The TB ‘health crisis’ in Latin American jails

High rates of tuberculosis (TB) in Latin American prisons are subverting efforts to control the disease in the wider population, and constitute a “health and human rights crisis”, a study warns.

According toresearch出版于柳叶刀该地区监狱中的结核病案件从2011年报告的总案件的五％增加到2017年的11.1％。中美洲和南美的监禁人口占总人口的百分之一。

“The health and human rights crisis of tuberculosis among PDL (people deprived of their liberty) and their communities demand urgent action and sustained attention from ministries of health and justice and the global medical community,” the study’s authors warned.

“越来越多的证据表明监禁使人们面临更高的疾病风险，这种风险扩大到邻近社区。”

Katharine Walter, epidemiologist, Stanford University

In Venezuela and El Salvador the problem is particularly acute. In Venezuela, in 2011, 1.8 per cent of reported TB cases were registered in prisons, but in 2017 that percentage rose to 15.5 per cent.

In El Salvador, 225 TB cases – 11 per cent of the total – occurred in prisons in 2011. Six years later, 1,889 cases – 51.5 per cent of all reported cases – were found among detainees.

In both Central and South America, the increase in the disease among prisoners surpasses advances in tuberculosis control achieved among the general population, the study found.

This high incidence of the disease in prisons also increases the risk of TB beyond prison walls, to prison workers and the families of detainees, researchers warn.

Epidemiologist Katharine Walter of Stanford University, USA, co-author of the study, said: “There is growing evidence that incarceration puts people at higher risk for diseases and that this risk extends to neighbouring communities.”

Latin American prisons – described by Walter as “inhumane” – are overcrowded and poorly ventilated, with prisoners often lacking access to proper healthcare and nutrition, the study notes, providing perfect conditions for infections to spread.

“The most direct way to cut the over risk of TB infection in jails is reducing the growing number of people incarcerated in these settings with a high risk of transmission,” Walter added.

该研究警告说，如果情况不受限制，耐药性也会带来风险。它指出：“尽管在许多东欧国家所见，尽管中部和南美尚未受到监狱耐药性结核病的影响，但目前的轨迹表明，还应密切监测耐药性。”

Sociologist and epidemiologist Maria Belen Herrero, who did not take part in the research, said the highlights “a real problem, which is the situation of TB in prisons and the need to address the problem urgently”.

然而，拉丁美洲社会科学学院（Flacso）的阿根廷研究员赫雷罗（Herrero）说，囚犯中的结核病是“是一个重要方面，但这并不是最终解释该地区疾病状况的原因。”

TB is a disease “strongly determined by the social context and by living conditions and often the result of the occurrence of TB cases in jails is a reflection of all this and it is not so much the origin of the problem,” Herrero added.

Zulma Rueda, co-author of the study and epidemiologist at the University of Manitoba, Canada, believes that to solve the problem we must understand that imprisoned people “are human beings and TB cannot become part of their sentence”.

她说，对结核病计划，更大的政治意愿，对研究的财政支持以及对疾病的有效治疗的投资至关重要，并解决了通常与结核病相关的污名。

Rueda说：“许多研究报告说，污名和歧视是如何成为及时护理，在治疗后获得成功结果的障碍。”