FOREWORD

Where figures are available it is clear that the prevalence of tuberculosis in prisons is higher, sometimes much higher, than in the general population of the country. This is not surprising. Many prisoners come from the more socially and economically deprived sections of the population. In prison they suffer much emotional, and sometimes physical hardship. Frequently, overcrowding facilitates the spread of tuberculosis infection. Medical services are usually inferior to those for the general population. This may result in poor treatment of tuberculosis patients. Good treatment should cure the vast majority of patients. Poor treatment may keep patients alive but infectious. Worse still, poorly treated patients in prison may spread multidrug resistant bacilli to fellow prisoners and staff. When released, they may infect their families and the general population. There is often no coordination to ensure the continuation of treatment started in prison.

Particularly in high prevalence countries, tuberculosis in prisons is thus an important threat to public health. There is often a rapid turnover of prisoners on remand. They may be imprisoned long enough to develop disease, but not long enough to be effectively treated (even if good treatment is available). Many are then released and may infect others.

Theoretically, good treatment and good tuberculosis control should be easier in a closed, disciplined environment. In practice, this is often not the case. Tuberculosis poses a real threat to prisoners, staff and the general public. These guidelines, based on much recent experience, outline the many obstacles to effective diagnosis and treatment. They give useful guidance as to how to overcome these obstacles. Prison health services are not usually under the control of the national Ministry of Health. The guidelines highlight the importance of coordinating the two services.

We hope that politicians, administrators and doctors in the relevant Ministries, national and international bodies concerned with the problem, and indeed the general public in many countries will read these guidelines with alarm. We trust that the alarm will ensure that every effort is made to implement the recommendations. For many countries the alternative is that a very dangerous situation will become much, much worse.

Sir John Crofton,
Professor Emeritus of Respiratory Diseases and Tuberculosis,
University of Edinburgh, Scotland

and

Dr Cornelio Sommaruga,
President, International Committee of the Red Cross, Geneva, Switzerland