The Resurgent Tuberculosis Epidemic in the Era of AIDS: Reflections on Public Health, Law, and Society

The resurgence of tuberculosis and the rise in drug-resistant cases is neither inexplicable nor unexpected, but rather is the predictable outcome of a complex configuration of biological, social, and behavioral factors that have converged in America over the past decade. This article examines the biological, social, and behavioral causes of the epidemic, and suggests a comprehensive public health strategy for curtailing tuberculosis and other infectious diseases. When thoughtfully conceived, public health strategies can be implemented that are consistent with the limitations that both constitutional law and disability law place on the authority of the state. While traditional concepts of public health law frequently have focused on individuals, the author argues that public health law should focus primarily on aggregate harms to communities. To that end, this article presents public health strategies for achieving a population-based objective, and theoretical constructs for thinking about constitutional law and disability law. Part I of this article presents a biological description of tuberculosis, its prevalence, and its contemporary interconnections with the Human Immuno-Deficiency Virus (HIV) epidemic. In particular, part I focuses on the etiology, diagnosis, transmission, progression, and treatment of tuberculosis, as well as the disease\u27s resistance to antibiotics. Part II of this article examines the social conditions surrounding the spread of tuberculosis. In particular, part II examines the relationship between tuberculosis and race, poverty, and homelessness. Part II also explores the dramatic capacity of Mycobacterium tuberculosis to spread in congregate settings, and examines the effects of tuberculosis on residents and staff in three congregate settings: prisons and jails, nursing homes, and health care facilities. Part III of this article focuses on the exercise of compulsory powers to impede the spread of tuberculosis, in particular, mandatory detention, treatment, and directly observed therapy. In this section, the author also presents a series of proposals for reconciling public health imperatives with individual rights while providing the greatest aggregate benefit to the population