Hep C cases behind bars outstrip those on the street by almost 10 to 1, and in a recent survey, 23 percent to 41 percent of prisoners in the United States had hepatitis C virus (HCV). Within the walls, the chance of being coinfected with HIV and HCV can also be much higher than outside the walls. So if you have both HIV and HCV, you’re far from alone.

If you are lucky, your prison follows proper guidelines for HIV and hep C testing and treatment, with a sympathetic, knowledgeable medical staff. But many don’t: Only 24 states test prisoners for HIV, and hep C screening is even spottier.

Because people living with HIV more often have hep C than people who are HIV negative, for once, HIV could give you an advantage. As Frederick Altice, PhD, of Yale School of Medicine, says, “Generally, I think, prisoners known to be HIV positive—but not others—are screened for HCV.”

That might not be true where you are though. If you’ve tested positive for HIV, make sure you’ve had an HCV test too. If not, ask for it: Federal health agencies recommend HCV screening for prisoners.

Then there’s treatment. Altice and others say most states don’t offer access to HCV treatment in prison. “Cost—especially for the newer drugs—is a major factor,” adds Josiah Rich, MD, professor of medicine at Brown Medical School in Rhode Island. Cost makes many prisons reluctant even to test for HCV, Rich says.

What’s a C-sick prisoner to do? Become your own advocate. Learn about hepatitis C and HIV, and take steps to preserve your health.

Prison Pointers

Know the Guidelines The Federal Bureau of Prisons and many state systems have guidelines on HIV and HCV. Ask your counselor, medical staff or prison law librarian for them. Or have an outside friend print them from the Internet (some are available at hcvinprison.org/treatment-guidelines).

Learn about monitoring and treating hep C (Click here to read “Double Trouble”) so you can discuss your care with the doc.

Be Your Own Health Team
Be wise: Promote liver health by drinking more water, exercising and eating less fat. Avoid hootch, cigarettes and drugs, including other people’s meds.

Tat not: Prison tattoos can spell trouble—with a capital C. Free world tat parlors are regulated, with sterilizing equipment and disposable needles. In the joint, those precautions aren’t available, and bleach (if you can get it) won’t do. Reused ink can spread HCV too.

Use your own: Don’t share razors, toothbrushes, nail or hair clippers or—above all—needles and rigs. If you mess around, be safe. If you can’t be safe, don’t mess around.

Pester the tester: If you haven’t been tested for hep C (or HIV), ask. You may have to file grievances to get results.

Follow through: If you have hep C, the next step is getting liver tests to see whether you need treatment.

Exert viral control: Take your HIV meds to stay healthy and help you manage coinfections like hep C. Getting hep C treatment? Make sure you take all those meds too. Ask the medical staff for help managing any side effects. Discuss possible drug interactions, especially if you can get the newest HCV meds.

Know the staff: Learn the names of medical personnel so you can address queries and complaints appropriately. Be patient and polite while being persistent.