Monday, 14 January 2013

TUBERCULOSIS: Tuberculosis and STD prevalence is different worry during EU presidency

Jan 09, 2013
By Linas Jegelevicius
UNDER COVER: Svetlana Kulshis says with such secrecy in the business, it’s difficult to know just how many women are sex workers.
KLAIPEDA - With Lithuania’s EU presidency just around the corner, luxury Vilnius hotels are dusting off their pillows in preparation of meeting the throngs of foreign guests from all over the European Union. The army consisting both of the EU institutions’ callous interns, and top EU decision-makers, will swarm over Vilnius for the EU chairmanship, held from July 1- December 31. They evidently seek not only the “European commonness” in the conference rooms and glitzy reception halls, but will perhaps be on the lookout for a more earthly and exciting cohesion.
This perhaps will happen right around the nearest corner, where a garish-looking hooker may be perking up in the hopes of luring a Brit, Frenchman, Spaniard or another sinful male from the 28-member state exclusive club. But where the real danger may lurk in Lithuania, is in its nearly unsurpassed leadership position in the EU on the STD and tuberculosis list.

A shameful rivalry
“What is quite shameful and is kept off the official presidency glossy booklets is the fact that Lithuania is right behind Romania in the abundance of such sexually transmitted diseases like gonorrhea and syphillis, and is the EU runner-up in tuberculosis cases. Considering that such lengthy international events bring out hordes of sex workers and pay-for-sex seekers, the disease situation will likely get a whole lot worse,” says Ramune Gradauskiene, a public health representative.
Unlike other EU member states with strong economies and well-functioning robust health care systems, the host of the EU presidency, Lithuania, cannot boast a firm economy and such a strong health care system, which makes the country more susceptible to the so-called “social-illnesses,” like tuberculosis, HIV, AIDS and other sexually transmitted diseases.
When the topic is STD and its carriers, we inevitably think of sex workers ready to please an army of salaciousness-driven individuals. “It is hard to tell how many sex workers are out there on Vilnius’ streets. But we have some 200 women coming in for psychological assistance, clean needles or just to have a chat. In fact, most of the women are pretty secretive, and we never try to get into their souls against their will. Therefore, I can just suspect that a considerable number of the walk-ins are sex workers. But as I said, they usually do not tend to speak of that openly,” Svetlana Kulshis, chairman of Lithuania’s HIV and AIDS Affected Women and their Relatives Association “Demetra,” told The Baltic Times.
She says that since the establishment of the organization, she has talked to thousands of women who make their living out on the streets. “Perhaps our cellar-like office is the only spot where they can hear kind words and receive understanding,” says the association chairman.

Police to work with municipality
Vilnius police are also getting ready to make sure the EU presidency event guests are not harassed by panhandlers and, sure, prostitutes. “We have some good experience in that regard from other events, which were smaller and shorter. We’re intending  to bolster the prevention in order to ward sex workers away from the venues. When it comes to panhandling, I believe the Vilnius Municipality has to chip in, applying more strictly the law against panhandling and maybe temporarily housing the beggars somewhere out of the Vilnius guests’ sight,” Vytautas Grasys, head of Public Order Department at Vilnius Country Police Commissariat, said to The Baltic Times.
Not only sex workers’ scourge
Frankly, the STD is far from being only a scourge of the sex workers. Both “normal” youngsters from “normal families” and older persons of both sexes catch syphillis, as it is an issue of social inequality, social isolation and poverty.
And perhaps not only of those conditions. “The insufficient level of diagnostics and lack of medical quality and ineffective cure should also be taken into consideration in explaining the spread of the diseases. On the other hand, this reflects not only the shortages that Lithuanian health care is dealing with, but also the questionable personal behavior, like having drinks with someone one little knows, and then perhaps sleeping with that person,” says Jadvyga Ciburiene, a professor at Kaunas University of Technology.
She says the increasingly larger consumption of alcohol, from 13.4 liters per person in 2007 to 14.1 in 2012, also boosts sexually reckless behavior. “Unfortunately, a lot of young people have a meager perception about alcohol’s impact on the body and psyche,” she says, noting that Lithuania lags well behind Western EU member states according to major health indicators.
What makes things perhaps a lot worse is the number of STD carriers, which is undoubtedly much higher than the official statistics. “Most of the people do not even suspect of being, for example, syphillis carriers. It is really very worrisome that nearly every second youth under 25 has had an STD, referring to one of the 25 sexually transmitted diseases. The most dangerous are the so-called ‘partisan’ forms of illnesses, when  a patient does not feel any signs of a disease and does not seek medical assistance,” says Svajunas Barakauskas, a doctor and head of a medical lab.
He says nine out of ten women with gonorrhea do not show any symptoms. “And a lot more people are chlamydia infection carriers,” the doctor notes.
Every year, over 6,000 new STD cases are diagnosed, but experts claim the real numbers might be ten-fold higher.

A dangerous TBC bacterium
However, to catch the tuberculosis bacterium no hanky-panky is needed, as sometimes it is enough to be in close proximity to a tuberculosis patient to get infected. As of October 2012, Lithuania was right behind Romania in the spread of the disease, registering every year some 1,500 new cases while 190 TBT-infected persons pass away.
“Yet back in 2007, the World Health Organization had enlisted Lithuania among the most TBC-vulnerable countries. Though over the years the illness-related mortality has receded insignificantly, we’ve been seeing a rise of tuberculosis cure-resistant forms of the disease,” says Gediminas Rimdeika, a coordinator of the tuberculosis cure project at the Rotary Club.
Doctors complain that, unlike in some other EU countries where the infectious bacterium carriers can be treated forcibly, Lithuania’s TBC curing system is built on the patient’s voluntary decision to have the cure.
“No need to say that the patients opting out of medical assistance endanger others and open up numerous possibilities for drug-resistant forms of the disease to develop. Sometimes it is difficult to make sure that patients in hospital wards use the prescribed medicine, and the task is really impossible when the patient is out of the hospital. What Lithuania really needs is to adopt legislation allowing the forceful care of such patients,” says Algimantas Taruta, director of Romainiai Tuberculosis Hospital at the Kaunas Clinic.
“However, first, local municipalities ought to make appropriate commissions enabling them to register treatment-avoiding patients and ask local courts to order their forcible treatment,” adds Taruta.

Economy to be taken into consideration
Excoriating the shortcomings, doctors also point out that Lithuania lacks  not only centralized control of the illness’ spread and necessary medicine, but much needed TBC prevention programs are also often absent.
In collaboration with the Lithuanian Health Ministry, the Rotary Club, over the last three years, has allocated 521,000 euros for tuberculosis patients. For the money, some 24,000 food packets have been bought and the Kaunas Clinic has been provided with a sophisticated piece of equipment for TBC treatment, and 13 labs all over the country have been supplied with the necessary lab facilities.
“The disease is sometimes being regarded as an illness of the past, but that is the completely wrong approach. Every year worldwide, some eight million people catch the infectious bacterium and it is estimated each TBC carrier can infect another 25-30 persons. The situation is especially worrisome in China, where the illness’ experts have been observing a rise of drug-resistant forms of the disease. Taking into consideration how fast people move around today, it may only be a matter of time when they may reach us,” says Rimdeika.
“Some 33 percent of the Lithuanian population faces poverty and social exclusion; we won’t be able to change anything in the illness statistical charts if we won’t improve the socio-economic situation. Besides, contrary to the perception that the infection threatens only people on the lowest rungs of the social ladder, we are seeing more TBC cases where well-to-do people get infected,” says the project coordinator.

Lithuanians’ healthcare habits encourage illness
Lithuanians’ healthcare habits also play in favor of the spread of venereal and tuberculosis diseases. According to a recent poll, some 80 percent of compatriots feeling unwell do not rush to seek medical assistance, but tend to self-treat.
“On the first day of deteriorating health, only mothers with little children seek a doctor’s help. Even if the kids are older, mothers opt for consulting doctors. The worst situation is with men, who very rarely come to see a doctor on their own. As a rule, most of the time they are taken to medical facilities by their wives and moms,” said Natalija Vaicekauskiene, a Vilnius doctor.

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