (IDU) was not made worse by providing free supplies to inmates.
“NSPs substantially and cost effectively reduce the spread of HIV among IDUs and do so without evidence of exacerbating injecting drug use at either the individual or societal level,” the WHO wrote. “This suggests that authorities responsible for areas threatened by or experiencing an epidemic of HIV infection among IDUs should adopt measures urgently to increase the availability and utilization of sterile injecting equipment and expand implementation to scale as soon as possible.”
Like the Canadian tattoo pilot project, the benefits of investing in needle exchange programs are fiscally prudent. The benefits can be seen through program costs and their relation to HIV health care costs. The Center of Disease Control (CDC) says the average cost of a needle in the exchange program is 97 cents. Truvada, a common pill used to treat HIV, costs an estimated $36 per day. The CDC also estimates that every HIV infection prevented by the exchange program saves an estimated $178,000 in health expenses.
“Multiple reviews have concluded that syringe exchange leads to reductions in injecting risk behaviors among IDUs,” the CDC said. “HIV incidence among IDUs declined by approximately 80 percent from 1988-1990 to 2003-2006 in the United States. Injection-related transmission is the only adult transmission category to show a reduction of this magnitude.”