Where are gender sensitive responses in TB programs?

5-8 December 2015 - The Stop TB Partnership, Women For Global Fund (W4GF), the Global Fund and PANGAEA co-hosted a workshop to strengthen TB and malaria responses within the HIV gender response in Harare, Zimbabwe. The workshop aimed to strengthen the capacity and responses of HIV gender advocates around TB and malaria to engage in country level processes (including National Strategic Plans, Global Fund Country Dialogues, and Country Coordinating Mechanisms) from a gender equality perspective.

According to the Global TB Report 2015 (WHO) there were 9.6 million incident cases of TB globally in 2015. 5.4 million were men, 3.2 million women and 1 million children. Of the 1.5 million people who died of TB in 2014, 480,000 were women, 890,000 men and 140,000 children.

In most of the world, more men than women are diagnosed with TB and die and it is a leading infectious cause of death among women. TB affects men and women mainly in their economically active and reproductive years and the impact is strongly felt by their children and families. One of the key issues in defining gender sensitive responses in TB programming is the lack of data. Sex-disaggregation of TB data is rarely available to inform programming and epidemiological and treatment outcome data are not always available by sex and age. The latest change in global TB reporting (WHO Global TB Database) only asks for limited indicators disaggregated by age and sex. Country programs, implementers, donors and WHO could, for example, strengthen monitoring and evaluation to capture gender dimensions of TB and they can begin the process by undertaking a gender analysis to make key interventions gender responsive.

The male/female ratio of those with TB varies by geographic location and year with over 60% of TB incidences occurring in men (2014). Despite higher HIV prevalence among women in Sub-Saharan Africa, incidence of TB is higher in men except in women 15-24 years in areas of high HIV prevalence. Locally relevant, evidence-based interventions for both genders, pregnancy status and all ages are needed.

TB is a gender issue as social and behavioral context makes people vulnerable to infection, lack of treatment adherence and TB deaths. Male-specific risks include more social contacts, work in high-risk settings, smoking, alcohol consumption, limited health seeking behavior whereas female-specific risks include higher stigma, delayed diagnostics, less accesses to passive case-finding.

Full integration of TB into all services is often missed for particular genders, for example, TB screening at services for maternal TB/HIV, adherence support tailored for men, women and children, TB screening for women living with HIV (including services for extra-pulmonary TB), TB services for both men and women in prisons including prison staff.

This workshop aimed to inform participants about TB and gender, programmatic issues and new tools such as the HIV/TB Gender Assessment Tool developed by Stop TB and UNAIDS for advocacy on gender-transformative programs on HIV, TB and malaria during country processes.

Forty women and men, mainly from African countries, participated and many did not have much understanding of TB, despite many of the attendees being TB survivors. After a TB 101 session all the participants discussed how they could include TB in their advocacy work in their home countries and raise awareness of the Global Plan to End TB 2016-2020.

Dynamic discussions were held around the new Global Fund Strategic Framework 2017 - 2021 and helped participants identify key next steps and actions at country level for implementation and monitoring.

Participants also outlined key areas of synergies, as well as gaps and challenges on integrating gender into HIV, TB and malaria programs to feed into the process of operationalizing the Global Fund Key Strategic Framework 2017 - 2021.

There is a need to increase awareness of gender issues in TB programming. There are many opportunities for people to advocate for their inclusion in national strategic plans, Global Fund concept notes and grants. The key is to ensure that gender sensitive and transformative interventions are not only included in TB programs but are budgeted and monitored as well.