"Prison stress" is the term that has been coined in Russia to describe the main cause of tuberculosis (TB) among the nation's vast population of prisoners. Those new to the prison system often experience this when faced with conditions that allow only 2.5 square meters of living space per inmate and the serious behavioral changes and emotional upsets experienced when adapting to prison life.

 "Your immune system starts malfunctioning and it is easier to get sick," says Dr. Yefgeni Andrei, Head of Health for the Russian Department of Justice. When prisoners do get sick, they are transported to a prison hospital in Oktyabrsky, a town on the outskirts of Tomsk in Siberia. The facility houses 1,000 inmates and specializes in treating TB.

The growth in the prison population has combined with poverty, homelessness, drug abuse and alcoholism to cause Russia's TB epidemic to rise. Nationwide, Russia reports 84 cases of TB for every 100,000 people, compared to only five per 100,000 in the United States. And ten percent of new cases of TB are drug-resistant. Learn more about Multi-Drug Resistant TB in Tomsk.

Global Fund-supported projects in Tomsk are starting to show results. With more money available to purchase more sophisticated lab equipment, to make improvements to hospital infrastructure and to administer DOTS, the international standard for treatment of TB which relies on health workers to observe as patients take their medication, death and incidence rates are declining.

Thanks to early detection and treatment services available in Tomsk, "TB is stable in the civilian sector and has improved in the prison sector," says Dr. Aivor Strellis, founder of the Tomsk TB Service. Even though Tomsk region has 30 percent more new cases per year when compared with the rest of Russia, the number of people who remain uncured each year is 20 to 25 percent lower.

Results also show at the national level. In 2000, there were more than 100,000 TB-infected inmates in Russian prisons. National projects and international contributions have brought that number down to 40,000 in 2007, Dr Andrei says.