CAPE TOWN, Oct 24, 2006 (AFP) - A constitutional shield against compulsory testing and treatment is hampering South Africa's battle against a contagious and virulent form of tuberculosis, the health department said Tuesday.
"There are legal implications," the department's head Thami Mseleku told a parliamentary health committee. "We have been battling with this ... in ethical and constitutional terms."
South Africans had a right to refuse testing, he said. "And if you pass a law, how do you enforce it? Do you lock them up? You cannot force them to take treatment."
The department was also "grappling with issues of the isolation of people".
"We feel it is very important for these people (with multi-drug resistant or MDR-TB) to be kept for some time," to stop it spreading, said Mseleku.
Another problem was that while the department could forcibly confine TB patients during the contagious stage, it could not do so once they were past this stage or if they had stopped medication despite the possibility of a relapse, he said.
More than 300,000 South Africans are believed to have tuberculosis with up to 9,700 suffering from MDR-TB. A total of 106 cases of extreme drug-resistant XDR-TB were reported in South Africa in recent months, of whom 81 died.
The spread of XDR-TB in South Africa, which has one of the world's heaviest HIV caseloads, is very fast, Mseleku said, because of its high correlation to the virus that can lead to AIDS. Most patients died within three weeks.
He said XDR-TB was proving to be a national crisis and require up to 24 months of hospitalisation. South Africa ranks fifth among 22 countries contributing 80 percent of the world's tuberculosis burden.
A Johannesburg woman with XDR-TB was placed in isolation by health authorities last month but only after being persuaded to return to hospital having earlier refused treatment.
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