In 2002, WHO identified the need for gender analysis of differences in TB that went beyond differences in prevalence between males and females (172). As illustrated in previous sections, a gender and equity analysis is about looking at how sex, gender and other social and cultural determinants intersect to create different patterns of exposure, risk, vulnerability, health behaviors, service use and outcomes for men and women (171). This includes looking at the economic consequences of treatment and the stigmaassociated with being known to have TB (172).

A study from the Hunan Province of China, assessed the impact of efforts to improve the health care system in relation to gender and regional disparities in TB (2005-2009). The average annual incidence ofTB was 111.75 per 100,000 in men and 43.44 in women (173). Regional inequalities decreased significantly for males but remained stable for females suggesting that the TB control policy during the study period had limited effect on gender inequality in TB incidence. While the 2005-2009 DOTS strategy and NCMS program was effective for men, it seems less so for women. This study also found differences in health service use with older women preferring to seek comfort in religion rather than medical treatment after developing TB (173).

In addition, TB policy and servicesare developed and delivered within a health policy environment that is not gender neutral but very much the normative masculine culture of science (171). As such services maybe unable to adequately meet the needs of men and may be even poorer at addressing the needs of women. “New ways of developing policy and services that take gender into account are required—both with regard to the gender‐related needs of patients, and the gendered behavior of service providers.” (171) Doing so requires systematic application of a gender and equity lens to identify and analyze  differences between and among men and women.

References

171. Mason PH et al. Tuberculosis and gender in the Asia-Pacific region. Australian and New Zealand Journal of Public Health, 2017, 41(3):227–229.

172. Genderand Tuberculosis.WHO, 2002 (Gender and Health; https://apps.who.int/iris/bitstream/handle/10665/68891/a85584.pdf;sequence=1, accessed 30 January2020).

173. Chen M et al. Gender and regional disparities of tuberculosis in Hunan, China. International Journalfor Equity in Health, 2014, 13:32