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Forcible Detention and Isolation Needed for XDR-TB Patients, warn Experts

It’s a tough call between human rights and a medical problem of utmost urgency but researchers support the latter//.

Jerome Singh and colleagues from Durban's Centre for the AIDS Programme of Research in South Africa have come out strongly for forcible detention and isolation of those affected with XDR-TB.

They warn in the peer-reviewed journal PloS Medicine that the disease may swamp the whole of South Africa and even spread beyond its borders.

XDR-TB or extreme drug resistant TB refers to a case of tuberculosis, which is virtually untreatable by any type or any dosage of antibiotics. The patient will usually die in around two weeks.

According to scientists, the disease discovered a decade ago in South Africa, probably came about due to the evolution of highly drug- resistant strains of bacteria caused by blatant misuse or skipping of anti-TB drugs used in the treatment of AIDS patients.

As such, regular TB is the killer of almost all persons with AIDS.

The disease is highly contagious, and the organisms are airborne, hence the threat of a global pandemic if not controlled at the earliest, say the researchers.

So far 300 cases of the disease have been recorded and 75 persons have died in the last few months. Yet the South African government’s lethargic response can be attributed to the nation’s uncompromising adherence to human rights, after years of apartheid rule was toppled. Forcible detention of a person is accordingly, against human rights.

This is understandable says Mary Edginton of the Witwatersrand University's medical school, yet,” You can look at it from two points of view. From the patient's point of view, you are expected to stay in some awful place, you can't work and you can't see your family. You will probably die there. From the community's point of view such a person is infectious. If they go to the shops or wander around their friends they can spread it, potential ly to a large group of people."

Yet says Jerome Singh, "XDR-TB represents a major threat to public health. If the only way to manage it is to forcibly confine then it needs to be done.

"Ultimately in such crises, the interests of public health must prevail over the rights of the individual."

The World Health Organization has called for the world to prioritise XDR-TB on par with bird flu and recommended governments in impoverished sub-Saharan Africa to develop one strategy to deal with the twin challenges of HIV and TB.

Although South African law permits enforced isolation some lawyers say it comes into conflict with the constitutional guarantees on individual rights.

However, the constitution also guarantees communal rights, including protection from infection and the right to a safe environment.

South Africa's health department yesterday said it has discussed the possibility of enforced isolation with the country's Medical Research Council and the World Health Organization but has not reached a conclusion.

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