TB: When the Barriers to Care Are Too High

Drug addiction compounds the risk of contracting TB, HIV or hepatitis C. This woman has just injected herself with acetylated opium. Most drugs in eastern Ukraine are easy to find.

Roza, an outreach worker, kneels in order to counsel Katya, a 37-year-old drug user in Donetsk who is living with HIV and possibly TB. Her legs are scarred from using used needles to inject drugs. Peer outreach workers are the best hope for reaching drug users and convincing them to accept medical help.

People who use drugs are especially under-diagnosed in Ukraine, usually out of fear that doctors will report their drug use to police. Often, TB cases go undiagnosed until it is too late for them to be effectively treated.

Hospital equipment can be outdated. The laundry woman at a TB clinic in Donetsk says the washing machine jokes it is as old as she is—it is used to clean the laundry of 150 in-patients.

For most drug users in Ukraine, there isn't a happy ending. At a TB clinic outside Donetsk a doctor checks Andrei for signs of life and finds none. He had checked himself into the hospital three days ago. A drug user of many years, he has died at the age 46 from HIV-associated drug-resistant tuberculosis.