This is the fourth in a series of blog posts exploring how challenges to gender equality affect efforts to end the epidemics of AIDS, tuberculosis (TB) and malaria. The full series is available here

As discussed in one of our earlier blog posts on gender issues and the HIV/AIDS, tuberculosis (TB) and malaria epidemics, social norms can have severe impacts on a subpopulation’s susceptibility to infection. That earlier post explores how societal gender inequalities increase female vulnerability to contracting HIV. However, the issue of discriminatory social dynamics is highly complex and impacts many other aspects of disease, such as one of the most vital steps to eradication: treatment.

A meta-analysis of 28 studies from the African, Middle Eastern, Asian-Pacific, and the South East Asian regions found that more than 60 percent of the studies reported on the inhibiting effect of imbalanced social gender norms on female access to TB treatment. Findings are similar in relation to treatment access for HIV and malaria.

To effectively combat the three diseases, it is crucial that gender-related social dynamics are thoroughly understood. Supporting barrier-free access to treatment can help strengthen sick populations, empower communities, and alleviate the economic cost of death and illness. However, to do this, the following harmful social norms impacting treatment programs must be addressed.

Stronger stigma for women

People living with disease often face stigma, which can be especially crippling for women and girls who feel pressure to hide the status of their condition from their families, communities, and health professionals.

In regards to TB, stigma is one of the primary barriers for women to pursue treatment. Women in hard-hit countries report fear of household and community prejudice, psychosocial consequences, feelings of isolation, and retraction of proper care as reasons for not reporting their disease or seeking treatment.

Many HIV-positive women in high-burdened areas experience similar fears surrounding stigma. In Kenya, one third of HIV-positive women have reported physical and/or emotional violence following HIV status disclosure to their spouse. Furthermore, stigma can be harmful to women’s family relationships. A 2013 UNAIDS study of Malawi women found that more than 40 percent of women living with HIV had been divorced by their husbands. In developing countries where males hold more societal and economic power, divorce can be financially catastrophic for women.

Imbalance of power dynamics

In countries with higher disease prevalence, social norms that perpetuate imbalanced gender power dynamics can also create obstacles for women’s access to treatment. Such power dynamics can include unequal access to finances. In many societies, women do not share the same economic opportunities as men, inhibiting their ability to pay for treatment. In cases where the male of the household is the primary breadwinner, he can have ultimate control over whether a woman is able to pursue and maintain treatment.

For instance, a 1999 report by the World Health Organization explains how insecticide-treated nets (ITNs) for malaria prevention are provided to families; if a family only has one net, it is not uncommon to give the male head of the household priority to ITN use. In Benin, women have reported that, due to financial dependence, they are unable to provide an ITN for themselves or their children if their husband claims priority.

Obstacles to health literacy

Another societal challenge that may hinder women’s access to treatment is educational opportunity. In many nations with high rates of the three diseases, men have higher literacy rates than women. Globally, women make up two-thirds of the world’s 774 million adult illiterates. This is heavily influenced by cultural standards such as early female marriage, early pregnancy, and discouragement of female education. Studies and notable organizations have established that literacy — specifically health literacy — which can be obtained through education, is strongly correlated to greater health outcomes.

The work of the Global Fund

The Global Fund is going beyond necessary support for gender-specialized programs. With its Gender Equality Strategy Action Plan, the Global Fund has put in place a thorough plan for how it can promote a dedicated focus in anti-disease programs it finances that address societal gender inequality.

For instance, the Global Fund is prioritizing programs that encourage education for women and girls. These programs can help overcome obstacles to education and protect girls from societal norms such as early marriage — a practice that, in some countries, can increase girl’s vulnerability to contracting HIV.

The Global Fund also advocates for disease intervention programs that favor female empowerment. With the help of the Global Fund, the Ethiopian government was able to institute the National Health Extension Program, a program that trains women to serve as traveling health educators for rural villages. Programs like this can have a positive influence on gender roles and power dynamics. The Global Fund is planning to engage donors and further highlight this area of work by early 2018.

There is much that needs to be done for women both in regard to gender equality and equitable access to disease treatment. These two issues are strongly associated; one cannot be eradicated without addressing the other. Responsible disease management must incorporate gender-based needs to be successful.

[Sydney Spencer, research intern at Friends, will receive a B.S. in Public Health from George Washington University in 2018].