A/HRC/38/36 against tuberculosis, to be held pursuant to General Assembly resolution 71/159, in the present chapter the Special Rapporteur will focus on the illustrative case of tuberculosis. 86. Few populations experience more risk factors for tuberculosis than people deprived of liberty, owing to factors ranging from poor nutrition and unhygienic conditions to poor medical care. Prevalence rates in prisons are 3 to 1,000 times higher than those among the general population; prison populations account for 25 per cent of the tuberculosis burden in some countries.70 87. Rights violations contributing to the spread of tuberculosis result not only from the conditions of detention, but also from punitive responses to this and other infectious diseases, including criminalization, isolation, coercion and forced hospitalization. Too often, today’s approaches to tuberculosis are as archaic as the disease itself and lack a modern, community-based approach to secure the right to health and better address the disease. Realization of the right to health requires a full commitment to developing responses to tuberculosis in the community, moving towards the full elimination of the use of punitive measures, including confinement, as a response. A. Criminalization as a determinant of the right to health for people living with tuberculosis 88. Incarceration and detention approaches not only impede the realization of the rights to health, to informed consent, to privacy and to freedom from treatment, from inhuman and degrading treatment and of movement, but can also worsen social inequalities and lead to a paradoxical increase in tuberculosis incidence.71 89. In some countries, national laws permit mandatory hospitalization and forced treatment for persons with tuberculosis, in contravention of the right to informed consent, further creating fear and stigmatization of both the disease and people suffering from it. This drives people with tuberculosis symptoms away from the needed health care. Certain laws explicitly provide that examinations, hospitalization and observation may be carried out, isolation may be imposed and medical treatment may be provided without consent, in some cases without a court order. Some countries have tuberculosis-specific laws that include stigmatizing language, for example suggesting that people with the disease maliciously evade treatment, and authorize non-consensual hospitalization. Such legal frameworks reflect outdated approaches to health care, including approaches in which the amount of funding a health facility receives is determined by the number of occupied hospital beds. 90. People who are deprived of liberty disproportionately come from groups in disadvantaged situations who often have inadequate access to health-care services. Placing them in closed settings increases the risk that they will not have access to health care and can lead to the spread of tuberculosis where prison conditions, including overcrowding, poorly ventilated spaces, inadequate prevention, medical care and treatment, stress, malnutrition and denial of harm reduction services, elevate the risk of infection and transmission,72 as does the high HIV rate in prisons. 73 People in detention often do not have adequate access to counselling and information about medicine and the side effects of treatment. Lack of access to quality diagnostic tools and medicines further contribute to 70 71 72 73 18 See www.who.int/tb/areas-of-work/population-groups/prisons-facts/en/; F. Biadglegne, A. Rodloff and U. Sack, “Review of the prevalence and drug resistance of tuberculosis in prisons: a hidden epidemic”, Epidemiology & Infection, vol. 143, No. 5 (April 2015). G. Mburu and others, “Detention of people lost to follow-up on TB treatment in Kenya: The need for human rights-based alternatives”, Health and Human Rights Journal, vol. 18, No. 1 (2016), abstract. Masoud Dara, Dato Chorgoliani and Pierpaolo de Colombani, “TB prevention and control care in prisons”. Available from https://pdfs.semanticscholar.org/c9d4/e241b8d4204108df36c16ad4e7 cea4d8e56f.pdf. Stop TB Partnership, Key Populations Brief: Prisoners. Available from www.stoptb.org/assets/documents/resources/publications/acsm/KPBrief_Prisoners_ENG_WEB.pdf.