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12 Dec 2015
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Discussion Paper: Gender and Tuberculosis - Making the investment case for programming that addresses the specific vulnerabilities and needs of both males and females who are affected by or at risk of tuberculosis

UNDP This discussion paper was developed by Katya Burns, with support f...+9 more
UNDP
This discussion paper was developed by Katya Burns, with support from Caitlin Boyce. Special thanks to Susana Fried, Heather Doyle, Motoko Seko, Ntombekhaya Matsha-Carpentier, Jill Gay, Melanie Croce-Galis, Malgorzata Grzemska, Darivianca Laloo, Douglas Webb and Clifton Cortez.
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What you'll learn
Integrating gender in tuberculosis programming
  • This paper is intended to support practitioners, civil society, and government partners in making the ‘investment case’ to increase resource allocation toward tuberculosis (TB) programming that addresses the gender-specific vulnerabilities and needs of people living with or at risk of TB
  • The paper summarises existing evidence of the impact of sex and gender on the risks and effects of TB and highlights data and implementation gaps
  • It provides recommendations for future research and programming
Tuberculosis kills more women globally than any other infectious disease
Women face specific challenges
Globally, more men than women have TB. However, in some countries, more women than men are detected with TB. TB kills more women globally than any other infectious disease, and more women die annually of TB than of all causes of maternal mortality combined. Additionally, women co-infected with TB and HIV are significantly more likely to die of TB than are co-infected men. A lack of research on the drivers of these differences has led to inefficient and/or ineffective programs and interventions.
A group of women sit with bags of food on the ground.

Gender-insensitive health care infrastructure also has an impact on women’s access to services. Although women are less likely to delay seeking care, once they do access TB services, women generally wait longer than men for diagnosis and treatment.

Key Takeaways
1
More evidence is needed
More evidence is needed
The sex- and gender-based dimensions of TB are under-researched, and the evidence to date tends to be insufficient, contradictory, or too narrow to be compared across different populations and geographies. There is also insufficient research on the disease’s impact on pregnant women, fertility, and children, as well as a lack of effort to address the unique challenges in diagnostics. Research aiming to identify and explain gender differences in access and adherence to TB services is also underdeveloped.
2
Increased funding is vital
Increased funding is vital
Expand medical and operational research on sex and gender differences in disease experience, diagnosis, and access and adherence to TB treatment are needed, and strengthen data collection and analysis to address large gaps in data disaggregated by sex, age, HIV status, and other factors.
3
Develop global and country-level TB guidelines, treatment protocols, and national plans
Develop global and country-level TB guidelines, treatment protocols, and national plans
Develop global and country-level TB guidelines, treatment protocols, and national plans that address the differential and context-specific needs and vulnerabilities of both men and women, and girls and boys.
4
Development of more gender-sensitivity programs
Development of more gender-sensitivity programs
Improve the gender-sensitivity of programs and develop interventions to promote gender equity in service utilisation.
5
Provide adequate training for heath care providers
Provide adequate training for heath care providers
Strengthen the gender capacity of health care providers, HIV testing counsellors, and community health workers, particularly in areas with high HIV prevalence.
6
Strengthen gender-sensitive monitoring and evaluation tools
Strengthen gender-sensitive monitoring and evaluation tools
Strengthen gender-sensitive monitoring and evaluation tools to identify and address gender-related barriers to accessing and utilising services, as well as ensure successful follow-up.

Women who attend TB services have also complained about a lack of privacy in health centres when receiving directly observed treatment short-course (DOTS), and women with children may not be able to attend TB services regularly due to a lack of child-care facilities.

An elderly woman smiles in Brazil.

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