The increase in tuberculosis in Latin America is linked to the number of prison sentences

High incarceration rates in Latin America – the region with the world’s fastest-growing prison population – are worsening tuberculosis in a region bucking the global trend of declining incidences of the disease, experts warn.

A study published in The Lancet Public Health The journal has estimated that, contrary to previous assumptions, HIV/AIDS is not the main risk factor for tuberculosis in the region – as is still the case in Africa, for example – but rather imprisonment.

While the global incidence of tuberculosis fell by 8.7% between 2015 and 2022, in Latin America it increased by 19%. Using mathematical models, researchers concluded that this increase was linked to the exponential increase in the number of prisoners in the region, surpassing other traditional risk factors such as HIV/AIDS, smoking, drug use and malnutrition.

The work focuses on six countries – Brazil, Colombia, Mexico, Argentina, Peru and El Salvador – which together account for 79.7% of tuberculosis notifications in the region. 82.4% of the prison population. Between 1990 and 2019, the prison population in these countries increased from 260,363 to 1,322,355 people.

“Our main conclusion is that in these countries about a third of all tuberculosis cases since 1990 were linked to incarceration,” says infectious disease specialist Dr. Julio Croda, of the Oswaldo Cruz Foundation (Fiocruz) in Brazil, one of the institutions involved in the study.

The worst scenario is in El Salvador, where 44% of the country’s tuberculosis cases in 2019 occurred in prisons, according to the study.

At the time, El Salvador already had the highest number of prisoners per 100,000 inhabitants of the six countries. After President Nayib Bukele imposed his controversial state of emergency to combat gangs in 2022, mass incarceration increased even further – which the study said is “expected to have catastrophic consequences for tuberculosis”.

“The environment in these prisons is very conducive to transmission,” Croda said, citing tuberculosis rates among people deprived of their liberty than among the general population. “Prisons are overcrowded spaces, without light and proper ventilation, with a population that already has individual risk factors for the disease, such as smoking or malnutrition.”

Juan Pappier, Human Rights Watch deputy director for the Americas, said the “dramatic increase in incarceration rates” in Latin America stemmed from a combination of excessive pre-trial detention – especially in the context of the so-called “war on drugs”. which has led to the incarceration of thousands of low-level offenders – and longer sentence lengths.

“And these are all the result of quite populist responses to crime that … have not achieved significant results in reducing the very worrying murder and extortion rates in the region,” Pappier said. On the contrary, he noted that mass incarceration had strengthened criminal organizations born in prisons, such as Brazil’s PCC and Venezuela’s Tren de Aragua.

Julita Lemgruber, a sociologist who headed Rio de Janeiro’s prison system between 1991 and 1994, emphasized that people in Latin America still believed that “punishment only counts when someone is put behind bars.”

“But society forgets that in countries like Brazil, for example, there is no death penalty – so those imprisoned will eventually be released and, after being exposed to the disease within the penitentiary system, could become a vector for the spread of tuberculosis outside it. she said.

The tuberculosis study predicted that if prison sentences had remained stable since 1990, the six countries would have had at least 34,393 fewer cases in 2019 alone, accounting for 27.2% of the total number of cases that year.

It predicted that if there were a gradual 50% reduction in prison numbers and sentence lengths by 2034, the incidence of tuberculosis among the population would fall by 10% in most countries.

In the case of El Salvador, even if the country were to end the state of emergency immediately, the country would not return to pre-Bukele levels of the disease until 2034. Next, the country should also work on a detention policy to “at least recover.” at least in part, a decade of missed opportunities for progress in tuberculosis.”

Pappier said one way to achieve this would be for security forces to focus on a more strategic approach, targeting the leaders of criminal factions, and for lawmakers and the judiciary to work on alternative sentencing for those not involved in violent crimes.

Croda also believes that reducing the number of prisoners is one of the solutions. But in the meantime, he said, it was also necessary to provide “more humane and less degrading conditions” in prison.

He said tuberculosis cases in correctional facilities are generally underreported because diagnostic tests are rarely performed. “Health care is simply not reaching these populations,” he said.