Stakeholders met to discuss strategies to prevent and treat tuberculosis (TB) – the leading cause of death in South Africa’s correctional centres – at the University of the Witwatersrand on 28 May 2013. The TAC, the Wits Justice Project, the Centre for Applied Legal Studies, and SECTION27 hosted the round-table meeting.

The round table focused on strengthening the Guidelines for the Management of Tuberculosis, Human Immunodeficiency Virus and Sexually Transmitted Infections in Correctional Centres, 2013. These Guidelines were jointly announced by the Department of Correctional Services (DCS) and the Department of Health (DoH) on World TB Day in March 2013.

Participants included representatives of the DCS and DoH, legal experts, medical experts, representatives of the Judicial Inspectorate for Correctional Centres, and a range of organisations involved in providing services in correctional centres as well as in health and human rights more broadly.

•  John Stephens of SECTION27 gave a presentation on the legal framework relevant to health, infection control and human rights in correctional centres.

•  Two former inmates, Dudley Lee and Ludwick Mabiyane, shared their experiences of contracting TB while in custody.

•  Maria Mabena of the DCS and Patricia Ntsele of the DoH presented the Guidelines. Jameelah Omar of the Centre for Applied Legal Studies presented a joint submission on the Guidelines authored by the hosting organisations.

•  Professor Robin Wood discussed the conditions of imprisonment that contribute to high TB transmission rates, including overcrowding, long lock-up times, and a lack of ventilation.

•  Paul Silver, an architect specialising in prison design, gave a presentation on the need for improved ventilation in South Africa’s prisons and models for improving ventilation and infection control generally.

•   Dr. Andrew Black of the Wits Reproductive Health and HIV Institute gave a presentation on the treatment aspects of the Guidelines.

Presentations from the round table are available on the TAC website. The hosting organisations will produce an outcome document to capture the discussions at the event. The document will be sent to stakeholders, including Government departments, and made public in the near future.

John Stephens noted with concern that the Guidelines seemed to have been developed without considering the existing laws about these issues. At worst, he said, the Guidelines contradicted them.

Professor Wood and Mr Silver expressed concerns that the Guidelines do not adequately address the need for improved prevention methods in correctional centres and agreed that attempts to curb transmission rates will not be successful unless issues like ventilation and overcrowding are addressed directly.

Dr Black noted that, for the most part, the Guidelines have simply stacked together previously existing DoH treatment guidelines. At least one of these DoH guidelines had already been updated by the DoH but the update was not reflected in the Guidelines.

Key recommendations from the round table

• Partnership with the Minister of Police to manage TB in police holding cells and to avoid the interruption of treatment when people are arrested;

•  Partnership with the Department of Public Works to improve ventilation and infection control in correctional facilities;

•  Implement systems to ensure more accurate reporting of TB cases in prisons and open sharing of data on TB in prisons;

•  Improve diagnosis and treatment for detainees and staff; and

•  Integration of anti-retroviral treatment and TB treatment.