United States: ‘You’re going to let me die from this’, prisoners fight to access a hepatitis-C cure

On May 15, 2017, after serving 37 years, David Maldonado was released from prison. He had been sentenced to life for a murder he committed when he was 16. But for Maldonado, getting out was about more than freedom; his release might have also saved his life. In 1997, Maldonado was diagnosed with chronic hepatitis C—a disease, now curable, that the state of Pennsylvania had refused to treat. “Society really didn’t care whether I lived or died,” he told me recently.

Hepatitis C is caused by a virus that infects and inflames the liver; it’s spread through blood, most often via intravenous drug use. Between 75 and 85 percent of those infected with hepatitis C develop chronic hepatitis C, which can lead to liver scarring, liver cancer, cirrhosis, and death. It’s the most deadly infectious disease in the United States, killing around 20,000 people a year—more than the next 60 infectious diseases combined.

Prisons are at the epicenter of this epidemic; an estimated 20 percent of incarcerated individuals carry the virus, compared to about 1 percent of the general population, according to American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD/IDSA).

“A huge concentration of people who have it are incarcerated, and if we don’t cure people in prison, then they’ll be released and it will make it more prevalent on the outside of prison,” said Mandy Altman, the director of the National Hepatitis Corrections Network, an organization that provides hep-C resources to those working in jails and prisons.

In 2011, the Food and Drug Administration started to approve direct-acting antiviral (DAA) medications, which now have a more than 95 percent success rate. The medications have few side effects and require taking as little as one pill a day for eight to 12 weeks. Previous medications cured about half of those who were treated, required weekly injections for months, and could have fatal side effects. Yet, despite having a cure, about 97 percent of prisoners with hep C have not received treatment, according to a survey released last year.

Maldonado told me that he first learned of the cure when he saw a TV commercial. But when he asked the Pennsylvania Department of Corrections (PA DOC) for DAAs, he was denied:

“I said, ‘My sentence is life imprisonment, not death.… You’re going to let me die from this.’”

While Maldonado was incarcerated, he wrote several handwritten pleas to prison officials. “I’m serving a life sentence so I don’t have the option of getting out and seeking treatment at other places,” he wrote in 2015. PA DOC responded that the drug had not yet been approved for use by the Bureau of Health Care Services, a PA DOC entity that oversees medical, dental, and food services.

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