International Committee of the Red Cross News
March 24 2004

Southern Caucasus: Towards TB-free prisons
Every year, two million people die of tuberculosis (TB), and another
eight million contract the disease.

In most countries of the Commonwealth of Independent States, it has
proven difficult to bring the disease under control because of the
social and economic situation and the breakdown of the health-care
system. In the southern Caucasus, where TB causes enormous suffering
and death in the prisons, the ICRC has been working with the national
authorities for many years to provide treatment for prisoners. In
1995, when the ICRC launched a TB-control programme in the prisons of
Azerbaijan, the disease was at least 60 times more prevalent among
inmates than among the country’s civilian population. In 1998, the
ICRC began providing support for implementation in Georgian prisons
of the DOTS (Directly Observed Treatment, Short Course) strategy
recommended by the World Health Organization. In 2002, the ICRC
extended its support for this programme to Armenia.

If prisoners have TB when they are released, they bring the disease
with them back into society. Since TB is a national public-health
issue that also affects the population outside prisons, the ICRC is
coordinating its activities in prisons with others working on behalf
of the population at large, including the donor community, to
reinforce joint efforts to fight the disease. Since 1995, the ICRC
has provided support for the treatment of more than 8,000 prisoners
in the southern Caucasus. One of the problems it has encountered is
that prisoners are sometimes released before they have completed
treatment, without proper coordination between the authorities
responsible for health care inside prisons and those responsible for
national TB programmes.

Major challenges still lie ahead. Outbreaks of multidrug-resistant TB
in prisons could cause these dangerous strains to spread into the
community through the families of prisoners, released prisoners, and
prison staff. In addition, as the number of AIDS cases rises
throughout the former Soviet Union, opportunistic TB infections will
increasingly destroy families and whole communities. In response, the
resources of the entire public-health system must be brought to bear
on this already devastating epidemic. Urgent action must be taken, in
particular to treat drug-resistant patients and reduce the
progression of HIV.