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WHO Director-General Jong Wook Lee presenting the 2006 TB report on March 22 in Geneva (epa) The World Health Organization (WHO) marked World Tuberculosis Day, held every year on March 24, by urging its member states to intensify efforts to fight tuberculosis (TB) in the WHO European region. Thanks to increased funding and attention, the TB epidemic in the Commonwealth of Independent States and Romania is receding. But WHO says the spread of multi-drug-resistant forms of TB, combined with high HIV-infection rates, are seriously hampering efforts to fight the disease in this region.


MOSCOW, March 24, 2006 (RFE/RL) -- "We call on our member states to ensure that TB is granted the highest priority on the health and development agenda of the WHO European region," said Dr Marc Danzon, the WHO's regional director for Europe, in a statement released on March 23.

Danzon added that "higher political commitment" was needed toward implementing the new strategy, dubbed DOTS (Directly Observed Treatment Short-course), that the WHO has recommended to combat the disease worldwide.


CIS Countries Suffering Badly

According to a new WHO report also released on March 23, countries of the Commonwealth of Independent States (CIS) countries and Romania are among the countries most badly hit by TB.

But Dr. Risards Zaleskis, regional adviser for tuberculosis control at the WHO Regional Office for Europe, told RFE/RL this does not mean the rest of Europe is sheltered from the epidemic.

"The main epidemiological problem is, of course, in the East -- the countries of the former Soviet Union plus Romania," Zaleskis said. "But we cannot say that tuberculosis is not a problem for Western European and Central European countries, because of the expansion of the European Union and because of immigration. That's why at the moment we are working on the agenda for TB control and are trying to involve all 52 member states."


High Infection Rates In Russia, Romania

Zaleskis said the prevalence of TB in Russia is 160 per 100,000 population, and 188 per 100,000 population in Romania.

According to the WHO report, Central and Eastern Europe and the CIS are estimated to have the highest rate of treatment failure in the world, and the second-highest TB death rate -- the WHO estimates that 69,018 people died of TB in the WHO European region in 2004. Worldwide, some 2 million people die from tuberculosis every year.

Part of the problem in Eastern Europe is that cases of multi-drug-resistant forms of TB -- when patients develop resistance to two or more of the four main antibiotics used in treatment -- are rising at an alarming rate.


Drug-Resistant Forms

"The most important reason for the development of multi-drug-resistant TB is first of all a very weak compliance from TB patients, when patients take drugs irregularly," Zaleskis explained. "Another reason is the weak TB control programs, when we cannot ensure appropriate TB detection and appropriate treatment for the newly detected sensitive cases."

Multi-drug-resistant TB becomes particularly dangerous when combined with HIV/AIDS, since it accelerates the progression of AIDS. TB is currently the biggest killer of AIDS patients worldwide.

Zaleskis said the WHO's biggest challenge is therefore to prevent and fight drug-resistant TB strains in Central and Eastern Europe and CIS countries, which are beset with rising HIV/AIDS rates.


Overcrowded Prisons A Breeding Ground

Overcrowded prisons are at the heart of TB epidemics in former Soviet countries, particularly in Russia.

But if prisons provide an ideal breeding ground for infectious diseases such as TB, they also provide a unique chance to combat the disease and curb its spread outside prison walls.

A prison in Afghanistan (RFE/RL)

"Prison is a unique opportunity to diagnose and treat the most difficult group of tuberculosis sufferers -- those who do not wish to get treatment," said Yelena Bogorodskaya, an academic secretary at the Research Institute of Phthisio-pulmonology of the Moscow Medical Academy. "In prison, diagnosing tuberculosis and healing these sufferers is easier than in the civilian sector. Over the past six years, the number of tuberculosis sufferers in prisons has dropped twofold."

This improvement is reflected in other former Soviet countries.

The International Committee of the Red Cross, which has been working for more than a decade to contain TB in prisons, said today that the mortality rate among new cases in Azerbaijan's prisons had dropped from 14 percent in 1995 to 3 percent in 2004.

In Georgia, the prevalence rate in prisons has decreased from 6 percent in 1998 to less than 2 percent in 2005.

The UN On AIDS



The United Nations has issued its annual report on the AIDS epidemic. Here are some of its findings:

  • There are currently an estimated 40.3 million people living with HIV, the virus that causes AIDS. Of those, 17.5 million are women and 2.3 million are children under the age of 15.
  • There were an estimated 4.9 million new HIV infections in 2005, including 700,000 children under the age of 15.
  • An estimated 3.1 million people, including 570,000 children, died of AIDS in 2005.
  • According to the report, more than 25 million people have died of AIDS worldwide since the disease was recognized in 1981.
  • In Eastern Europe and Central Asia, the number of HIV-positive people reached 1.6 million in 2005, up from 1.2 million in 2003. The bulk of people living with HIV in the region are in the Russian Federation and Ukraine. "Ukraine's epidemic continues to grow, with more new HIV infections occurring each year, while the Russian Federation has the biggest AIDS epidemic in all of Europe," the report states. A private Russian survey cited in the report found "no postive changes in sexual behaviour, with condom use decreasing slightly among people in their twenties."
  • In Central Asia, Uzbekistan and Kazakhstan have seen the most dramatic increases of HIV infections. In the Caucasus, the situation is described "relatively stable."

See also:

Central Asia: AIDS Project Seeks To Avert Epidemic

Eastern Europe: European Commission Warns Of 'Resurgent' HIV/AIDS Epidemic

Listen to a short interview by RFE/RL's Tajik Service with Gregory Henning Mikkelsen, director of EU team for a joint EU/UN AIDS initiative. In the November 21, 2005, interview, Mikkelsen describes the epidemic in Central Asia.
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