Gender is a socially constructed set of norms, roles, behaviors, activities, and attributes that a given society considers appropriate or valued for women and men, including transgender people. Gender is often simplistically understood as relating to biological sex, referring only to men and women. However, some people do not fit into, or associate with, these binary categories in terms of biology and identity. Gender is relevant to all aspects of the TB response.
Gender inequality is pervasive and contributes to poverty and other disparities that shape the social determinants of TB. Gender further shapes people’s access to resources, ability to make decisions and act on the decisions they make, and the power they hold within their communities. Gender also determines peoples’ health needs. For example, TB diagnosis is more difficult in women than in men for a range of biological and social reasons. Gender, then, plays a key role in shaping people’s ability to access and exercise their right to health.
A gender-transformative approach to TB aims at addressing the social, legal, cultural, and biological issues that underpin gender inequality and contribute to poor health outcomes. It encourages activities that are gender-responsive investments to prevent new cases of TB and strengthen the response to fulfil the right to health of women and girls, men, and boys in all their diversity. Wherever applicable, these protections should be included in constitutional law or legislation. If this is not possible, they should be incorporated as legal rights in national and local TB policies.
The Stop TB Partnership and UNAIDS have developed the Gender Assessment Tool for national TB and HIV responses. This tool builds on the UNAIDS HIV Gender Assessment Tool launched in 2013 and has been adapted to include TB. The tool assists countries in assessing both the TB and HIV epidemics from a gender perspective. Findings from the assessment will help countries make their responses gender-sensitive and reduce the burden of TB and HIV. The HIV/TB Gender Assessment Tool seeks to move the HIV and TB responses along the continuum from gender-blind to gender-sensitive, and ultimately to gender-transformative. This Gender Assessment Tool has been implemented as part of the roll-out of larger CRG assessment initiatives at country level.