Failing Siracusa: governments' obligations to find the least restrictive options for tuberculosis control

One of the world's leading causes of death, tuberculosis (TB) remains a stigmatized and feared disease. Prevention, diagnosis, and adherence to TB treatment remain a challenge for many people, including migrants, those with alcohol and drug dependency, sex workers, people living with the human immunodeficiency virus, and individuals with disabilities. Low levels of TB treatment literacy and ignorance of transmission risks are common, and-along with inadequate funding for treatment support-contribute to patients' non-adherence to treatment. Recent cases involving the detention of individuals with TB in Kenyan and Canadian correctional facilities illustrate the circumstances under which individuals interrupt treatment and how health authorities seek restrictive measures to oversee and compel treatment. The legitimacy of restrictive measures is often defended by international public health authorities in relation to the non-binding Siracusa Principles. Yet in practice, as illustrated by examples from Kenya and Canada, government authorities and local laws sometimes do not fully meet, or entirely disregard, the requirements in the Siracusa Principles that restrictions on rights in the name of public health be strictly necessary and the least intrusive available to reach their objective. In addition, more specific standards are required at the international level to guide states' development and use of rights-restricting measures to address TB.