We need people – people like those in TB Alert, who are focused and ambitious and care for people at grass roots in the UK, India and Africa. Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership
In the developing world, large family sizes are common and several generations of a family often live together under one roof. Tuberculosis is a particular problem in refugee camps, slums and shanty towns – where many people live in close proximity, in make-shift accommodation. In any nation, tuberculosis tends to be concentrated in urban areas.
In the UK, slum clearance following the two World Wars is credited with producing dramatic falls in TB. However, high rents and a lack of quality social housing mean people are increasingly living in sub-standard, overcrowded and/or temporary accommodation.
These include many of the most marginalised in society, including: people and families seeking asylum, people undergoing treatment for drink or drug issues, people leaving the prison system, homeless people.
In high-income and low-income countries alike, homeless people are at particular risk from TB. They are more likely to be exposed to TB bacteria in hostel accommodation or settings where homeless people gather to sleep or socialise. The immune stresses associated with homelessness – such as rough sleeping, cold, poor nutrition and drink or drug abuse – then make it more likely that someone exposed to TB will go on to develop the illness. Homeless people may then associate any symptoms that could be TB as simply the impact of their lifestyle on their health. People who are homeless may also be less able to access healthcare, perhaps through fear of authority figures or because their chaotic lifestyles prevent them from attending appointments.
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