Advancing Corrections Journal : Edition # 12-2021
Introduction
Tuberculosis in incarcerated settings Tuberculosis ( TB ) leads all infectious diseases in mortality worldwide . In 2018 , 1.5 million people died from TB ( WHO , 2019 ). Furthermore , 1.7 billion have latent TB infection ( WHO , 2019 ). TB is associated with poverty , both within countries and among nations . The TB incidence for Haiti , the country with the highest TB burden in the Western hemisphere , was 176 / 100,000 people in 2018 ( WHO , 2019 ). In the poorest neighborhoods of Port-au-Prince , the nation ’ s capital and largest city , TB incidence was measured as high as 1,165 / 100,000 people over the three years following the 2010 earthquake ( Koenig et al ., 2015 ).
Within the country ’ s penitentiary system , TB is more concentrated in Haiti ’ s largest prison , the National Penitentiary , compared to the surrounding community in Port-au-Prince . Incarceration , in general , is associated with an increased risk of TB disease due to the congregate setting and overlapping risk factors for incarceration and infection . TB spreads easily within correctional facilities , especially in low-resource settings where there is an increased prevalence of HIV , overcrowding , insufficient ventilation , poor hygiene , malnutrition , and diminished overall health of incarcerated persons ( Baussano et al ., 2010 ; Gizachew Beza , Hunegnaw , & Tiruneh , 2017 ; Mabud et al ., 2019 ; Parvez , Lobato , & Greifinger , 2010 ; Sosa , Lobato , Condren , Williams , & Hadler , 2008 ). Additionally , there is a bidirectional relationship between poor nutrition and TB disease , meaning that TB contributes to malnutrition , and malnourished patients are more likely to develop severe TB disease and experience more unfavorable outcomes . A further complication to TB management in corrections is that the unpredictable nature of prison releases and transfers may interrupt treatment . Without information on the length of stay , planning for treatment completion is difficult . Incarceration , in summary , exacerbates the community ’ s TB burden ( Baussano et al ., 2010 ).
The National Penitentiary The National Penitentiary , the flagship institution run by Haiti ’ s Directorate of Prison Administration , is comprised of several buildings , most of which sustained extensive damage during the 2010 earthquake . The housing component consists of open dorms [ Figure 1 ]. These dorms , originally designed to house 20 men , often accommodate 80-100 . This male-only prison , built with a total capacity of 800 beds , is consistently overcrowded and , from 2016-2018 , held an average daily population of 4,200 men . Lock-downs can last 22 hours in a 24-hour period ( BBC , 2017 ).
Overcrowding is aggravated by the bottlenecked judicial system . About 90 % of the prison ’ s population is comprised of persons awaiting trial , with prisons outside the country ’ s capital receiving persons post-conviction . TB patients faring poorly in provincial prisons are often transferred to the National Penitentiary facility in Port-au-Prince , where health resources are more accessible . While in custody , individuals are fed two meals a day : typically , oatmeal in the morning ; rice and beans , or cornmeal in the afternoon . Chicken , beef , or fish may be used for flavoring the dinner , rather than served as a discrete course . Inadequate nutrition has led to several cases of beriberi , caused by a thiamine ( vitamin B1 ) deficiency ( May , Joseph , Pape , & Binswanger , 2010 ). Additionally , personal and facility hygiene is compromised . As of 2019 , only one out of three water pumps worked properly . Access to soap is severely limited and defecation must be done in plastic bags during lockdown periods . Since 2001 , a non-governmental organization , Health through Walls ( HtW ), has sent staff and
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