Similarly, populations most at risk of TB infection are also often those who live in conditions of poverty, social inequality and marginalization. Populations most vulnerable to and affected by TB include those living in substandard housing, in conditions of poor sanitation, overcrowding and with poor nutrition. They include people in prisons and closed settings, miners, migrants, refugees and internally displaced persons. Their socio-economic circumstances place them at greater risk of TB infection and impacts on their ability to realize their health rights to voluntarily access TB prevention, treatment, care and support services without discrimination.
TB policies and programmes may also impact on the rights of affected persons. In some countries, unnecessarily punitive public health policies aimed at preventing TB transmission or managing patients with drug-resistant TB, infringe human rights even further. They isolate, hospitalize and even incarcerate TB patients for lengthy periods of time, forcing them to remain away from their homes, families and community support systems for purposes of prevention or treatment. While limitations of rights may be necessary to achieve public health goals, in many cases TB policies are unreasonable, unable to achieve the stated goals and contrary to the UN Siracusa Principles.
In Kenya, a group of TB patients were arrested and detained in prison, in terms of the Public Health Act, for failing to comply with their TB treatment. They were kept in overcrowded prison conditions that failed to support their treatment for TB and also placed other prisoners at risk of infection.
The High Court of Kenya determined that, while isolating a person with TB who fails to take treatment may be necessary in the interests of public health, it should be for purposes of treatment rather than punishment. Isolation should also comply with ethical and human rights principles set out in the Siracusa Princples – for example, with adequate measures to promote treatment adherence, appropriate infection control and reasonable social support. The court held that the imprisonment of the patients was unconstitutional in the circumstances. It ordered the government to develop an appropriate policy on the involuntary confinement of persons with TB and other infectious diseases.Daniel Ng’ etich v Attorney General, Petition No. 329, 2014
In 2016, a working group of experts convened by the Global Fund comprehensively defined programmatic responses to address human rights and gender-related barriers to TB services. The Tuberculosis, Gender and Human Rights Technical Brief specifically recommends, in addition to the programmes promoted for HIV:
The Task Force aims to protect and promote human rights in pursuit of universal access to TB prevention, diagnosis and treatment through global frameworks and strategies that address the human rights dimensions of TB and that prioritize: