PITTSBURGH -- When Charles White was sentenced to prison in Oregon for robbery five years ago, he knew nothing about hepatitis C. It was only after his release in December that he found out he was infected with the blood-borne virus.

A prison doctor had told him he had high liver enzymes -- a telltale symptom of the sometimes fatal condition -- and cautioned him against taking aspirin or drinking coffee. Nothing more.

"I asked him, 'What does that mean?"' White said. "He didn't answer my questions, he didn't tell me about hepatitis C, he didn't counsel me."

Inmate advocates say White's experience is common in America's prisons, where a staggeringly high 18 percent of inmates are infected, compared with 1.6 percent of the overall population, according to the Centers for Disease Control and Prevention. That translates into about 360,000 out of the nation's 2 million inmates.

Hepatitis C is spread by intravenous drug use and, in rare instances, transfusions or sex. It can cause jaundice, fatigue, pain and vomiting and gradually affects the liver, leading to cirrhosis and liver cancer.

About 4 million Americans are infected and about 8,000 people die of the disease each year.

The problem in prisons may be bigger than the numbers themselves: Health care experts still do not agree whether prevention counseling or treatment is the best way to fight the epidemic in prisons.

That is because the liver infection develops slowly and can now be treated only with expensive drugs that have potentially serious side effects and sometimes low rates of success. Liver transplants are an option, but waiting lists are long.