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Concerns have been raised about whether the interaction between tuberculosis and human immunodeficiency virus (HIV) may lead worldwide to a recrudescent tuberculosis pandemic. These concerns are particularly grave in Africa which has a high prevalence of both tuberculosis and HIV. This study used a computer simulation model to examine the effect of tuberculosis-HIV interactions on tuberculosis prevalence and mortality in Africa. The model then assessed the impact of expanding treatment and chemoprophylaxis programmes on tuberculosis prevalence and mortality over the next decade. In communities where 20% of the population is infected with HIV and 25% receive treatment for tuberculosis, deaths from tuberculosis would be 100% higher than in communities where none of the population is HIV-infected. In a population the size of Uganda's, during one decade there would be approximately an additional 530,000 deaths from tuberculosis. When 50% of patients with active tuberculosis receive treatment, one death will be averted for every 2.5 people who receive treatment. The prevalence of active tuberculosis could be cut by over 90% in a decade by providing effective chemoprophylaxis to 30% of individuals with inactive TB. In conclusion, TB is only one example of a preventable and treatable infectious disease which can be spread through casual contact and which, because of its higher prevalence among the HIV positive population, may lead to a preventable increase in incidence of infection among the general population.

Marginal changes in programs targeted directly at children are significantly more effective at further reducing pediatric TB morbidity and mortality than the same changes in programs targeted at adults with the indirect goal of reducing spread to children. Marginal increases in the number of children who enter treatment are far more effective at decreasing morbidity and mortality than equivalent marginal increases in treatment effectiveness. Unfortunately, declining insurance coverage and increasing restrictions on services to immigrants have made it harder for those who are at greatest risk of TB to get medical care. Marginal increases in preventive therapy rates substantially reduce future pediatric TB cases and deaths among children with TB infection and human immunodeficiency virus.

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Implicitly and explicitly, human rights have played a significant role in public health debates for decades. At the turn of the century, when health department officials in the United States were debating measures to control sexually transmitted diseases, it was argued that "the progress of preventive medicine has been a history of the conflict between the so-called rights of the individual and the higher rights of the community."' In the U.S., the government has historically treated human rights in the area of infectious disease control differently than in any other area of social policy. In comparing the Department of Health to other municipal departments in New York, Stephen Smith, a Department of Health member from its establishment in 1868 until 1875, wrote: "The Department of Health of the City of New York is an anomaly. It has the power to make laws, to execute those laws and to sit in judgment on its own acts. Its acts within this sphere of its jurisdiction can not be interrupted or even reviewed by the courts."2 W. A. Purrington commented further: "salus populi suprema lex. .. there is no branch of the law in which, of late years, individual liberty has been curtailed more than in sanitary legislation."3 While the roles of public health departments have