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Analysis: Spreading epidemic of tuberculosis and HIV combination in Russia

March 14, 2003

BOB EDWARDS, host: Russian prisons have become a breeding ground for strains of tuberculosis that resist treatment with common drugs. The problem could get worse in the former Soviet Union as the TB epidemic meets the increase in HIV cases. People with weakened immune systems are far more susceptible to TB. Officials from the Russian Federation have been in Washington this week seeking money to stop the TB epidemic before it spreads to other countries, including the United States. NPR's Jon Hamilton reports.

JON HAMILTON reporting:

Yury Kalinin is deputy minister of the Russian Federation Ministry of Justice, which runs the nation's prisons. Ask him how bad the TB problem is there, and he answers with alarming statistics.

Mr. YURY KALININ (Deputy Minister, Russian Federation Ministry of Justice): (Through Translator) You know, I will just give you two figures. We have 79,000 TB patients, and half of them have the multidrug-resistant form of tuberculosis.

HAMILTON: Drug-resistant TB takes two years to cure and requires more than $1,000 in drugs for each prisoner. Untreated prisoners can quickly infect those around them. Kalinin says TB rates were already high, and then in the mid-1990s, intravenous drug users began to show up with HIV.

Mr. KALININ: (Through Translator) There was trafficking going through Russia. More young people started using drugs, and soon we saw many HIV-positive patients.

HAMILTON: The United Nations estimates that between one and two million Russians have become infected with HIV so far; about 30,000 of them are in prison. Some already have a weakened immune system from HIV and find themselves living in cramped quarters alongside prisoners with drug-resistant TB. Dr. Jim Kim of Harvard University says that's a frightening prospect.

Dr. JIM KIM (Harvard University): We've never seen, in history, HIV disease and multidrug-resistant tuberculosis coming together in those numbers. We simply don't know what's going to happen. This is what one might call the perfect storm of epidemics. These two happen to mix--feed on each other so much that we can only guess what the numbers are going to look like in a year or two.

HAMILTON: Kim says people whose lungs are being ravaged by TB are more likely to infect others, which means an epidemic could spread very quickly.

Dr. KIM: It's a problem that will start in the Russian prison system, but soon extend into the civilian sector and, without question, into Eastern and Western Europe. This is a problem at our doorstep right now. We have a small window of opportunity to respond to it, and we're just not seeing an appropriate response from the global community.

HAMILTON: Kim says it's possible to stop even drug-resistant TB. In Tomsk, Siberia, TB was killing more than 50 prisoners a year before an experimental program brought the number down near zero. The program was supported by the Russian government and private groups. But to implement such efforts in every Russian prison, not to mention whole cities and surrounding countries, will require much larger sums from the US government or the global health fund. Representative Sherrod Brown, a Democrat from Ohio, says the Bush administration needs to respond quickly.

Representative SHERROD BROWN (Democrat, Ohio): I think the president doesn't yet understand the danger of the intersection of tuberculosis and HIV. I think he hasn't seen what's beginning to happen in Russia, what's about to happen in India, where TB and AIDS could be so explosive and could be so dangerous to a society.

HAMILTON: Brown has pushed to increase funding for TB programs in other countries. The US now spends about $80 million a year. He says the prospects of an increase are good if the president delivers on his State of the Union promise to provide an extra $10 billion to fight diseases, including HIV and TB, around the world. Jon Hamilton, NPR News, Washington.

EDWARDS: It's 11 minutes before the hour.

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