Tuberculosis cases in prisons in Paraguay have grown in the last two decades from 5% to 22%, according to national records of the disease, a situation that
has created a "spillover effect" of infections
from these centers to the community, warned epidemiologist
Guillermo Sequera.
From 2000 to 2021, the specialist explained in an interview with EFE, the country counted an average of 3,300 annual cases of the disease, "despite the fact that the health system grew" and "diagnosis improved."
"Of those 3,000 cases in Paraguay, 5% were in the 18 main prisons in 2005, then 7%, 8% and today - of the 3,000 -
20%, even more, 22%, are in the prisons.
That means that cases in the community are decreasing, but they are growing in prisons," explained the official, who sees prisons as "the engine of the epidemic."
Parallel to the increase in cases, noted the former director of Health Surveillance of the Ministry of Public Health and Social Welfare,
the prison population doubled between 2010 and 2022
, due, among others, to the increase in the application of preventive detention measures. , which caused overcrowding.
Sequera showed together with a team of experts that in certain cases of tuberculosis diagnosed in the metropolitan areas of Asunción and Ciudad del Este (bordering Brazil and Argentina), the germ lineage
came from the two largest prisons in the country.
The so-called "prison lineage" was detected in Tacumbú, a prison located in the Paraguayan capital, and in the Ciudad del Este Regional Penitentiary.
The Tacumbú prison, in Tacumbú (Paraguay).
Photo: EFE
The expert and his team, made up of Gladys Estigarribia and Sarita Aguirre, did "whole genome sequencing" among the positive cases of tuberculosis, both from the two prisons and their cities, analyzed "the lineage" and followed the source of the disease.
"There were a lot of people who had tuberculosis and had never been in prison
and the lineage they had was the lineage of the prison," said Sequera, an issue that he describes as
a "reservoir phenomenon"
in prisons and a "spillover" phenomenon. to the community.
This finding was published in 2020 in the British scientific journal Nature, a study that states that the key to the overflow is the
"high level of turnover in the prison population."
However, Sequera estimates that the incidence rate of tuberculosis in prisons could be higher: "This is the tip of the iceberg," he said, although he stressed that "the trend" is known.
"Condemned" to have tuberculosis even if they are free
In other research published in February 2024 in the British scientific journal The Lancet, Sequera's team followed a cohort of prisoners from 2013 to 2021 and found that the rate of the disease increased "from 1,335 per 100,000 people in the first year of prison to 8,455 per 100,000 people after 8 years".
Sequera explained that although the incidence of tuberculosis decreases when a prisoner is released, "their probability of having tuberculosis is still 10 times higher compared to the rest of the community."
"It's like
a sentence to having tuberculosis
," he lamented.
A sample tests positive for tuberculosis under the microscope.
Photo: Reuters
"When you enter prison you not only lose your freedom, but you are also condemned to have tuberculosis," even if you are free, Sequera reflected on the findings of this study prepared from data from the 2013 prison census.
And the "most serious" thing for this epidemiologist is that close to 60% of the prison population in Paraguay
is under preventive detention
and "they are already condemning them to have tuberculosis."
In 2020, as this research noted, "the incidence rate of tuberculosis in Paraguay was 48 cases per 100,000 inhabitants, but in the prison environment it exceeded 3,000 cases per 100,000 inhabitants."
Comprehensive security policy
The solution, for Sequera, must be a security policy that guarantees comprehensive health care for inmates.
"The Ministry of Health has to understand that prison health is a public health problem," stated this researcher and professor, and considered that to "take care of the community against tuberculosis," work must be done in prisons.
He also drew attention to "structural determinants" in prisons, such as
overcrowding, poor nutrition, lack of ventilation, unsanitary conditions
, which constitute the "ideal breeding ground for tuberculosis."
According to statistics from the Ministry of Health, Paraguay is a country with a "moderate burden" of tuberculosis, with an incidence of 43.6 cases per 100,000 inhabitants.
Indigenous communities - which represent less than 2% of the population -
account for 12% of the cases.
"Tuberculosis is a disease of the poor," concluded Sequera.