Latin America: prisons are an ideal breeding ground for tuberculosis
Tuberculosis (TB) poses a serious threat to public health, and the incidence of the disease can be 20 times higher in places of detention than among the general population. Alain Vuilleumier, ICRC doctor for Bolivia, Ecuador and Peru, explains why this is and how the ICRC is supporting prison services in the region.
Unfortunately, there is currently no system in place in Latin America for gathering information on health in prisons. This makes it difficult to learn about and assess the prevalence of health problems suffered by detainees. Some studies have given us an idea of the current situation for tuberculosis, a major cause for concern in terms of both prison and public health.
Surveys were carried out by the Pan American Health Organization in 2003 and 2007 on tuberculosis in prisons in several Latin American countries. Both surveys showed that the incidence of tuberculosis in prisons in those countries was up to 20 times higher than in the rest of the population. Prisons in Peru and Bolivia were the most severely affected.
Why is there such a high concentration of TB cases in prisons?
Prison conditions favour the transmission of tuberculosis, make development of the active form of the disease more likely, and increase the possibility of complications, all of which explains the high percentage of TB sufferers.
To prevent the disease from spreading, prisons need to combat overcrowding and premises must be clean, well ventilated, and have enough natural light. Inmates also need a healthy diet to build up their immune systems. In Latin America, the problem of tuberculosis in prisons is tackled piecemeal, which promotes development of the active disease, and far worse, of drug-resistant bacilli.
How can we fight the spread of this disease in the prison environment?
If tuberculosis is to be brought under control, a prison must have the facilities to isolate suspected or confirmed cases during the most contagious stage - when patients begin their treatment. Some prison services are able to offer this, but in most Latin American prisons, there is simply not enough space. This is one factor pointing to poor control of the disease in prisons. However, it is only one of many indicators, most of which are linked to difficulties in diagnosis and treatment.
When tuberculosis is suspected, a patient should be isolated, tested and diagnosed. If it is indeed tuberculosis, he should begin treatment as soon as possible. Treatment lasts for six months and the drugs have to be taken every day. It is an gruelling regime, and must be strictly followed. If treatment is not completed, the bacilli may become resistant to the drugs, which will create complications once the patient restarts treatment.
What is the role of health promoters in prisons?
Health promoters play a crucial role, since they educate inmates on the symptoms of tuberculosis. Responsibility lies with inmates themselves to seek medical attention if they develop symptoms, so they need to be aware of them. Health promoters educate the prison population, and facilitate the inmate's transfer.
Is there any way to control transmission of the disease between the prison population and visitors?
Prisons are a real breeding ground for tuberculosis, with a very high number of cases. Tuberculosis goes hand-in-hand with another serious disease, HIV/AIDS. This is mainly because HIV/AIDS patients have compromised immune systems, which makes them more likely to develop active TB.
Prisons are not hermetically sealed environments: detainees are released, and relatives and medical staff visit. All of them can carry the disease between the prison and the outside world. In public health terms, the disease can be controlled, but action must be taken to address the serious situation within prisons. It is important for control of the disease at a national and continental level.
Can anyone catch the disease?
Many people who are exposed and become infected do not go on to develop the active disease because they have strong immune systems. These people have the bacilli in their bodies, but the microbes lie dormant. However, if their immune systems are compromised in the future, they may develop the active form of the disease. We are all at risk.
Among Latin American countries, Peru has one of the highest incidences of TB in prisons. What is the ICRC doing to help combat the disease?
Since 2000, the ICRC has been working very closely with the Peruvian authorities for prison health. The ICRC is gradually reducing its activities with a view to handing over responsibility to this body, which will continue to run the programmes and implement health-system reform. Progress has already been made in the control of tuberculosis and HIV, and also in the provision of compulsory insurance for inmates. Other organizations are supporting the national authorities by funding a study into the prevalence of HIV among the prison population.
Tuberculosis in Peruvian prisons has never been so tightly controlled. Huge efforts have been made, and major projects, financed by the Global Fund, have been set up to boost control of tuberculosis and HIV/AIDS. Control mechanisms have vastly improved and we have better, more reliable statistics all the time. We are getting closer to the heart of the problem in Peru, but we must not let our guard down. Medical staff must always receive support, and specific activities must be planned to tackle the problem. Health-care workers are responsible for implementing strategies in the long term.
It is first and foremost in the areas of supervision and planning that the ICRC will continue to support prison health in Peru.