Recent reports of multi-drug resistant tuberculosis (MDR-TB) cases in prisons in some African countries are a wake-up call for public health authorities across the continent.
In 2017, there were half a million new cases of MDR-TB globally, and resistant strains are continuing to spread. This growing health threat thrives in spaces where people lack access to proper TB treatment, where the airborne disease spreads rapidly due to inadequate ventilation and where poor sanitation and nutrition are rife. Put simply, MDR-TB thrives particularly in prisons.
While many African countries have constitutional guarantees for prisoners to be held in conditions consistent with human dignity, the reality is that many places of detention do not yet meet those standards.
And it is not just a question of conditions. These forms of the infection are highly contagious and caused by bacteria resistant to the most powerful first-line TB drugs. Treatment for drug-resistant TB is lengthy, expensive, incredibly toxic and has a high failure rate.
So, what can be done? The answer is that the issue of MDR-TB in prisons must be confronted as a human rights issue. Addressing poor conditions of detention will be fundamental. This must also be coupled with investment to fulfill all prisoners’ right to health, meaning they have access to life-saving TB screening, diagnostics and treatment services.
Incarcerating TB patients who have challenges adhering to their treatment, while intended as a means to stop MDR-TB in its tracks, must be firmly rejected on human rights grounds and recognized as an ineffective and inhumane way to address the problem.
Thankfully, there is some progress being made.
As partners to a joint human rights programme for TB and HIV, supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, we are operating in 10 African countries, working to remove legal barriers to access to health services by providing documentation of human rights violations, advocacy, strategic litigation and training for legal professionals. Partners are currently providing legal support to inmates in Malawi who have been treated for MDR-TB in hospital and who are now challenging their return to prison until their treatment is complete.
In 2016 in Kenya, a case was brought concerning the legality of detaining people with TB whose treatment was interrupted. This resulted in the Kenyan health authorities developing a new rights-based policy which emphasizes the use of a patient-centred approach during the entire course of treatment, whilst also spelling out the rights and responsibilities of people with TB.
From 2000 to 2014, in Africa an estimated 10 million lives were saved thanks to TB diagnosis and treatment – but much more needs to be done, especially when it comes to the transformation of the legal and policy landscape for TB.
No prison sentence should include the contraction of a life-threatening disease like TB. It is time to recognize that efforts to address TB within the confines of prisons also have an important impact on wider public health.
A human rights based approach will not only help to halt the rise of MDR-TB among those incarcerated, it will also protect staff, visitors and the wider community.
World TB Day reminds us that we must remain vigilant in our response to the disease but we should also recognize that the human rights of prisoners and a rights based approach to TB are key pieces of the puzzle.
With 25% of new global TB cases reported in Africa in 2017, it’s time to act now.
About the authors
Amitrajit Saha, Team Leader on HIV, Health and Development at the United Nations Development Programme (UNDP) , Africa
Annabel Raw, Health Rights Lawyer at the Southern Africa Litigation Centre (SALC)
Allan Maleche, Executive Director at the Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN)
Michaela Clayton, Director at the AIDS and Rights Alliance for Southern Africa (ARASA)
Daouda Diouf, Executive Director at ENDA Santé.
UNDP, SALC, KELIN, ARASA and ENDA Santé are partners of the Africa Regional Grant for HIV: Removing Legal Barriers, a Global Fund-supported programme that seeks to strengthen the legal and policy environment to reduce the impact of HIV and TB on key and vulnerable populations in Africa. Learn more.