Kazakhstan: Tackling TB and HIV co-infection

Published: 24 March 2010 0:00 CET

Amanda George, British Red Cross, in Temirtau

On the northern Kazakh steppe lies the ‘metal town’ of Temirtau, named after the heavy industry that dominates the city. The population of 120,000 is employed almost entirely in the vast steel works that line the horizon, spewing acrid smoke. Snow is frozen solid into the ground, as temperatures do not climb above freezing - even on a sunny March day – although this snow is black with pollution. The area has the feel of a vast industrial wasteland, a remnant of Soviet times.

This young, sombre city has an even more sombre health problem with the highest rate of HIV in Kazakhstan, although, encouragingly, incidence and mortality rates are down four per cent from 2007. The current global economic climate has also taken its toll on Termirtau’s industry, with consequences for local employment rates and migration.

This is why the Kazakh Red Crescent, through funding from AstraZeneca via the British Red Cross, is working in this area. As part of the Red Crescent’s plan to tackle tuberculosis (TB) in Kazakhstan, TB and HIV co-infection has been singled out as vital to making progress in reducing TB incidence and mortality because those living with HIV are five times more likely to contract TB. In Temirtau, 47 per cent of people living with HIV are diagnosed with TB. TB is also the leading cause of death for people living with HIV.

Supporting health systems

The Kazakh Red Crescent works very closely with the Ministry of Health (MoH) to ensure that services are coordinated. The project aims to strengthen the country’s health system by working as an auxiliary to the government TB and HIV programmes.

Sholpan Baimurzina, Termirtau AIDS centre director from the MoH, says: “We (MoH) work to provide the medication necessary to those with HIV. But because our main clients are from low-income backgrounds and from the most vulnerable sector of the population, to reach these people and to ensure treatments are adhered to we need the social component that the Red Crescent provides. Our government structure is not yet prepared to provide this support and the Red Crescent fills the gap.

”We needed a strong social partnership and we found this with the Red Crescent. This partnership is not just rhetoric; it is constructive reality. The Red Crescent is the only organization in Temirtau to specialize in HIV and TB co-infection support. Now we are able to provide real help to these people. As a result we have seen the mortality rate in Temirtau start to decrease by roughly 25 per cent since the co-infection project started.’

Social and nutritional support

Working closely alongside the local AIDS centre, Red Crescent multi disciplinary teams of a psychologist, social worker and a lawyer support each client. Galina (lawyer), Galina (psychologist) and Jelena (social worker) all have many years experience working with these vulnerable people and are undaunted by the challenges. It is impossible to overemphasise how important this three-tiered support is.

Sveta, 37, is an HIV-positive injecting drug user. ”These are people who I can talk to, cry with, and who will listen to me,” she says. “It is so important for me to talk to people about normal things, normal life, and not about drugs. They reassure me and comfort me. It is so important to feel that we are not forgotten, that there is someone who thinks about us, stands up for us and cares for our children.”

The teams provide regular food and hygiene packs to all clients. It is difficult to grasp the importance of these basic provisions, but once co-infection clients are able to have food on the table and a basic level of hygiene, then they are able to think about more complex steps including taking medication and finding employment.

Moral support

The Red Crescent also provides support to help adherence to lengthy treatments that can often have unpleasant side effects. Galina, the lawyer, represents clients in legal cases as well as providing them with moral support. This is essential because those who are HIV positive often face discrimination, making it hard to find employment, or even register for citizenship.

Galina, the Red Crescent psychologist, says: “What makes this support so unique is that it is free and it is holistic. I come from a medical background and used to believe that purely medical treatment was the answer but now I know that human and moral support is almost more important and helps people to learn how to plan their lives again, to understand that they do not need to die.

“We turn their lives around. When they first arrive at the centre they are destroyed people. They feel like trash. We help them to understand that they have a purpose in life. One lady, Olia, even asked me at the beginning: ‘Can I plan my life?’ They don’t even know that it is possible. We help them feel human again.”