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EXPERIENCING SYNDEMIC: DISENTANGLING THE BIOSOCIAL COMPLEXITY OF TUBERCULOSIS THROUGH QUALITATIVE RESEARCH

  • Olga Zvonareva (a1) (a2) (a3), Willemien van Bergen (a1), Nadezhda Kabanets (a4), Aleksander Alliluyev (a4) and Olga Filinyuk (a4)...

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.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited

Corresponding author

*Corresponding author. Email: o.zvonareva@maastrichtuniversity.nl

References

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Abubakar, I, Zignol, M, Falzon, D, Raviglione, M, Ditiu, L, Masham, S Zumla, A (2013) Drug-resistant tuberculosis: time for visionary political leadership. The Lancet Infectious Diseases 13(6), 529539.10.1016/S1473-3099(13)70030-6
Azar, MM, Springer, SA, Meyer, JP Altice, FL (2010) A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug and Alcohol Dependence 112(3), 178193.
Baum, MK, Rafie, C, Lai, S, Sales, S, Page, JB Campa, A (2010) Alcohol use accelerates HIV disease progression. AIDS Research and Human Retroviruses 26(5), 511518.
Bobak, M, Pikhart, H, Rose, R, Hertzman, C Marmot, M (2000) Socioeconomic factors, material inequalities, and perceived control in self-rated health: cross-sectional data from seven post-communist countries. Social Science & Medicine 51, 13431350.
Bobrik, A, Danishevski, K, Eroshina, K McKee, M (2005) Prison health in Russia: the larger picture. Journal of Public Health Policy 26(1), 3059.
Boyatzis, RE (1998) Transforming Qualitative Information: Thematic Analysis and Code Development. Sage, Thousand Oaks, CA.
Chiang, C-Y, Centis, R Migliori, GB (2010) Drug-resistant tuberculosis: past, present, future. Respirology 15(2), 413432.
Cockerham, W (1999) Health and Social Change in Russia and Eastern Europe. Routledge, London.
Cohen, J (2017) Drug-resistant tuberculosis strains gain foothold in Russia. Science, doi:10.1126/science.aal1167.
Cohen, S, Janicki-Deverts, D Miller, GE (2007) Psychological stress and disease. Journal of the American Medical Association 298 (14), 16851687.10.1001/jama.298.14.1685
Corbett, EL, Watt, CJ, Walker, N, Maher, D, Williams, BG, Raviglione, MC Dye, C (2003) The growing burden of tuberculosis. Archives of Internal Medicine 163 (9), 1009.
Cornia, GA Paniccià, R (eds) (2000) The Mortality Crisis in Transitional Economies. Oxford University Press, Oxford.
De Silva, V, Samarasinghe, D Hanwella, R (2011) Association between concurrent alcohol and tobacco use and poverty. Drug and Alcohol Review, 30 (1), 6973.
Diedrich, CR Flynn, JL (2011) HIV-1/mycobacterium tuberculosis coinfection immunology: how does HIV-1 exacerbate tuberculosis? Infection and Immunity 79, 14071417.
Drobniewski, FA, Balabanova, YM, Ruddy, MC, Graham, C, Kuznetzov, SI, Gusarova, GI Fedorin, IM (2005) Tuberculosis, HIV seroprevalence and intravenous drug abuse in prisoners. European Respiratory Journal 26(2), 298304.
Farmer, P (1997) Social scientists and the new tuberculosis. Social Science & Medicine 44(3), 347358.10.1016/S0277-9536(96)00143-8
Farmer, P (1999) Infections and Inequalities: The Modern Plagues. University of California Press, Berkeley.
Farmer, P (2003) Pathologies of Power: Health, Human Rights, and the New War on the Poor. University of California Press, Berkeley.
Fedorin, IM (2005) Tuberculosis, HIV seroprevalence and intravenous drug abuse in prisoners. European Respiratory Journal 26(2), 298304.
Field, MG (2004) HIV and AIDS in the former Soviet Bloc. New England Journal of Medicine 531(2), 117120.10.1056/NEJMp048066
Friedman, H, Pross, S Klein, TW (2006) Addictive drugs and their relationship with infectious diseases. FEMS Immunology and Medical Microbiology 47(3), 330342.
Gandhi, NR, Nunn, P, Dheda, K, Schaaf, HS, Zignol, M, van Soolingen, D Bayona, J (2010) Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis. The Lancet 375(9728), 18301843.
Glaser, R Kiecolt-Glaser, JK (2005) Science and society: stress-induced immune dysfunction: implications for health. Nature Reviews Immunology 5(3), 243251.
Keshavjee, S, Gelmanova, IY, Pasechnikov, AD, Mishustin, SP, Andreev, YG, Yedilbayev, A Shin, SS (2008) Treating multidrug-resistant tuberculosis in Tomsk, Russia. Developing programs that address the linkage. Annals of the New York Academy of Sciences 1136(1), 111.
Kiriazova, T, Lunze, K, Raj, A, Bushara, N, Blokhina, E, Krupitsky, E Gifford, AL (2017) “It is easier for me to shoot up”: stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care. AIDS Care–Psychological and Socio-Medical Aspects of AIDS/HIV 29(5), 559563.
Lönnroth, K, Jaramillo, E, Williams, BG, Dye, C Raviglione, M (2009) Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Social Science & Medicine 68, 22402246.
Lönnroth, K, Williams, BG, Stadlin, S, Jaramillo, E Dye, C (2008) Alcohol use as a risk factor for tuberculosis–a systematic review. BMC Public Health 8(289).
McEwen, B (1998) Protective and damaging effects of stress mediators. New England Journal of Medicine 338(3), 171179.
Manderson, L Warren, N (2016) “Just one thing after another”: recursive cascades and chronic conditions. Medical Anthropology Quarterly 30(4), 479497.
Mason, PH, Roy, A Singh, P (2017) Reciprocity-building and the importance of interdisciplinary collaboration in tuberculosis research. Journal of Biosocial Science 49(4), 559562.
Mason, PH, Roy, A, Spillane, J Singh, P (2016) Social, historical and cultural dimensions of tuberculosis. Journal of Biosocial Science 48(2), 206232.
Mayer, KH Dukes Hamilton, C (2010) Synergistic pandemics: confronting the global HIV and tuberculosis epidemics. Clinical Infectious Diseases 50(s3), S67S70.
Mendenhall, E (2016) Beyond comorbidity: a critical perspective of syndemic depression and diabetes in cross-cultural contexts. Medical Anthropology Quarterly 30(4), 462478.10.1111/maq.12215
Miller, AC, Gelmanova, IY, Keshavjee, S, Atwood, S, Yanova, G, Mishustin, S Shin, SS (2012) Alcohol use and the management of multidrug-resistant tuberculosis in Tomsk, Russian Federation. International Journal of Tuberculosis & Lung Disease 16(7), 891896.
Mitchell, AJ, Malone, D Doebbeling, CC (2009) Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies. British Journal of Psychiatry 194(6), 491499.
Nemtsov, A (2002) Alcohol-related human losses in the 1980s and 1990s. Addiction 97, 14131425.
Nichter, M (2008) Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter. University of Arizona Press, Tucson, AZ.
Pawlowski, A, Jansson, M, Sköld, M, Rottenberg, ME Källenius, G (2012) Tuberculosis and HIV co-infection. PLoS Pathogens 8(2), doi: 10.1371/journal.ppat.1002464.
Perelman, MI (2000) Tuberculosis in Russia. International Journal of Tuberculosis and Lung Disease 4, 10971103.
Popovich, L, Potapchik, E, Shishkin, S, Richardson, E, Vacroux, A Mathivet, B (2011) Russian Federation–Health system review. Health Systems in Transition 13(7), 1190.
Rehm, J, Samokhvalov, AV, Neuman, MG, Room, R, Parry, C, Lönnroth, K Popova, S (2009) The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review. BMC Public Health 9(450).
Riessman, C (2008) Narrative Methods for the Human Sciences. SAGE Publications, Boston College, USA.
Santana, P (2002) Poverty, social exclusion and health in Portugal. Social Science & Medicine 55(1), 3345.
Schmidt, L, Mäkelä, P, Rehm, J Room, R (2010) Alcohol: equity and social determinants. In Blass E and Kurup A (eds) Equity, Social Determinants and Public Health Programmes. World Health Organization, Geneva.
Simandan, D (2017a) Considering neoliberalism, contempt and allostatic load in the social dynamics of tuberculosis. Journal of Biosocial Science 49(4), 557558.
Simandan, D (2017b) Wisdom and the path-dependent politics of biomedical research. Journal of Biosocial Science, 49(4), 563565.
Singer, M (1996) A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the Sava syndemic. Free Inquiry in Creative Sociology 24(2), 99110.
Singer, M, Bulled, N, Ostrach, B Mendenhall, E (2017) Syndemics and the biosocial conception of health. The Lancet 389(10072), 941950.
Toungoussova, OS, Bjune, G Caugant, DA (2006) Epidemic of tuberculosis in the former Soviet Union: social and biological reasons. Tuberculosis 86, 110.10.1016/j.tube.2005.04.001
Tsai, AC, Mendenhall, E, Trostle, JA Kawachi, I (2017) Co-occurring epidemics, syndemics, and population health. The Lancet 389, 978982.
Vedhara, K Irwin, M (eds) (2005) Human Psychoneuroimmunology. Oxford University Press, Oxford.10.1093/med:psych/9780198568841.001.0001
Weaver, LJ, Barrett, R Nichter, M (2016) Special section on comorbidity: Introduction. Medical Anthropology Quarterly 30(4), 435441.
WHO (2014) Global Status Report on Alcohol and Health. WHO, Geneva.
WHO (2017) Global Tuberculosis Report 2017. WHO, Geneva.
WHO Regional Office for Europe (2016) European “Health for All” Database (HFA-DB). URL: http://data.euro.who.int/hfadb/ (accessed 1st December 2017).
Willen, SS, Knipper, M, Abadía-Barrero, CE Davidovitch, N (2017) Syndemic vulnerability and the right to health. The Lancet 389(10072), 964977.
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Journal of Biosocial Science
  • ISSN: 0021-9320
  • EISSN: 1469-7599
  • URL: /core/journals/journal-of-biosocial-science
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