Improving healthcare for incarcerated women.
Improving healthcare for incarcerated women.
复制标题
改善被监禁妇女的医疗保健。
DOI：
10.1089/jwh.2009.1786
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Springer,SandraA
中科院分区：
文献类型：
--
作者：
Springer,SandraA
The article by Nijhawan et al. 1 in this issue of the Journal of Women’s Health evaluated the important aspect of identifying preventive healthcare needs of incarcerated women. Unequal access to healthcare unfortunately continues to plague our nation’s prison population, currently totaling almost 2 million people. 2, 3e The overall incarceration rates of state and federal prisoners continue to rise; at midyear 2007, 509 of 100,000 US residents were incarcerated, up from 480 of 100,000 at end of year 2003. 3, 3a By the end of year 2007, the number of female inmates has continued to rise since the end of year 2000 at a greater rate (3.2%) compared to male inmates (2%). 3b Although women account for approximately 7% of the total inmate population in state and federal prisons, female incarceration rates reveal racial and ethnic differences similar to those of male inmates. Black women (with a prison and jail rate of 348 per 100,000) were nearly two and a half times more likely than Hispanic women (146 per 100,000) and over 4.5 times more likely than white women (95 per 100,000) to be incarcerated in midyear 2007. 3a Not only do the majority of these inmates carry a racial disparity, but they also carry considerable disparity in the burden of disease within the correctional system as well as in the community upon release. Prevalence rates within the correctional setting of mental illnesses are 30%–50% compared with 11% in the general population, 4 and alcohol and drug problems occur in 30%–70% of the incarcerated population compared with 3%–6% in the general population. 5 Furthermore, certain communicable infectious diseases occur at higher rates in the incarcerated population than in the community. HIV/AIDS is three to four times greater; tuberculosis (TB) occurs in 40% of incarcerated populations, and chronic hepatitis C viral (HCV) infection occurs in almost 50%. 6, 7 In the article by Nijhawan et al., 1 of the 70% incarcerated women who reported being tested for HCV, almost 40% reported testing positive, which is 20 times greater than in the general population (1.6%). 7 The authors do not state in the article if the HCV-positive inmates received treatment or evaluation for treatment for chronic HCV infection; however, it is unlikely given previous low reports of HCV treatment in correctional settings. 8 Previous studies have demonstrated that prisoners adhere to antiretroviral therapy regardless of the antiretroviral regimen, 9 causing the majority to have undetectable HIV viral loads. 10 Extrapolating from these results, it would be expected that HCV treatment adherence rates with weekly injections of pegylated interferon and daily oral ribavirin would likely be high within incarcerated populations. Future work should be done to begin the evaluation process of detecting chronic HCV infection (ie, checking HCV viral load and HCV genotype, imaging of the liver, liver biopsy) and initiating treatment for all inmates who meet the criteria and then developing linkages with HCV treatment providers in the community upon release.Although women comprise only 7% of the incarcerated population in the country, 3a they have a higher prevalence of HIV and other sexually transmitted diseases (STDS) than male prisoners. 11, 12 In terms of HIV, the Centers for Disease Control and Prevention (CDC) now reports that heterosexual contact is the most common mode of acquiring HIV in women (83%), 13 and most women tend to be incarcerated for drugrelated and sex work crimes that put them at risk for acquiring HIV and other STDs. 12 Most prisoners have a high degree of other STDs besides HIV upon entrance to correctional facilities, including gonorrhea …
