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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

While the hepatitis C epidemic is substantial in the country as a whole, it has become a major concern in correctional settings. Prevalence of Hepatitis C Virus infection in prisons is 8- to 20-fold higher than in the community, with infection rates between 16-41 percent and evidence of chronic infection in 12-35 percent (Centers for Disease Control and Prevention, 2003). An estimated one out of three Americans with chronic hepatitis C infection rotate through correctional facilities annually (Hammett, et al., 1997). Despite slow progression of most infections, illness and death within correctional systems is already substantial, likely explained by a large number of infections acquired decades ago. Hepatitis C infection is a leading cause of illness and death among in-custody inmates in some correctional facilities (Allen, 2003; D. Reiger, personal communication, 2002) and an emerging cause in others (J. Paris, personal communication, 2003).