Tennessee prisons are currently facing a massive epidemic of hepatitis C virus (HCV), with nearly one in two inmates testing positive for the virus in 2015. However, health advocates say the state has routinely denied its prisoners access to hepatitis C testing or treatment, in an illegal move designed to save on costs, The Tennessean reports.

The revelations are part of a recent two-part investigative series by the Nashville newspaper focusing on hepatitis C in Tennessee prisons. Part one examines how HCV is largely untreated among inmates due to a “don’t ask don’t tell” attitude toward the disease in prisons across the state. Part two analyzes the public health impact of the Tennessee prison epidemic.

According to those reports, hepatitis C reached “epidemic” levels in the Tennessee prison system last August. Of the 901 inmates tested in 2015, 424 tested positive for hepatitis C. So far, only eight of the 3,487 inmates currently known to have hepatitis C in the state system are receiving treatment. Reports also show that prison officials across Tennessee are refusing to test all inmates for the disease, knowing that the law (and the constitution) would require them to treat those who test positive.

However, prison officials say paying for hepatitis C treatment (which can cost $84,000 or more per person) for every HCV-positive inmate would bankrupt the Department of Correction. Even if the Tennessee prison system spent all of its annual $1 billion budget on hepatitis C treatment, it might not cover the cost of the cure for every person with hepatitis C. Today, there are more than 20,000 inmates in Tennessee state prisons, with almost 11,000 admitted and 5,754 released last year alone.

Prison advocates say the potential impacts of Tennessee’s failure to acknowledge the hepatitis C epidemic among its prison population could be devastating to public health as a whole. Currently, the prisons don’t tell victims of rape, assault or other crimes whether their attackers have tested positive for HCV (which is common protocol in the state for other blood-borne illnesses, like HIV). Reports also show that prisoners are routinely given outdated or false information about hepatitis C treatment in an attempt to dissuade them from taking it, such as that it is difficult to predict who will “respond to treatment,” that treatment has “serious side effects” and that current regimens rely on injections every week for 48 weeks.

To read part 1 of The Tennessean’s coverage, click here. To read part two, click here.