THE RIGHT TO HEALTH IN PRISON: RESULTS OF A NATIONWIDE SURVEY AND REPORT Tuberculosis (TB) 3.24 Tuberculosis, an airborne infectious disease, is prevalent in prisons and is considered to be a major killer among prisoners, globally. The World Health Organization estimates that the prevalence of tuberculosis is up to 100 times higher among prisoners compared to the general population.59 As such, the Commission advises that improving TB control in prisons will benefit all sectors of the society as prisons act as a reservoir for TB, pumping the disease into the community through prison staff, visitors and improperly treated former prisoners. 3.25 Given its airborne mode of transmission, the control of tuberculosis requires more efforts in closed settings. The Ministry of Health Malaysia offers free-ofcharge tuberculosis medications and services to all prisoners, irrespective of their nationality, but the Commission notes that access to timely diagnosis of tuberculosis in prison remains low. The true burden of tuberculosis in the Malaysian prison system is not known due to the unavailability of active case finding surveys, but recent information from the Ministry of Health showed that there were 244 cases among 42,009 prisoners surveyed in 2013, meaning that tuberculosis was seven times more prevalent in prison compared to the general population.60 3.26 The Commission notes that the prevalence of latent TB infection in Kajang Prison was extraordinarily high, in that tuberculin skin tests (TST) were positive in 88.8 per cent (84.7 per cent among HIV-infected and 92.5 per cent among HIV-uninfected subjects). The CERiA research team concluded that an integrated TB control programme that simultaneously and actively screens for and treats TB, HIV and substance abuse be implemented in prison, and that implementation of infection control measures, intensified TB case finding by screening upon arrival and TB preventive therapy with isoniazid or short-term preventive therapy along with evidence-based treatments for HIV and opioid dependence be included.61 “Tuberculosis in Prison”. Accessed via http://www.who.int/tb/challenges/prisons/story_1/en/ on 1/4/16 Dr Chong Chee Kheong, Director of Disease Control Division, Ministry of Health 61 Haider Al-Darraji, Adeeba Kamarulzaman, Frederick L Altice. Latent tuberculosis infection in a Malaysian prison: implications for a comprehensive integrated control program in prisons. BMC Public Health, 2014; 14 (1). Accessed via http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-22 on 19/2/2016. 59 60 41