death (BJS, 2004a; National Institutes of Health [NIH], 2002). Both viruses are spread through infected blood, most commonly via shared needles used to inject illegal drugs and through sexual contact. Nearly 2 percent of the U.S. population is chronically infected with hepatitis C virus (Hammett et al., 2002), while studies in prison populations in California, Virginia, Connecticut, Maryland, and Texas have found evidence of hepatitis C infection in 29 to 42 percent of prisoners (Centers for Disease Control and Prevention [CDC], 2002). Across the country, hepatitis C infection rates for prisoners are estimated at 15 to 30 percent. Between 1.3 and 1.4 million prisoners released from prison or jail in 1996 were infected with hepatitis C (NCCHC, 2002). The prevalence of hepatitis B infection among incarcerated individuals has been reported to range from 8 to 43 percent (Khan et al., 2005), while the rate in the U.S. population as a whole is 4.9 percent. In a state correctional facility in Georgia (housing up to 1,340 male inmates, one-third of whom are transferred or released each year), and within Rhode Island’s prison system, there was a high prevalence of hepatitis B, and a high rate of ongoing HBV transmission (Khan et al., 2005).

Antiviral therapies for chronic hepatitis B and C are complicated, have limited effectiveness, and are not appropriate for everyone (CDC, 2002). Hepatitis B vaccination is recommended for incarcerated individuals (CDC, 2003). Although vaccination is offered to some inmate populations in state and federal correctional settings, universal immunization is not common (Khan et al., 2005).

HIV/AIDS At year end 2003, there were 23,659 inmates in state and federal prisons known to be infected with HIV (BJS, 2005d). Female prisoners were more likely to be HIV positive than male prisoners. Overall, 1.9 percent of male inmates and 2.8 percent of all female inmates were known to be HIV positive. In two states, more than 10 percent of the female inmate population was HIV positive (New York State: 14.6 percent; Maryland: 11.1 percent).

The overall rate of confirmed AIDS cases among the prison population (0.51 percent) was more than three times the rate in the U.S. general population (0.15 percent). In 2002 the percentage of deaths from AIDS was more than two times higher in the prison population than in the U.S. general population among individuals ages 15 to 54 years. About 1 in every 11 prisoner deaths were attributable to AIDS-related causes compared with 1 in 23 deaths in the general population. AIDS is the second leading cause of death in prisons (BJS, 2003d).

Tuberculosis Tuberculosis (TB) is an airborne disease that thrives among people who live in close quarters (Restum, 2005). About 12,000 people who had active TB during 1996 served time in a correctional facility

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