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.

根据研究published inThe Lancet, TB cases in the region’s prisons rose from five per cent of the total reported cases in 2011, to 11.1 per cent in 2017. The incarcerated population in Central and South America represents one per cent of the total population.

该研究的作者警告说：“ PDL（被剥夺了自由的人）和社区中的结核病的健康和人权危机要求紧急行动，并持续关注卫生与正义和全球医学界。”

“There is growing evidence that incarceration puts people at higher risk for diseases and that this risk extends to neighbouring communities,”

斯坦福大学流行病学家Katharine Walter

在委内瑞拉和萨尔瓦多，这个问题尤为严重。在委内瑞拉，2011年，报告的结核病病例中有1.8％在监狱中注册，但在2017年，该百分比上升到15.5％。

在萨尔瓦多（El Salvador）中，2011年的监狱中有225例TB案件 - 占总数的11％。六年后，被拘留者发现了1889例 - 占所有报告案件的51.5％。

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.

该研究的合着者的流行病学家凯瑟琳·沃尔特（Katharine Walter）说：“越来越多的证据表明监禁使人们面临较高的疾病风险，这种风险扩大到邻近社区。”

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.

沃尔特补充说：“削减监狱中结核病感染风险的最直​​接方法是减少在这些情况下被监禁的人数越来越高，并具有很高的传播风险。”

Drug resistance also poses a risk if the situation is left unchecked, the study warns. It notes: “Although Central and South America have not yet been affected by high rates of drug-resistant tuberculosis in prisons, as seen in many Eastern European countries, the current trajectory suggests that drug resistance should also be closely monitored.”

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”.

However, Herrero, an Argentinean researcher at the Latin American Faculty of Social Sciences (FLACSO), says TB among prisoners “is an important aspect but it is not what ends up explaining the situation of the disease in the region.”

TBis 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.

加拿大曼尼托巴大学的研究和流行病学家的合着者祖尔玛·鲁达（Zulma Rueda）认为，要解决问题，我们必须理解，被监禁的人“是人类和结核病不能成为他们的判决的一部分”。

More investment in TB programmes, greater political will, financial support for research, and effective treatments against the disease are crucial, she said, as well as addressing the stigma often associated with TB.

“许多研究报告了耻辱和discrimination become a barrier to seeking timely care, following the treatment, and getting successful results,” Rueda said.