Next-generation hepatitis C virus (HCV) treatment has been available for over five years, but, according to public health statistics, the epidemic is far from over. As advocates continue to push for legal and political fixes to stem the tide of infections, many are now arguing it simply cannot be done without first tackling the epidemic in our nation’s prisons, U.S. News reports.

According to the Centers for Disease Control and Prevention (CDC), prevalence of hepatitis C among prisoners is thought to be around 17 percent in the United States—compared with a prevalence of just 1 percent among the general population. Former inmates are also considered to be one of the most at-risk groups for spreading the blood-borne virus via intravenous drug use and, less often, sexual contact.

“Since the prison system has the highest concentration of people living with the virus, failure to scale up treatment in prisons dooms any effort to eliminate hepatitis C in America,” states a 2018 study conducted by researchers at Yale University. The study, a follow-up to a landmark study published two years ago, found that hepatitis C spiked more than 200 percent in 30 U.S. states since the period between 2010 and 2014.

The problem is, with cure costs averaging $20,000 per patient for a standard eight- to 12-week course of treatment in the corrections system, many prisons aren’t willing to pay for hepatitis C treatment for their inmates. Because of the U.S. Constitution’s Eight Amendment ban on cruel and unusual punishment, health officials are not allowed to deny inmates access to treatment for serious health needs. Still, the vast majority of inmates with hep C in America still aren’t receiving cures.

Over the past few years, advocates have filed class-action lawsuits in nearly a dozen. states to spur change and drive down infection rates among incarcerated populations. Cases in Massachusetts and Colorado have been settled. A Pennsylvania settlement is currently awaiting approval by a federal judge. Other lawsuits in Indiana, Alabama, Missouri, Tennessee, Idaho and North Carolina are trying to push federal judges to order prisons to comply with treating prisoners for hepatitis C on a set timeline—which is exactly what happened in Florida two years ago, expanding access to treatment for thousands of prisoners across the state.

To learn more about hepatitis C in prisons and why access to treatment is important, click here.