Tuberculosis (TB) is an infectious airborne disease that attacks the lungs of the person it infects. Statistically, more men contract TB around the world, but health experts in developing countries argue that the disease's social impacts on women affect far more than their physical health.
In countries where TB prevalence is high, gender inequality is also often high, according to Amrita Daftary, assistant professor in the department of epidemiology, biostatistics, and occupational health at McGill University.
Unlike some diseases of poverty, TB doesn’t target women specifically.
“If you were to just go by the numbers, it doesn’t look like women are in any … particularly bad shape when to comes to TB, compared to men,” Daftary told Global Citizen. “But the aftermath, the consequences in men and women — particularly the social consequences — can be quite different.”
Women with TB face stigma in countries around the world. In India, for example, married women are sometimes divorced for testing positive for TB, or else beaten or isolated. Single girls or women often lose prospects for marriage.
The question of addressing gender in TB diagnosis and treatment delivery is part of a much larger issue when it comes to global health.
A recent report by the World Health Organization (WHO) highlighted social and economic factors that impact women’s ability to lead in global health, such as stereotypes, discrimination, racism, classism and power imbalances. The report found that the lack of women in leadership roles didn’t just impact women’s careers and further an existing pay gap, but it also impacts the delivery of health services and medical research, which experts say need to be different for men and women.
For a woman, Daftary explains, it might be important to provide guidance on how to explain the treatment process to her husband and his family, or to help her find ways to avoid or cope with divorce.
“Even the scientific community, the policy community, as yet is not addressing those differences adequately,” Daftary said.
Given that education is so important when it comes to global health initiatives, the need to understand gender differences in TB treatment is essential.
This thought is shared by Rabia Abeid, monitoring and evaluation coordinator in a TB REACH Project at SHDEPHA+ Kahama.
The TB project Abeid works on involves door-to-door outreach that provides TB education and screenings for populations in the Shinyanga and Geita regions in Tanzania. Health workers visit homes and collect sputum samples for people suspected to be infected with TB. They will then follow up with results and provide information on how to access treatment.
Abeid confirmed that she’s seen men react quite negatively to their wives being diagnosed. She’s seen cases where men leave their wives, become abusive, or refuse to believe the diagnosis, preventing them from receiving treatment.
TB stigma does also affect men, especially in developing countries, according to both Abeid and Daftary.
Daftary said a man won’t likely be worried that his family will leave him, but he will be concerned that his community will turn its back on him, as he will be seen as weak.
“But it’s just so much harder [for women]. Because they rely on men — for money, for getting to the clinic — but at the same time they don’t really want to tell anyone that they have this, because they are afraid that if they open their mouth about it, they are going to be left,” Daftary said, adding that women will even ask doctors not to include their TB diagnosis in their lab reports.
Abeid stresses that dispelling misinformation and stigma is key to improving the current status of TB.
“Men tend to feel like they are superior compared to anything, to anyone,” she said. “So when you are to remove that in their mind, I think probably it is easier for them to change.”
TB is not a discriminatory disease, Daftary points out. Technically anyone can get TB — but it’s not just anyone who gets TB.
Social determinants, such as income and status, education, and access to health care, greatly impact the likelihood of a population being prone to TB transmission.
In low-income countries, where access to health services, education, and good employment and working conditions may be low, the TB rates will likely be higher.
The WHO’s 2018 Global Tuberculosis Report indicated that India had the highest number of deaths from TB in 2016, followed by Indonesia, China, the Philippines, and Pakistan.
But the report also indicated that TB rates decreased in 2016.
“Diagnosis and successful treatment of people with TB averts millions of deaths each year (an estimated 54 million over the period 2000–2017), but there are still large and persistent gaps in detection and treatment,” the report reads.
While working in Tanzania, Abeid has seen firsthand the need for a gendered approach to TB outreach and education, and Daftary, in India, highlights the need for a comprehensive approach to health efforts around the world.
“Without addressing the underlying determinants, taking on that holistic approach, where you actually fix the housing, you fix the standard of living … get education levels up, make sure people have social protection … If you don’t fix all that other stuff, I don’t know if we can really eliminate TB — amongst men and women,” she said.