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Prisoners' HIV/AIDS Support Action Network (PASAN) CATIE

Staying Healthy Behind the Walls: Hepatitis C and HIV in Prison

10 things to know about Hep C and HIV if you are in prison

The rates of hepatitis C (Hep C) and HIV are higher in prison than in the community.
You can do many things to protect yourself and others from Hep C and HIV while in prison.
Hep C is an infection that attacks your liver. HIV is an infection that makes it difficult for your body to fight infections.
Hep C or HIV can be passed when sharing equipment to inject or inhale drugs.
Hep C or HIV can be passed when getting a tattoo with equipment that hasn’t been sterilized.
HIV can also be passed through sex. Sex is low risk for passing Hep C but the risk increases with condomless anal sex where blood, HIV and other STIs are present.
Getting tested for Hep C and HIV is the only way to know for sure if you have Hep C or HIV. You can get tested by making an appointment at healthcare with the nurse.
Hep C treatments can cure Hep C. There is no cure for HIV but there are treatments that can help a person stay healthy for a long time.
You can do many things to take care of your health if you have Hep C or HIV.
If you need support or have questions about Hep C or HIV, you can talk to a Peer Education and Counselling (PEC) worker or call PASAN (1-866-224-9978) or CATIE (1-800-263-1638).

What is Hepatitis C?

Hepatitis C (also known as Hep C, or HCV) is a virus that attacks the liver. If untreated over many years it can lead  to liver damage, liver cancer and liver failure.

What is HIV?

HIV is a virus that makes it difficult for your body to fight infections. This means that you can get sick more easily  and more often.

Why do Hep C and HIV matter if you are in prison?

The rates of Hep C and HIV are higher in prison than outside prison. Hep C is much more common in prison than HIV. That is why it is important to know how to protect yourself and others from these infections.

How do you get Hep C or HIV?

Hep C is passed from one person to another through blood. It may also be passed in semen and anal fluid.

HIV can be passed from one person to another through:

blood
cum (semen/sperm) or pre-cum
vaginal fluid or anal fluid
breast milk

For Hep C or HIV to be passed on, the blood or other body fluid that is infected has to get into the blood stream or body of another person.

Hep C is a strong virus that may be able to survive on a surface for up to six weeks. HIV can only survive on a surface for a few minutes. Both HIV and Hep C can survive inside a syringe for several weeks.

How Hep C and HIV pass from person to person

Hep C and HIV can pass from one person to another when:

people share equipment for injection drugs (works)
people share crack pipes
somebody gets a tattoo or piercing and the artist does not use new equipment, sterilize the tools or re-uses ink

HIV is in cum, pre-cum, vaginal fluid and anal fluid. This means that HIV can pass from one person to another during unprotected sex. Condoms are one kind of protection. Also, people with HIV who take treatment and keep the virus suppressed do not pass HIV through sex. It is not very likely to get Hep C from sex, but the risk increases when blood, HIV or other STIs are present.

Hep C is different from HIV because Hep C can pass from one person to another when people share razors, toothbrushes or nail clippers. This is a less common way of passing Hep C.

Hep C and HIV can pass from a pregnant person to an unborn baby. This is also called perinatal transmission.

It is not clear if bleeding during fighting or using punching bags with blood on them can pass Hep C or HIV, or if  re-using someone else’s menstrual pad can pass Hep C or HIV. If it is possible, the chance of passing HIV or Hep C with any of these activities is likely very small.

Learn how to protect yourself and others from Hep C and HIV while in prison

In prison you don’t have authorized access to new drug use equipment or to properly sterilized tattooing or piercing equipment. Still, there are many things you can do to protect yourself and others.

Most activities in prison do not put anyone at risk of getting Hep C or HIV

You CANNOT get Hep C or HIV from:

sharing a cell or range
using the same showers or toilets
kissing or hugging
shaking hands
using the same forks, spoons, knives, cups or plates
sharing cigarettes or joints
coughing or sneezing
sharing towels, soap or shampoo
playing sports or cards

Can using bleach stop Hep C and HIV?

Using bleach to clean needles before sharing or re-using them is not an effective way to prevent passing Hep C or HIV. Using all new injection drug use equipment is the best way to not pass Hep C or HIV. If you can’t get new injection drug use equipment, try to use some of the strategies from the section “Protect yourself and others while using drugs”.

Protect yourself and others while using drugs

If you can get new injection drug use equipment, use a new needle and syringe every time you inject, or keep your own needle for re-use.
Use new cookers, water and swabs every time you inject, or keep your own supplies for re-use.
If you don’t have new injection drug use equipment, consider switching to drugs you can swallow, eat, smoke or snort, if you have this option.
If you are inhaling drugs, use your own pipe and try not to share it.
If you are snorting drugs, use your own straw or rolled up piece of paper and try not to share it.

People with HIV who take treatment and can keep their viral load undetectable (that is, too low to be measured by blood tests) have a much lower chance of passing on HIV when sharing drug use equipment. HIV treatment doesn’t lower the chance of passing on or getting Hep C or other infections if they are present.

Protect yourself and others while fucking

Use condoms every time you have vaginal or anal sex.

Use water or silicone-based lubricant (avoid oil-based lubes because they can make condoms break).

Avoid sharing sex toys, but if you do, cover them with a new condom and wash the toys with warm, soapy water after each use.

Oral sex (blow jobs or going down on someone) is less likely to pass HIV than vaginal or anal sex.

Even though the chance of passing HIV through oral sex is low you can choose to use condoms or dental dams when you have oral sex.

If you or the person you are having sex with has HIV and the HIV viral load is undetectable (which means that HIV treatment keeps it so low that it cannot be measured), there is no chance of passing HIV during sex. For this strategy to work, a person needs to have two undetectable viral load tests in a row. It can take three to six months for a person to have an undetectable viral load after starting treatment.

Protect yourself and others while getting a tattoo or piercing

When getting a tattoo or piercing, prepare and bring your own equipment if you can. That way you can be sure that everything is new, including:

the needle
the ink
the ink pot
the rag

If you don’t have your own equipment, ask the tattoo artist to prepare the tattoo machine, ink and work area in front of you so you know it is new.

If you are getting multiple sessions on the same tattoo or think you will get another tattoo or piercing, save your equipment for the next time.

For more info, check out Staying Healthy Behind the Walls: Tattooing, Piercing and You.

Protect your personal items

Try to avoid sharing razors, toothbrushes and nail clippers. There may be blood on them that is too small to see but  could pass Hep C.

Protect yourself and your baby while pregnant and after the birth

If you have Hep C, the chance of passing it to your baby during pregnancy or delivery is low. It is OK to breastfeed your baby but if your nipples are cracked and bleeding, it is important to stop until they heal.

If you have HIV, it is possible to have an HIV-negative baby. You need to get proper HIV care and treatment during pregnancy and birth. It is also important not to breast feed your baby because HIV can be passed through breastfeeding.

If you have Hep C or HIV and are pregnant, tell your healthcare team about your status so they can give you the right care.

Get tested for Hep C or HIV

It is important to get tested for Hep C and HIV because the rates of these infections are higher in prison than outside.

The only way to find out if you have Hep C or HIV is to get tested. You can’t tell if someone has HIV or Hep C by looking at them. Many people do not feel any symptoms after they get Hep C or HIV.

Some people may not want to get tested for Hep C or HIV because they are afraid to know the results or they don’t want to be discriminated against. If you are close to getting out of prison, you may want to wait to get tested in the community as there are more options for care. The benefits of knowing your status are that you have the option of getting treated earlier and you can help to protect others from Hep C or HIV.

If you have any questions before or after you get tested, you can contact PASAN at 1-866-224-9978 or CATIE at 1-800-263-1638.

Hep C testing: It takes two different blood tests to find out if you have Hep C. A person who tests positive for both tests has Hep C.

HIV testing: The HIV test is a blood test. If you test positive that means you have HIV.

When to get tested for Hep C and HIV

It is a good idea to get tested for Hep C and HIV if you have ever had unprotected sex, shared drug use equipment or gotten a tattoo or piercing outside of a professional shop (such as in prison).

If you think you might have been exposed to Hep C or HIV recently, you can get tested right away. In these cases, you should also get another test three months later to know for sure whether or not you have been infected. This is because it can take some time for your body to produce the reaction that confirms the infection.

What if you find out you have Hep C or HIV?

If you’ve been diagnosed with Hep C or HIV, you may feel fear, anger, sadness and other emotions. It is very normal to feel this way. Getting support can help. If you feel comfortable, talk to a family member or friend about what you’re going through. A lot of prisoners who have Hep C or used to have Hep C are open to sharing their experiences and supporting other prisoners with Hep C. You can also call PASAN or another community agency.

It’s important to know that you can live well with Hep C and HIV. There is Hep C and HIV treatment available inside and outside of federal prisons. Treatment has a high chance of curing Hep C, and HIV treatment can’t cure you but it can help you stay healthy for a long time.

Being HIV positive in prison can be hard

Health information should be confidential, but in prison keeping your health information confidential can be more difficult than on the outside. Some people may think they have a right to know if their cellmate or someone on their range is HIV positive. Some people don’t understand how HIV is transmitted and may not want to share a cell or range with someone who is HIV positive, even though you can’t get HIV from sharing a cell or a range. Prisoners with HIV are sometimes discriminated against verbally, emotionally and/or physically. Also, there can be more barriers to health care in prison than in the community.

In spite of these challenges, you do have rights, whether you have HIV or Hep C.

These are your rights in prison related to your health care:

You have the right to have your health information kept confidential even in prison.
People do not have the right to know your HIV or Hep C status, even if they think they do.
You have the right to not be discriminated against because of your HIV or Hep C status.
You have the right to health care in prison, even though getting the health care you need doesn’t always happen.

If you are living with Hep C or HIV in prison and you need support to advocate for your rights, you can call PASAN and they will support you or try to connect you with a community organization that supports prisoners in your area.

Living with Hep C and HIV: Staying Healthy

If you test positive for HIV or Hep C in prison, there are a lot of things you can do for yourself to stay healthy:

Learn about the treatment options for Hep C and HIV. There are treatments that can cure Hep C and HIV treatments that can keep you healthy for a long time.
It may be difficult to maintain a healthy diet in prison,  but do the best you can.
If you are having trouble eating enough calories, see if you can access nutritional supplement drinks like Ensure. If people ask why you are getting Ensure and you don’t want to tell them you have Hep C or HIV you could say it’s for another health issue like diabetes.
If you have Hep C, drink coffee. Many studies show that a few cups of coffee a day may reduce the risk of developing liver damage or liver cancer. If you like to put sugar in your coffee try not to use too much because that can be bad for your health.
Drink water. Try to get at least 7 hours of sleep. Exercise regularly – this can help to increase your appetite and manage stress.
Get regular health check-ups.
Try to reduce your stress by talking to someone you trust or doing exercise or meditation. Even taking deep breaths may help you feel more calm.
Get the hepatitis A and B vaccines if you haven’t gotten them already. Getting another infection can make your liver worse.
Drinking alcohol is hard on the liver, so try to cut down or stop.

If you have HIV and are experiencing numbness, tingling, burning and pain in your toes, feet, lower legs, hands or arms this could be a health problem called neuropathy.

Here are a few things you can do:

talk to someone in health care; they can help you figure out what is causing it
limit the amount of walking you do
avoid wearing tight-fitting shoes and socks
avoid standing for long periods

If you are taking Tylenol or Advil

Some people take acetaminophen (Tylenol) or ibuprofen (Advil) to manage pain. It is important to be careful about how much you are taking because taking too much acetaminophen or ibuprofen can cause liver injury and even liver failure. Talk to your doctor about how much acetaminophen or ibuprofen is safe for you. Also, it can be risky to your health to combine alcohol and acetaminophen.

It’s a good idea to tell a practitioner you trust if you are taking any medications purchased from the canteen.

Hep C and HIV Treatment

Good treatments are available for both HIV and Hep C.

Hep C treatment has changed a lot. New treatments have high cure rates, few side effects and short treatment lengths. Hep C can be cured!

For people living with HIV, medical experts recommend starting treatment as soon as possible after being diagnosed with HIV, because people are often healthier when they do this. There are many HIV treatments that are easy to take and have few side effects.

If you want to know more about treatment, speak to the nurse or the institutional doctor or you can request to see a specialist.

You can also speak to other prisoners who know about Hep C  or HIV or you can reach out for support by calling PASAN at 1-866-224-9978 or CATIE at 1-800-263-1638. Both organizations are able to accept calls from federal institutions.

Remember that you are not alone! PASAN is a great resource for support and information about your diagnosis and treatment options or if you just need to talk about what you’re going through.