Southern Caucasus: Eliminating tuberculosis in prisons

Prisoners are particularly vulnerable to this deadly epidemic. Not only do they come from the most vulnerable sectors of society, but prison living conditions and frequent overcrowding favour the spread of the air-borne bacteria, making TB epidemics even worse. Moreover, HIV is fuelling the TB epidemic by destroying victims’ immune systems.

On World Tuberculosis Day 2003, the international community commemorates the discovery of the TB bacillus, a discovery that opened the modern era of the fight against the disease. The current approach to fighting this epidemic, recommended by the World Health Organisation, is known as “Directly Observed Treatment Short” (DOTS). This is the strategy that the ICRC has adopted in the prisons of the Southern Caucasus.

Economic collapse in the former states of the Soviet Union led to the collapse of health care. Ill prisoners were left untreated or were given little care. If left untreated, one prisoner with active TB will infect an average of between 100 and 150 inmates every year. Prisoners with TB were self-treating, but were not using anti-TB drugs correctly, rendering the bacillus resistant to most of the antibiotics used in DOTS and creating the multi-drug resistant strain of TB (MDR-TB). This, the most deadly form of the disease, is currently spreading through prisons, but it will not remain confined to the prison system, as prisoners are eventually released. ICRC action includes ensuring universal access to DOTS in the prisons of the Southern Caucasus. Steps will be taken to address the MDR-TB epidemic, curing prisoners who are ill, protecting those who are not and ultimately benefiting society as a whole.

Next year will mark the 10th anniversary of the ICRC TB programme in the prisons of Azerbaijan. The ICRC also runs TB programmes in Armenian and Georgian prisons, and has treated over 7,000 prisoners with TB. Around 80% of the patients who followed DOTS in prisons were cured, proving that the method works even in the difficult environment of a prison. DOTS is not just treatment; it also restores prisoners’ dignity as they receive medical care and the attention of medical and administrative staff. The partnerships established with the ministries of justice and health, and with others involved in fighting TB, play a vital role.

The aim is to bring TB under control in the prisons of the Southern Caucasus within the next decade or so. In Georgia, the number of prisoners falling sick with TB has already been cut by half. However, sustaining and building on this achievement will require investment in all sectors of civil society. Investment in health promotes human rights and reduces inequality.

 Further information: Annick Bouvier, ICRC Geneva, tel.: ++41 22 730 24 58