Searching for sex- and gender-sensitive tuberculosis research in public health: finding a needle in a haystack

Abstract

Despite broadening consideration of sex- and gender-based issues in health research, when seeking information on how sex and gender contribute to disease contexts for specific health or public health topics, a lack of consistent or systematic use of terminology in health literature means that it remains difficult to identify research with a sex or gender focus. These inconsistencies are driven, in part, by the complexity and terminological inflexibility of the indexing systems for gender- and sex-related terms in public health databases. Compounding the issue are authors’ diverse vocabularies, and in some cases lack of accuracy in defining and using fundamental sex–gender terms in writing, and when establishing keyword lists and search criteria. Considering the specific case of the tuberculosis (TB) prevention and management literature, an analysis of sex and gender sensitivity in three health databases was performed. While there is an expanding literature exploring the roles of both sex and gender in the trajectory and lived experience of TB, we demonstrate the potential to miss relevant research when attempting to retrieve literature using only the search criteria currently available. We, therefore, argue that for good clinical practice to be achieved; there is a need for both public health researchers and users to be better educated in appropriate usage of the terminology associated with sex and gender. In addition, public health database indexers ought to accept the task of developing and implementing adequate definitions of sex and gender terms so as to facilitate access to sex- and gender-related research. These twin advances will allow clinicians to more readily recognize and access knowledge pertaining to systems of redress that respond to gendered risks that compound existing health inequalities in disease management and control, particularly when dealing with already complex diseases. Given the methodological and linguistic challenges presented by the multidimensional and highly contextual nature of definitions of sex and gender, it will be important that this review task be undertaken using a multidisciplinary approach.

Conducting gender-based analysis of existing databases when self-reported gender data are unavailable: the GENDER Index in a working population

“…Despite growing attention given to the importance of considering sex and gender in health research (Johnson et al 2009;Day et al 2017;McGregor et al 2016;Pilote and Humphries 2014), these terms are still used inconsistently and interchangeably in the literature (Vissandjee et al 2016;Boerner et al 2018). Whereas sex refers to a set of biological attributes and is associated with physical and physiological features (CIHR 2018), gender can be defined as socially constructed roles, behaviours, expressions, and identities of girls, women, boys, men, and gender diverse people (CIHR 2018).…”

“…Measurement of biological sex is relatively straightforward (male, female, intersex) and is usually included as a variable in clinical and epidemiological studies (Vissandjee et al 2016). As for gender, some validated self-report indexes are available for the measurement of selected gender constructs in prospective studies (e.g., gender roles, identity, relations) (Nanda 2011;McHugh and Hanson Frieze 1997;Shulman et al 2017;Kachel et al 2016;Bem 1974).…”

Women Living with HIV in India: Looking up from a Place of Stigma, Identifying Nexus Sites for Change

“…Diagnosis then follows development of advanced symptoms of AIDS, a related sexually transmitted illness, or often after developing a comorbidity with tuberculosis [18,14,27]. Vissandjeé et al [28] and Sinha et al [14] note that while no consensus has been reached as to causality, men typically have higher infection rates for tuberculosis than women. Whether this relates to biological sex related disease factors or results from social constructions of gender, women's reduced incidence of tuberculosis symptoms with attendant tuberculosis and HIV testing and diagnosis means that for women, one opportunity for HIV testing is removed and diagnosis potentially delayed.…”

Inequalities in Access to Tuberculosis Services in South Africa: Does Gender Matter?

“…The researchers concluded that these inequalities in access seemed to be more related to gender norms than to health system factors [15]. However, while men comprise close to 60% of those with TB in South Africa, systematic evaluations of access barriers by gender remain a key research gap [3,16].…”