Tuberculosis in prisons: anatomy of global neglect

Abstract

Infectious diseases can be transmitted readily within prisons due to close contact between prisoners. Tuberculosis (TB) and HIV/AIDS are two important causes of morbidity and mortality from infectious diseases worldwide [1, 2]; prisons have become reservoirs for these diseases in many settings. TB prevalence among prisoners worldwide can be up to 50 times higher than national averages [3, 4]. Prisons account for a substantial proportion of the TB burden in the USA [5] and TB in prisons poses a major problem in the rest of the world, especially in countries of the former Soviet Union [6, 7] and sub-Saharan Africa (SSA) [8, 9]. Co-infection with HIV in prisoners with active or latent TB is well documented [4, 10, 11] and this presents difficult diagnostic and management challenges to prison health systems. Apart from immunosuppression due to HIV, the high concentration of TB in prisons is often related to prisoner-associated risk factors such as poor nutrition, stress, drug and alcohol abuse, malnutrition, and associated chronic illnesses [3, 4, 9]. In addition, poor prison living conditions and mass incarceration [12] with inadequate ventilation, in such congregate settings, promote the transmission of Mycobacterium tuberculosis between prisoners. Such host and environmental risk factors facilitate new M. tuberculosis infections to progress to active disease, or may cause re-activation of latent TB in prisoners, the risk of which is at least an order of magnitude higher in prisons than in the general community [3]. Prisons serve as reservoirs of drug-resistant TB [10–12] which is increasingly being reported from Eastern European [6, 7, 10, 11, 13] and SSA prisons [8 …