In April 2001, prison inmate Winston K. Goforth tested positive for hepatitis C. Despite his repeated requests for treatment, it was two years before state prison officials ordered a liver biopsy to determine the progression of his illness, according to a complaint filed in federal court.

A prison system gastroenterologist prescribed an expensive drug to treat his disease, a viral infection of the liver that can be fatal. But the prison system's medical director countermanded the decision, according to the complaint.

To this day, according to his suit, Goforth has received no other treatment besides periodic blood tests. And his time may be running out.

"This is an action to compel the Georgia Department of Corrections to provide Mr. Goforth with adequate treatment, without which he may suffer further liver damage and die," his lawsuit says.

Sarah Geraghty, a staff attorney for the Atlanta-based Southern Center for Human Rights, said the center has heard from numerous prison inmates like Goforth who have been denied treatment for hepatitis C. And those people are not going to leave their disease behind when they get out of prison, she said.

"The uncontrolled hepatitis C within the prison system is not just going to affect people in prison," Geraghty said. "It's going to affect everybody. Almost everybody who comes into prison is going to get out of prison."

State prison officials say about 2,800 inmates have been diagnosed with hepatitis C. But testing is voluntary, so the total number of cases is unknown.

"Consequently, descriptions on whether the disease prevalence is increasing, stable or decreasing are only estimates. The hepatitis C prevalence appears stable at this time," Department of Corrections spokeswoman Peggy Chapman said in an e-mail.

She declined to comment on Goforth's suit because it is pending litigation. In a court filing, the Department of Corrections said Goforth's medical treatment in prison was "reasonable and proper."

Goforth, serving a 10-year drug sentence at Men's State Prison in Hardwick, filed a pauper's lawsuit in March 2002 in U.S. District Court in Macon to force the state to treat him. He got nowhere until this year, when the 11th U.S. Circuit Court of Appeals ruled that he had been denied access to his medical records. In May, the Southern Center took on his case. Last week, U.S. Magistrate Claude Hicks reopened the discovery process, allowing lawyers to take depositions and examine the medical records.

"(Goforth) contacted us at a time when we were investigating the treatment provided by the Georgia Department of Corrections for this particular illness," Geraghty said.

Prisons spokeswoman Chapman said via e-mail that hepatitis C treatments are about 40 percent effective, and the strain of hepatitis C prevalent in Georgia prisons is highly resistant to treatment.

"The consequence of these medical facts is that practitioners must consider the odds very carefully with their patients, balancing the likelihood of a failure versus the possibility of ongoing liver damage for untreated patients," she said. "Treatment is offered to those with disease sufficiently advanced to warrant a try with the imperfect therapies available today and who have sufficient time left in their sentence to complete the treatment and follow up testing."

Goforth's suit contends that prison officials denied him treatment because he has cirrhosis, a liver disorder. But his lawyer said his cirrhosis has not progressed to the point where treatment would no longer help.

She also cited a Federal Bureau of Prisons guideline that says hepatitis C patients with cirrhosis should be considered "priority candidates for treatment."

Goforth's suit also says he was denied because officials said he may be paroled before the treatment is up.

Madie Lamarre, a nurse practitioner and former clinical services manager in the office of health services for the Georgia prison system, said hepatitis C is one of several diseases that typically shows up at a higher-than-normal rate in prison.

She said hepatitis C is spread by blood-to-blood contact. Among drug abusers, who represent a large percentage of prison inmates, that typically stems from shared hypodermic needles. Inside prison, she said, hepatitis C is commonly spread when inmates get tattoos. She also said as many as 25 percent of people who get hepatitis C get rid of the infection on their own without treatment. Eight out of 10 people with hepatitis C do not develop cirrhosis.

"As a general comment, prisons house people with a much higher incidence of communicable diseases than is in the general population," Lamarre said. "That's well-documented. If the prison systems don't do a good job of controlling communicable diseases in prison, most inmates are released to the community, and it increases the risk to the public health. That's why it's very important that prison systems all over the United States cooperate and collaborate with public health to do things to take steps to reduce the risk of communicable diseases in prison.

"I think the Georgia Department of Corrections historically has done pretty well at collaborating with public health, but there's a lot more to be done."

She said prison systems should consider providing sterile settings for prisoners to do their tattooing. She also said the spread of hepatitis B and HIV could be slowed if prisons acknowledged the reality of prison sex, and distributed condoms.

"It's been done in other states," she said. "It's done in Europe, it's done in Australia, it's done in Canada. It should be done because it's the right thing to do for public health. People get upset because they think it's about condoning sex. That's not what it's about. It's the right thing to do for protecting public health."