Tuberculosis (TB) and drug-resistant TB

TB is the number one killer of people living with HIV in South Africa. The TAC is committed to intensifying our work on TB in the coming years and to build alliances with other progressive organisations around the world working on TB. The TB epidemic requires a global activist movement such as that which we’ve had for HIV. Such a movement will be essential to changing the politics around TB and ensuring sufficient investment in R&D of much-needed new medicines.

The TAC’s local TB work currently has two focus areas: Decentralisation of DR-TB care and TB in prisons

1.     Decentralisation of DR-TB care

Rates of DR-TB are increasing in South Africa. Many people with DR-TB are never diagnosed, others are diagnosed but cannot access treatment and care, of those who do access care, less than 50% survive the disease.

According to the TAC’s analysis the decentralisation of DR-TB care is a key step in bringing this situation under control. This means taking screening, treatment and care closer to where people live and not hospitalising people for longer than what is strictly required. The National Departement of Health published a good policy on decentralisation in 2011 – but implementation of this policy in provinces is generally poor. The TAC’s goal is to ensure better implementation of this policy through monitoring on the ground and holding accountable those responsible for implementation where implementation is failing.

2.     TB in prisons

Between 200,000 and 300,000 people go through remand detention in South African correctional facilities every year. Available evidence suggests that the risk of contracting TB in these settings are extremely high. This has implications both for the people incarcerated, but also for the communities these people move back into when they leave incarceration.

In December 2011 the Constitutional Court of South Africa gave a landmark judgement in which they found that the Department of Correctional Services could be held culpable for Mr Dudley Lee contracting DR-TB while incarcerated at Polsmoore Prison near Cape Town. The TAC acted as a “friend of the court’ in this case. We are now seeking to leverage this judgement to ensure prisons are no longer breeding grounds for TB and that people who are sent to prison are not also sent to contract and potentially die of TB. This requires a complex set of interventions that will have to reduce overcrowding in prisons through both sentencing reform and adaptation of existing prisons. Unfortunately, we have not seen the political will to take this difficult challenge on as yet. Our struggle continues.

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