HIV care for prisoners varies greatly in the state of Louisiana. Those sentenced to state prisons receive routine testing and treatment, but prisoners sent to local parish jails are faced with HIV care that is “limited, haphazard, and in many cases, non-existent,” according to a report by the Human Rights Watch and written about in The Marshall Project.

Louisiana has the highest incarceration rate of any state in the nation. It’s so high, in fact, that to reduce overcrowding, about 40 percent of people sentenced to state prisons end up serving time in parish jails. This creates a two-tiered system, in which the state prisoners receive better care.

It also creates economic pressure for local sheriffs to keep jail beds full and reduce costs, notes The Marshall Project. Jail administrators told Human Rights Watch researchers that in many cases they didn’t offer HIV tests to prisoners because if they tested HIV positive the treatment would be too expensive.

Of the state’s 104 jails, only five provide routine HIV testing, according to findings of the report, titled “Paying the Price: Failure to Deliver HIV Services in Louisiana Parish Jails.”

Prisoners reported that family members had to bring them their HIV meds or that they received no treatment at all.

Nationwide, about 1.5 percent of prisoners are living with HIV, which translates to nearly 30,000 people. This is about three times higher than the general population. In Louisiana, 3.5 percent of the state prison population is HIV positive.

“About 30,000 people are in Louisiana parish jails,” according to Human Rights Watch, which adds that “HIV testing is limited so the extent of HIV in parish jails is unknown.”

Below is a Human Rights Watch video based on the report.