Overview Tuberculosis has been an ever-present concern within the Russian prison system, and recently a new infectious threat has emerged:
multi-drug-resistant tuberculosis (
MDR-TB). Infectious disease researchers Nachega & Chaisson estimate that of the 10% of Russian prisoners with active TB (roughly 100,000 people), 40% of new cases are multi-drug resistant. This prevalence has alarmed public health experts, as have studies such as public health surveyors Bobrik et al.’s report that in 1997, approximately 50% of all Russian prison deaths were caused by TB. Although both MDR-TB and non-resistant TB are treatable, infectious disease experts like
Paul Farmer note that the second-line drugs used in MDR-TB therapy are more expensive than the
standard TB regimen, which can limit a MDR-TB patient’s access to care.
Living conditions and spread of TB in Russian prisons There are several factors within the Russian prison system that contribute to the severity and spread of MDR-TB. Overcrowding in prisons is especially conducive to the spread of tuberculosis; according to Bobrik et al., inmates in a prison hospital have 3 meters of personal space, and inmates in correctional colonies have 2 meters. Furthermore, in an International Journal of Tuberculosis and Lung Disease article, Kimerling et al. point out that arrested Russians cannot be transferred to TB colonies unless they are convicted, which allows them to potentially infect fellow cellmates before release or prosecution. Researchers Fry et al. note that even within the St. Petersberg prison system, which contains 8 TB colonies, prisons facilities are in need of further isolation systems as well as diagnostic and laboratory equipment. In addition to overcrowded and inadequately isolated conditions, many prisons lack sufficient ventilation, which increases likelihood of transmission. In Stern’s report on prison health, she notes that within Russian prisons, heavy shutters of wood or steel “keep out most of the air and most of the light…[and] a wise policy would be to remove them.” Bobrik et al. have also noted food shortages within prisons, which deprive inmates of the nutrition necessary for healthy functioning. Non-compliance with treatment regimens has also been highlighted as contributing increasing drug resistance. In Fry et al.’s study on TB outcomes within St. Petersburg prisons, they estimated that 74% of infected prisoners did not report visiting a TB treatment facility upon release from a correctional facility.
Historical context In Kimerling’s article within the International Journal of Tuberculosis and Lung Disease, he notes that the rise of TB and MDR-TB within Russia is a recent phenomenon. Prior to the
dissolution of the Soviet Union, "tuberculosis rates were substantially lower [in Russia] than they are today". The previous TB control program was marked by actions such as annual
chest radiographies to screen the Russian population, an emphasis on isolation of patients within long-term hospital settings, and mandatory
BCG vaccination. However, this system dissolved with the Soviet Union, as Russia's faltering economy failed to provide the industry necessary for production and purchase of adequate TB medication, healthcare workers, labs and diagnostic tests, and a sufficiently coordinated TB control system. Additionally, Kimerling discusses that a disconnect between Russian ideals of proper TB management and the internationally prescribed standard TB therapy (
DOTS therapy) has dampened control efforts. He notes that (with regard to short term standard therapy solutions) "the term 'short' has a negative association and is not felt appropriate [by Russian TB protocol]", and that "the term 'standard' can be interpreted or translated as rule or regulation in the Russian language, resulting in negative connotations by limiting a physician's right to take an individual approach to patient care". ==See also==