Abstract
Tuberculosis (TB) remains a major global public health problem that has become a crisis fuelled by HIV and the increasing occurrence of antimicrobial resistance. What has been termed the biosocial nature of TB challenges effective control of the disease. Yet, biosocial interactions involved in the persistence of TB in diverse settings are difficult to systematically account for. The recently developed framework of syndemics provides a way to capture how complex health problems result from the interactions between diseases such as HIV and TB, and harmful social conditions such as unemployment, malnutrition and substance abuse. This article advances the syndemics scholarship by examining health conditions that cluster together with TB in the Russian Federation, by eliciting a set of social processes that precipitate this clustering and exacerbate health outcomes, and by analysing interactions between these health conditions and social processes. To provide an account of this complexity, the article takes a qualitative approach and draws on the perspectives and experiences of people with TB. The results demonstrate emergence of a syndemic of stress, substance abuse, TB and HIV that is sustained by poverty, occupational insecurity, marginalization and isolation. Frictions between the narrow focus of the health care system on TB and the wider syndemic processes in which the lives of many persons with TB are embedded, contribute to poorer health outcomes and increase the risks of developing drug resistance. Finally, the article argues that the large-scale and impersonal forces become embodied as individual pathology through the crucial interface of the ways in which persons experience and make sense of these forces and pathologies. Qualitative research is needed for the adequate analysis of this biosocial complexity in order to provide a solid basis for responses to TB-centred syndemics in various settings.
Highlights
Tuberculosis (TB) is one of the top ten causes of death worldwide. It is caused by Mycobacterium tuberculosis, which spreads from person to person through inhalation of bacteria and commonly affects the lungs
For many TB patients who participated in this study work was a major part of life, as it was the first and sometimes only activity they mentioned when asked about their life before getting sick
The disease histories of persons with TB and the insights of TB physicians interviewed in this study suggest a complex syndemic nexus of interconnections between health conditions that cluster together with TB in the Russian context and a set of social processes that precipitate this clustering and exacerbate health outcomes
Summary
Tuberculosis (TB) is one of the top ten causes of death worldwide. It is caused by Mycobacterium tuberculosis, which spreads from person to person through inhalation of bacteria and commonly affects the lungs. Despite the existence of effective treatment, TB has remained a global public health problem that has become a crisis fuelled by the advent of HIV and the increasing occurrence of antimicrobial resistance (Farmer, 1997; Corbett et al, 2003; Chiang et al, 2010). The World Health Organization (WHO) estimates that in 2016 about 40% of deaths among HIV-positive people were from TB and there were 490,000 new cases of multidrug-resistant. When other individuals are exposed to the mutated bacteria, primary infection with resistant strains of TB may occur (Abubakar et al, 2013)
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