Tuberculosis in prisons
- TB is not an unavoidable consequence of incarceration and can be controlled through the application of Stop TB Strategy-based programmes and improvements in prison conditions.
- Effective TB control in prison protects prisoners, staff, visitors and the community at large.
- ‘Prison’ is a term used for any place of detention. It includes centres for pre-trial and convicted prisoners as well as centres for juvenile offenders and illegal immigrants.
- On any day, it is estimated that the world’s prisons hold 8-10 million prisoners. However 4-6 times this number pass through prisons each year, because of the high turnover of the population.
- A disproportionate number of prisoners come from socio-economically disadvantaged populations where the burden of disease may be already high and access to medical care limited e.g. substance abusers, homeless, mentally ill, ethnic minorities, asylum seekers, immigrants.
- Prison conditions can fan the spread of disease through overcrowding, poor ventilation, weak nutrition, inadequate or inaccessible medical care, etc.
Tuberculosis in prisons
- The level of TB in prisons has been reported to be up to 100 times higher than that of the civilian population.
- Cases of TB in prisons may account for up to 25% of a country’s burden of TB.
- Late diagnosis, inadequate treatment, overcrowding, poor ventilation and repeated prison transfers encourage the transmission of TB infection.
- HIV infection and other pathology more common in prisons (e.g. malnutrition, substance abuse) encourage the development of active disease and further transmission of infection.
Multidrug resistant tuberculosis (MDR-TB) in prisons
- High levels of MDR-TB have been reported from some prisons with up to 24% of TB cases suffering from MDR forms of the disease.
- Factors that encourage the spread of TB in prisons also promote the spread of MDR forms.
- Prisoners may self-treat because of barriers to access to medical care with supplies of anti-TB drugs available through visitors or internal markets. However such supplies are usually erratic and unregulated and promote further development of MDR-TB.
Why is TB in prisons important?
- Prisons act as a reservoir for TB, pumping the disease into the civilian community through staff, visitors and inadequately treated former inmates. TB does not respect prison walls.
- Improving TB control in prisons benefits the community at large. Community TB control efforts cannot afford to ignore prison TB.
- Prisoners have the right to at least the same level of medical care as that of the general community. Catching TB is not part of a prisoner’s sentence.
- Drawing attention and resources to the problem of TB in prisons is likely to lead to an overall improvement in prison conditions, the health of inmates and human rights.
What is the solution?
- The priority strategy must be the widespread implementation of the Stop TB Strategy, particularly addressing TB/HIV coinfection and MDR-TB, in the incarcerated population. Every prisoner should have unrestricted access to the correct diagnosis and treatment of TB.
- Delays in the detection and treatment of TB cases must be minimised to reduce further transmission of infection and pressures to self-treat TB.
- Unregulated, erratic treatment of TB in prisons should cease.
- Urgent action is needed to integrate prison and civilian TB services to ensure treatment completion for prisoners released during treatment.
- Measures to reduce overcrowding and to improve living conditions for all prisoners should be implemented to reduce transmission of TB.