A Tuberculosis Crisis in Central and South American Prisons

The increase in tuberculosis cases in Central and South American prisons explains why the region has not made progress in the fight against the disease, according to a review published in The Lancet, in which ISGlobal, an institution supported by “la Caixa”, participated. The results highlight the need to address the escalating health and human rights crisis in these prisons. 

Tuberculosis kills more people worldwide than any other infectious disease: 1.2 million deaths in 2018 (and an additional 200,000 deaths in people with HIV). Over the last decades, the incidence (i.e. the number of new cases) has declined in almost all regions of the world, except in Central and South America, where it has even increased.    

“The reasons for this increase are not completely clear,” explains Alberto García-Basteiro, ISGlobal researcher and study co-author, “but the data that we reviewed indicate that it is mostly due to an escalating crisis of tuberculosis in prisons.”  

Indeed, the number of incarcerated people in Central and South America has grown in more than 200% over the last two decades, mostly as a result of drug criminalization. The life conditions in these prisons (overcrowding, confinement in poorly ventilated closed spaces, inadequate nutrition, and poor healthcare) increase the risk of many diseases, including tuberculosis.

The study found that 11% of tuberculosis cases reported in Central and South America in 2017 occurred among people deprived of liberty, even if they account for less than 1% of the general population. This is twice the cases reported in 2011 (5%). In some countries, the increase in cases among the incarcerated population was even higher: Venezuela (15.3% in 2017 versus 1.8% in 2011) and El Salvador (51.5% in 2017 versus 11.9% in 2011). Brazil was the country with the greatest number of cases in prisons: 45% of total cases in the region. In all the countries, the incidence of tuberculosis in prisons was higher than the incidence among the general population.

“This increase of tuberculosis cases in prisons largely explains why the region has not made progress in controlling the disease,” says Guillermo Sequera, director of surveillance at the Ministry of Health in Paraguay and ISGlobal researcher. Therefore, tuberculosis control will only be achieved if the health conditions in prisons are improved. Reducing overcrowding (for example by reducing the population of people awaiting trial or reducing prison sentences), improving ventilation and health care, and actively screening people who enter or exit the prisons would help reduce the transmission of tuberculosis and other infectious diseases within and outside the prisons.  

The authors warn that health ministers and the global medical community must take urgent actions to address this health and human rights crisis among prisoners and their communities.

Reference

Walter KS, Martinez L, Arakaki-Sanchez D, et al. The escalating tuberculosis crisis in central and South American prisons. The Lancet. 2021 Apr 8;S0140-6736(20)32578-2. doi: 10.1016/S0140-6736(20)32578-2.