Prison Health is Public Health: A Talk with an Ardent Advocate

Dr. Matthew Akiyama is the face of compassion in medicine. His entire clinical and research career has been devoted to advancing health equity in unequitable environments.

The prison system is one of those environments. It is fertile ground for infectious diseases. Incarcerated populations have high rates of hepatitis C — 10%-20% of the 2.1 million people incarcerated in U.S. jails and prisons are estimated to be infected. People with lived and living experience of incarceration have also suffered disproportionately from COVID. Yet, they have largely been left out of public health and policy efforts to prevent or mitigate these diseases.

Dr. Akiyama, who is an associate professor in the department of medicine (general internal medicine) and attending physician at Montefiore Medical Center in internal medicine and infectious diseases, has received global recognition for his commitment to improving the care for the most at-risk and stigmatized populations. 

He has received several grants — over 10 in the past five years alone – as principal or co-investigator. Here are just a few.

  • Five-year, $3.4 million R01 grant from National Institutes of Health (NIH) to test a program aimed at reducing COVID transmission among people recently released from incarceration.
  • Four-year, $2.5 million Avenir Award from NIH/National Institutes of Drug Abuse (NIDA) to study new sequencing technology for the prevention and treatment of HIV and hepatitis C among at-risk people who inject drugs in Kenya.
  • Five-year, $1.1 million K99/R00 award from NIH/NIDA to develop and study an enhanced model for linkage to care among people living with hepatitis C post-incarceration.
  • Two-year, $1.3 million grant from NIH/NIDA on wastewater-based testing for COVID in correctional populations.
  • $650,000 grant from the Bill & Melinda Gates Foundation to evaluate wastewater and nasal self-testing as a strategy to control COVID in correctional settings.

We spoke with Dr. Akiyama to learn more what motivates him.  

What inspired you to devote your career to medically underserved, marginalized, and vulnerable populations?

One of the most influential factors in my career was undertaking a Master of Science in medical anthropology. Medical anthropology helps frame how historical, socioeconomic, and political forces shape health and illness and provides a lens on how these forces unpin health disparities and exacerbate structural violence. That's been a thread that's run through my residency, fellowship, and transition to Montefiore. I also can't say enough about the importance of mentorship. My mentors in the division of general internal medicine have been incredible role models and have been instrumental in helping me launch an independent research career.

As an infectious disease fellow, I helped to staff the Correctional Health Clinic at Bellevue Hospital where patients were brought from the New York City jail system. The majority of our consults were for hepatitis C, and it was clear that this was a major public health problem locally and in the nation's carceral system as a whole that was only going to get worse.

This was when my clinical and research focus shifted to the epidemiology of hepatitis C in carceral settings and care delivery models to maximize engagement for this highly marginalized population.

How did you get involved with the International Network on Health and Hepatitis in Substance Users (INHSU)—Prisons Network?

Hepatitis C is the most prevalent infectious disease in carceral settings affecting millions of people worldwide. Yet, few receive care and treatment. Our goal was to establish international collaboration to build political will and promote knowledge exchange on best practices for the management of hepatitis C in carceral settings globally. We want to get political leaders on board to recognize that there's a problem in their carceral systems and that addressing it is not only a critical human rights issue but also essential for public health because 95% of people who are detained return to the community. The borders are very porous and there's a strong interrelationship between infectious diseases found in carceral settings and marginal populations in the surrounding community.

What's the most rewarding part of your work?

To see the impact of culturally sensitive care provided to the Bronx community we serve and to design and implement studies that generate evidence to change policy and improve care is one of the most gratifying things that I have been able to do.