citing First Amendment freedoms. Some faith-based initiatives promote the positive effects of correspondence on inmates, and some have made efforts to help ex-offenders reintegrate into society through job placement assistance. Inmates' ability to mail letters to other inmates has been limited by the courts. Conditions The non-governmental organization Human Rights Watch claims that prisoners and detainees face "abusive, degrading and dangerous" conditions within local, state and federal facilities, including those operated by for-profit contractors. The organization also raised concerns with prisoner rape and medical care for inmates. In a survey of 1,788 male inmates in Midwestern prisons by Prison Journal, about 21% responded they had been coerced or pressured into sexual activity during their incarceration, and 7% that they had been raped in their current facility. In August 2003, a Harper's article by Wil S. Hylton estimated that "somewhere between 20 and 40% of American prisoners are, at this very moment, infected with hepatitis C". Prisons may outsource medical care to private companies such as Correctional Medical Services (now Corizon) that, according to Hylton's research, try to minimize the amount of care given to prisoners in order to maximize profits. After the privatization of healthcare in Arizona's prisons, medical spending fell by 30 million dollars and staffing was greatly reduced. Some 50 prisoners died in custody in the first 8 months of 2013, compared to 37 for the preceding two years combined. The poor quality of food provided to inmates has become an issue, as over the last decade corrections officials looking to cut costs have been outsourcing food services to private, for-profit corporations such as Aramark, A'Viands Food & Services Management, and ABL Management. A prison riot in Kentucky has been blamed on the low quality of food Aramark provided to inmates. A 2017 study from the Centers for Disease Control and Prevention found that because of lapses in food safety, prison inmates are 6.4 times more likely to contract a food-related illness than the general population. Also identified as an issue within the prison system is gang violence, because many gang members retain their gang identity and affiliations when imprisoned. Segregation of identified gang members from the general population of inmates, with different gangs being housed in separate units often results in the imprisonment of these gang members with their friends and criminal cohorts. Some feel this has the effect of turning prisons into "institutions of higher criminal