Hepatitis C is an under-diagnosed and prevalent bloodborne illness, resulting in chronic cirrhosis in up to 25% of those infected. While the overall prevalence in the United States is 1.7%, high-risk populations may have up to 80% prevalence. The mechanism of transmission is well understood, but effective preventive measures are hampered by economic, social, and political factors. Antiviral treatment is expensive, and efficacy ranges from 40% to 85%. The value of screening high-risk populations has been demonstrated, and should be expanded; however, there is insufficient evidence to recommend universal screening for adults.