South Africa: Drug-Resistant TB and AIDS are Deadly Combination

The rise of drug-resistant tuberculosis in South Africa, which is already inundated with HIV/AIDS, has led to the highly controversial decision to enforce quarantine, particularly for patients with deadly extensively drug-resistant TB (XDR-TB).

"There are challenges without answers," said Simon Moeti, medical superintendent of Brooklyn Chest Hospital in the Western Cape province. "There are people who are refusing treatment, people who want to abscond," he said on the sidelines of the 38th Union World Conference on Lung Health in Cape Town.

In 2006, South Africa reported 343,000 TB cases, 6,000 of which were multidrug-resistant TB (MDR-TB). The government said there have been about 400 XDR-TB cases, though groups like Doctors Without Borders say this figure is a large underestimate.

In Western Cape, local health officials say 64 XDR-TB cases have been identified this year. Twenty of the patients have died, and 39 are currently in the quarantine ward at Brooklyn.

Moeti said patients hate going to Brooklyn because of the stigma of TB and its association with HIV/AIDS. The hospital struggles to retain staff, he said. It was bad enough before, but the surge in XDR-TB has made it even worse, he said.

Health authorities were forced to erect a fence around Brooklyn's XDR-TB unit after four patients escaped. Two guards monitor the fence, while any patient wanting to go to another part of the hospital must be accompanied. Family visits are strictly controlled.

"We are dealing with very depressed people," said nursing sister Joan Blackburn. "They feel like they are in prison, but it's the only way."

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