Staunton, November 2 – Russia has made significant progress in reducing the rate of tuberculosis infections in both the prison and free populations over the last two decades, but it is experiencing a dramatic rise in antibiotic resistant strains that are far more difficult to cure and that are likely to spread because of inadequate medical facilities and cultural attitudes.
Those are the judgments of Russian and international medical specialists and the case histories of individuals suffering from both kinds of TB in Russia today, according to a review of their latest findings by Moscow journalist Olga Zvonaryeva on the Takiye Dela portal (takiedela.ru/2017/11/medicina/).
Tuberculosis, one of the top ten leading causes of death in the world, currently takes more lives than does HIV/AIDS, she says. According to World Health Organization, some 115,000 Russians became infected in 2015, the last year for which data is available; and in that year, 16,500 Russians died of the disease. (Russian figures are slightly lower.)
This is a real tragedy because as the WHO points out, tuberculosis is both avoidable and curable. But because it is, many have been lulled into “a false sense of security” and thus allowed conditions and practices to develop in such a way that new outbreaks and the rise of anti-biotic resistant strains have been able to occur.
Experts suggest that in Russia as in the other countries with the most tuberculosis cases, just under half are now antibiotic resistant and therefore far more difficult to cure. In Russia, their number increased after 1991 when the Soviet system of hospitalizing TB patients for the entire term of their treatment ended.
In post-Soviet times, those with tuberculosis were allowed to self-medicate which often meant they didn’t take the medicines they were supposed to or couldn’t afford them even if they wanted to do so. That and increasing poverty meant that ever more Russians had the anti-biotic resistant form.
Between 1991 and 2000, the number of cases almost trebled, from 34 per 100,000 population to 90.6 cases per 100,000. Many of these cases were among the poor: in figures for 2010, Zvonaryeva continues, the rate of TB infection among the unemployed was 850 per 100,000, 22 times that of those with jobs.
And those who were incarcerated had even worse figures. In 1999, 4347 prisoners per 100,000 incarcerated had tuberculosis. But by 2014, that number had fallen to 984 per 100,000, still greater than among the poor but a significant improvement nonetheless.
In the last decade, the journalist continues, tuberculosis rates have gone up in some places because of HIV infections and narcotics use. Indeed, there is a symbiosis among these three plagues, although most Russian efforts directed at treatment tend to focus on one or the other rather than to approach them systematically.
But the biggest problem by far is the spread of antibiotic resistant strains to as many as 5.2 per 100,000 according to official data and probably twice that number according to medical experts, the journalist says. To address this plague, Zvonaryeva says, Russia must restore social medicine and address underlying poverty and incarceration.
At the same time, she concludes, there are three things that Russia should not do if it wants to have success. First, it should not incarcerate drug abusers but treat them. Second, it should not assume it can counter the HIV/AIDS epidemic by an appeal to traditional values and abstinence alone.
And third, the society must not assume that it can address the problem by incarcerating those most likely to have the disease. Otherwise, when convicts are released, they will spread the problem more widely into society. Further, the prisons must improve treatment facilities, and the society must address poverty and access to quality medical care.