Scott A. Allen

From a public health standpoint, the high concentration of patients in correctional institutions with hepatitis C — now a curable contagious disease — presents a critical opportunity to curtail this epidemic.

Provisions of the Affordable Care Act offer new opportunities to apply a public health and medical perspective to the complex relationship between involvement in the criminal justice system and the...

Several recent studies have shown that the racial disparities in U.S. mortality nearly disappear in prisons. We review the social determinants of the recent epidemic of incarceration, especially the war on drugs, and describe inmate morbidity and mortality within the context of U.S. health disparities. Incarceration provides an important public health opportunity to address health disparities by accessing a high-need, medically-underserved, largely non-White population, but it has also been associated with poor long-term health outcomes. Viewing incarceration within the context of community health and community life shows that the more equitable mortality rates among inmates are not evidence of the beneficial effects of incarceration so much as an indictment of disparities in the community at large. Because people of color are incarcerated far more frequently than Whites, the experience may ultimately exacerbate rather than mitigate health disparities.

Despite prior U.S. recognition of “enhanced interrogation” techniques as torture, science was misrepresented to support their use.

Goals To report our experience with pegylated interferon and ribavirin treatment of hepatitis C virus (HCV) RNA-positive inmates at the Rhode Island Department of Corrections. Background An estimated 1 out of 3 HCV-infected individuals will spend time in a jail or prison within a 1-year period, making prisons a unique setting for management of chronic HCV. Study Chart review of all inmates identified as having initiated HCV treatment between October 2000 and April 2004. HCV-infected individuals were identified by HCV antibody screening at intake for known risk factors, elevated aminotransferase levels, or per individual request. Treatment followed standard guidelines with weight-based dosing of pegylated interferon-α2b and ribavirin. End points were completion of therapy plus 6 months for sustained virologic response (SVR), therapy discontinuation, and loss to follow-up. Results The cohort included 71 male patients, was mostly white (80%), and genotype 1 (65%). All 9 African Americans (AA) had genotype 1. Of 59 patients having liver biopsy, 41 had early stage disease. Overall SVR was 28%. Response rate was lower for genotype 1 compared with genotypes 2 and 3 (SVR 18% vs. 60% and 50%). Of inmates with genotype 1, no difference existed in treatment response by race (SVR 22% AA vs. 18% white). Thirty-three patients completed treatment, 26 stopped for side effects, and 5 for initial nonresponse. Eleven were lost to follow-up. Conclusions Acceptable HCV treatment outcomes can be achieved in prisons. Our small study indicates no difference in treatment response by AA versus white race for genotype 1.

HIV/AIDS prevention efforts in Cambodia have largely focussed on urban populations. This focus, however, has diverted attention from the impact of the disease on rural communities, where poverty and a lack of basic infrastructure forced many to migrate to urban areas. Rural communities thus play a crucial part in the understanding of HIV/AIDS transmission dynamics in Cambodia. This paper will provide an analysis of socio-economic and health-related needs of rural communities in Cambodia, giving a different context for understanding the national burden of HIV/AIDS. These concepts will be illustrated with experiences from Project AID Khmer, a Cambodian non-governmental organisation that is working to improve Cambodian health through education programmes and community capacity building in rural Takeo province.