Gender and Tuberculosis: Discussion Paper

"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 [TB]."

This discussion paper from the United Nations Development Progrmme (UNDP) summarises the existing evidence base on tuberculosis, "demonstrating the ways in which gender has an impact on the risks and effects of TB (including those that intersect with HIV), and highlighting existing gaps in data and implementation." Written for the UNDP "in its role in supporting governments to implement and operationalize the [Sustainable Development Goals] SDG agenda", the evidence and recommendations are intended "for practitioners preparing concept notes for Global Fund resources. As such, this paper has been designed to be used in conjunction with UNDP’s 2015 ‘Checklist on Integrating Gender into the Processes and Mechanisms of the Global Fund to Fight HIV, TB and Malaria’". 

Because, as stated in the discussion paper, TB is kills more women than any other infectious disease, this discussion paper describes the vulnerability of women to TB, their increased risk for HIV-positive women, the impact on pregnant women, and gender and access to service issues, as well as recommendations for resources allocation, research, and programming.

The paper describes findings on the impact of TB in women, particularly those of reproductive age, including mother-to-child transmission, often resulting in low birth weight babies and higher infant mortality rates. Diagnosis of children is often not prioritised due to it being difficult and to a belief that they are unlikely to spread the infection.

Findings on treatment access include difficulty accessing services due to lack of economic resources, stigmatisation (including a higher likelihood of divorce), gender insensitive health services (lacking privacy, longer waits for treatment and diagnosis, care-giving responsibilities restricting time for treatment access), and lack of treatment provision for some populations, for example, women prisoners.

Data gaps for gender-specifc programming are being addressed by a roll-out of a new Gender Assessment Tool for National HIV and TB Response in 2016 developed by UNAIDS and the Stop TB Partnership. Guidance/monitoring and evaluation tools do not include gender considerations, and international guidance on indicators in the area of TB does not include gender-specific indicators (as of publication in 2015). Research gaps include medical research looking for critical biological differences and programmatic research on gender aspects of programmme provision.

In its recommendations, the discussion paper suggests "that concept notes developed for the Global Fund resources, and other funding sources, should specifically propose interventions that respond to the gender-specific needs and vulnerabilities of people affected by or at risk of TB. This funding could address the following:

1. Expand medical and operational research on sex/gender differences.

2. Develop gender guidance for TB.

3. Improve the gender-sensitivity of programmes.

4. Build human resource capacity.

5. Strengthen Data collection and analysis.

6. Strengthen gender-sensitive monitoring and evaluation."

Specific communication recommendations include:

• integrating TB screening, preventive therapy and TB treatment into reproductive health services... 
• strengthen[ing] the gender capacity of health care providers, HIV testing counsellors and community health workers through avenues such as occupational training materials. This would provide workers with TB prevention, screening and treatment literacy as a routine part of their work with women, particularly in areas with high HIV prevalence...
• compil[ing] of best practices in addressing gender in the context of TB programming should be developed, published and disseminated, to assist programmes to make their services gender-sensitive....
• better monitoring and evaluation of TB and HIV programmes to ensure that gender-related barriers are identified and addressed, that sex- and age-disaggregated data on TB are collected and fully utilized to improve prevention and care, and that indicators are harmonized."