Abstract
The high tuberculosis (TB) rates observed in the Brazilian prison population highlights the need for more efficient TB control measures in this population, especially in the state of Rio de Janeiro where detection rates are 30 times higher than in the general population. We present results of epidemiological, biomathematics modelling, molecular biology, psychosocological, architectural and juridical studies carried out in this state in order to assess the situation and to develop TB control strategies adapted to the specificities of the prison context. The implementation of these strategies implies to take into account the day-to-day realty of prison life and to turn more effective the supervision of the prison health system by instances in charge of monitoring the fulfillment of sentences, so as to guarantee access of prisoners to health in conformity with international and national laws.
Highlights
Incarcerating people deprived of liberty (PDL), in a country such as Brazil with high or median tuberculosis (TB) endemicity, in overcrowded and poorly ventilated environments, has as its immediate consequence the increase of transmission and a hyper endemicity in this setting[1]
As part of the Global TB Brazil/prisons Project Fund, we developed a program of national reach, in partnership with the National Penitentiary Department/Justice Ministry, whose objective was the proposal of realistic strategies for improving natural ventilation and illumination conditions in prisons
Our studies show how penitentiary agents and the parallel organizations of the PDLs that maintain the governance of the prisons[36] control access to the health care services, frequently using criteria distinct from those of health care itself, transforming access to the service into a bargaining chip
Summary
Incarcerating people deprived of liberty (PDL), in a country such as Brazil with high or median tuberculosis (TB) endemicity, in overcrowded and poorly ventilated environments, has as its immediate consequence the increase of transmission and a hyper endemicity in this setting[1] This is a risk for PDLs, and for their families, professionals who carry out their duties in prisons, and for the communities to which the PDLs will return after being freed[2]. This is the case of prisons in Rio de Janeiro (RJ), the state where TB detection rates cases are amongst the highest in the country, as much in terms of the general population as the prison population. It presents control strategies they developed, as wellas discussing the difficulties encountered in the day-to-day reality of prison life for the implementation of measures of proven efficacy
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