Despite signs of progress in the fight against tuberculosis in Russia, much more needs to be done to control the epidemic, health officials said on Friday. The Russian government announced last month that the number of people newly infected with TB had dropped slightly -- from 134,000 in 2000 to 133,000 in 2001 -- the first positive sign in more than a decade of fighting the disease. "Mortality from tuberculosis still remains at an unacceptable level, so the fight has to continue," said Mikhail Perelman, head of the TB department at Russia's Health Ministry.

TB re-emerged with a vengeance after the breakup of the Soviet Union, including new strains resistant to traditional drug treatments. The problem is most acute in Russian prisons, full of overcrowded, poorly ventilated cells. Among the nearly 1 million prison population, 100,000 inmates have TB, and almost 30 percent are infected with drug-resistant strains. Every year, roughly 50,000 prisoners with active TB are released into the community, many without adequate health care. Experts said ex-prisoners infected with TB need counseling to ensure that they continue treatment after their release and that they understand how to keep from passing the disease to others.

"To fight only the medical aspects of tuberculosis is to fight only half the battle," said Samantha Perkins of Merlin, a British health charity that runs one of Russia's most successful TB programs in the Siberian city of Tomsk. "Today our health institutions are not supplied adequately to screen the population, in particular the high-risk groups," Perelman said. International health organizations are also funding anti-TB efforts. But some Russian officials are reluctant to accept outside help. Last year, Russia rejected a $150 million loan from the World Bank for TB treatment. The loan stipulated that Russia use a heavily drug dependent treatment -- including mandatory home visits by health care workers, which many Russians considered intrusive.

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