Paul
Goble
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.
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