Zvonareva Olga, van Bergen Willemien, Kabanets Nadezhda, Alliluyev Aleksander, Filinyuk Olga
1Department of Health,Ethics and Society,Maastricht University,The Netherlands.
4Department of Tuberculosis and Pulmonology,Siberian State Medical University,Russian Federation.
J Biosoc Sci. 2019 May;51(3):403-417. doi: 10.1017/S0021932018000263. Epub 2018 Oct 9.
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.
结核病仍然是一个重大的全球公共卫生问题，已演变成一场由艾滋病毒以及日益增多的抗菌素耐药性引发的危机。所谓结核病的生物社会性质对有效控制该疾病构成了挑战。然而，在不同环境中导致结核病持续存在的生物社会互动难以得到系统的解释。最近发展起来的综合征理论框架提供了一种方法，用以了解诸如艾滋病毒和结核病等疾病与失业、营养不良和药物滥用等有害社会状况之间的相互作用是如何导致复杂的健康问题的。本文通过研究俄罗斯联邦与结核病聚集在一起的健康状况、找出一系列促成这种聚集并加剧健康后果的社会过程，以及分析这些健康状况与社会过程之间的相互作用，推动了综合征理论的学术研究。为了阐述这种复杂性，本文采用定性研究方法，并借鉴了结核病患者的观点和经历。结果表明，压力、药物滥用、结核病和艾滋病毒形成了一种综合征，由贫困、职业不安全、边缘化和孤立状况所维系。医疗保健系统对结核病的狭隘关注与许多结核病患者生活所置身的更广泛的综合征过程之间的矛盾，导致了更差的健康结果，并增加了产生耐药性的风险。最后，本文认为，大规模的非个人力量通过人们体验和理解这些力量及病症的关键方式，具体表现为个人病症。需要进行定性研究，以便充分分析这种生物社会复杂性，从而为应对不同环境中以结核病为中心的综合征提供坚实基础。
