Reforming drug laws to quell TB transmission in Brazil

Punitive drug laws, which have contributed to mass incarceration and severe overcrowding in Brazil’s prisons over the past decade, are facilitating the spread of the deadly bacteria tuberculosis (TB), according to a new report by GHJP. The report, Reservoirs of Injustice: How incarceration for drug-related offenses fuels the spread of tuberculosis in Brazil, draws a direct connection between a law passed in Brazil in 2006 that conferred harsher prison sentences for petty drug crimes and the continued spread of TB among Brazil’s general population.  Read the press release and full report, which includes a forward by the Brazilian unit of Doctors without Borders.

The motivation for this project stemmed from preliminary epidemiological findings of a collaboration between researchers at Stanford University and the Federal University of Grande Dourados in Brazil that identified prisons as reservoirs for TB. Pathogens circulate at higher rates in disease reservoirs compared to the general population. Worse, they can spill over from places like prisons into the general population via guards and visitors. The report argues that Brazil’s prisons represent a serious impediment to national efforts to eradicate TB.

As part of their investigation into the legal mechanisms driving this phenomenon, the authors of this report, comprised of students from Yale Law School, School of Public Health, and Jackson School of Global Affairs, traveled to Brazil to interview legal and public health stakeholders. The team also reviewed current scientific literature to understand how the combination of traditional epidemiological metrics and novel molecular technology such as whole genome sequencing has been used to identify Brazil’s prisons as the source of some TB cases diagnosed in the general population.

Based on these findings and input from partners and interviews in Brazil, the authors call for the expansion of psychological support services at custody hearings, additional guidance on prosecutorial and judicial discretion, active case finding within prisons, and improved mechanisms for treating TB patients once they are released from prison.