Why do we need to think about TB in prisons?
Compared with the general public, people in prison are more likely to have communicable diseases such as TB. This increased disease prevalence in this population is recognised as a significant public health concern, both for people living and working in prisons and for the general population at large because the vast majority of people held in prisons eventually return to their communities.
Most of the of the people in prison are from poor communities and vulnerable social groups, with an increasing proportion of migrants and people with a minority ethnic background. People with drug use disorders form a large part of the imprisoned population.
The increased prevalence of communicable diseases among people in prison can constitute a risk for the health of people who live/work in prison settings and for the general population, as the vast majority of people in prison eventually return to their communities.
There are several risk factors associated with increased transmission rates in prison settings, e.g. proximity (aggravated by overcrowding), which is common in many prisons; high-risk sexual behaviour; injecting drug use; sharing of injecting equipment; and tattooing and piercing. Diet and individual hygiene are also important risk factors especially for TB.
In addition, lack of awareness of infection status (often combined with substandard healthcare) appear to have substantial implications for public health. There are excellent opportunities for primary, secondary and tertiary prevention measures in prison settings, provided they are coupled with adequate linkage to care during detention and after release. Prison settings can be used to reach vulnerable groups of the population and provide adequate care for them.
The 2010 WHO Madrid Declaration emphasised that health protection in prison settings is an essential part of public health and should be based on the principle of equivalence of health for people in prison.
Several guidance documents define the principles and standards of prison healthcare delivery. Together with international human rights case law, these documents offer a wide variety of tools, helping prison healthcare services to deliver their services in line with human rights requirements and based on the principle of equivalence of healthcare between prison and community.
Success in improving the health of people in prison requires adequate conditions of detention, appropriate hygiene and avoidance of overcrowding. Conversely, there is evidence that poor conditions of detention may contribute to the dissemination of communicable diseases and add an additional risk of infection.
Incarceration may represent a unique opportunity to make adequate healthcare services available to people and target groups that are usually hard to reach when in the community.