The Challenge of Infectious Disease: Time to Take Gender into Account

Efforts to address infectious diseases have long been hindered by the failure to take into account the social aspects of these diseases. Gender is a fundamental dimension of these social aspects. There is currently a focus in international health on the import ance of addressing diseases of poverty. Attention to gender is a crucial part of a poverty-focused response to the challenges posed by infectious disease. In this article we provide a framework for analysing gender inequities in infectious disease in developing countries, and briefly draw implications for policy and practice.

Gender identities, status, roles and responsibilities influence vulnerability to dis ease, access to health care, and the impact of disease for women, men, girls and boys. Women's and men's roles affect their risk of infection with specific diseases, whilst gender relations influence their ability to protect their own health. Gender differences in access to and control over resources, in decision-making power in the household and in roles and activities can limit women's ability to access health care for them selves and their children. Gendered norms and identities influence both women's and men's willingness and ability to seek care. The social consequences of infectious disease are often more severe for women than for men, and illness imposes a parti cularly heavy labour burden upon women.

Health services need to adjust their practices to improve the appropriateness of preventive and curative services for infectious disease control for both women and men amongst the poor and disadvantaged. However, measures to reduce gender inequities in health cannot be limited to the health sector alone.

Impact of AIDS on rural livelihoods in Benue State, Nigeria

This study addresses the socio-economic impact of AIDS on rural livelihoods in Benue State, Nigeria, where HIV prevalence is 9.3% but the number of AIDS cases is still relatively low. About 6% of the study households had experienced illness and death classified as AIDS, and reported high costs in terms of expenditures and time spent on care, funerals and mourning. These demands on time affected income and productivity, while the diversion of resources had implications for investments and savings. Coping strategies varied between households, mainly as a reflection of asset levels, which were often related to the gender of the household head. Reported coping strategies also differed between ethnic groups. First-line relatives were the most important source of support for households under pressure. Erosive coping strategies that undermined the sustainability of livelihoods were used by more vulnerable households following multiple cases of illness and death. Mourning practices, rules of inheritance and stigma tended to increase a household's vulnerability. Currently, Benue State is facing growing adult morbidity and mortality because of HIV infections. A context-specific study of its possible impact in a setting with a still relatively low number of AIDS cases is therefore important for informing local policy development and for building advocacy.

Viewpoint: medical infertility care in low income countries: the case for concern in policy and practice

Based on published, 'grey' and anecdotal information, this paper explores some aspects of infertility, its medical treatment and their burden in poor countries. Many cases of infertility result from sexually transmitted infections (STI) and unsafe abortion and there is no doubt that their prevention and adequate treatment are of utmost importance, especially as effective infertility treatment, if any, comes at a high price for the consumer, materially as well as physically. Medical infertility interventions are apt to fail a free market of provision because of major information asymmetry. This renders patients in low-resource countries prone to exploitation, potentially damaging practices and waste of their savings. The authors argue that in countries struggling with limited funds and a range of pressing public health problems, public investment in infertility treatment should not have priority. But governments should take an active role in quality control and regulation of treatment practice, as well as invest in counseling skills for lower-level reproductive health staff to achieve rational referral of patients.

Reproductive tract infections, gynaecological morbidity and HIV seroprevalence among women in Mumbai, India

Reported are the prevalence of reproductive tract infections and their contribution to pelvic inflammatory disease (PID), as well as the seroprevalence of human immunodeficiency virus (HIV), among women living in three inner city wards of Mumbai, India. Women aged < or = 35 years were recruited and screened as cases if they had been admitted to hospital for gynaecological investigation for suspected PID (n = 151) or infertility (n = 295); controls were healthy fertile women attending for laparoscopic tubal ligation (n = 2433). The women were mainly of low socioeconomic status. A total of 59.4% were migrants and 14.9% of these came to Mumbai to seek treatment. Cases reported a history of adverse pregnancy outcomes significantly more often than controls, and 30.5% of suspected PID cases had previously undergone laparoscopic tubal ligation. At examination 24.2% of cases and 8.4% of controls had a vaginal discharge. Pelvic infection was confirmed in 42.0% of suspected PID cases and 14.6% of infertile cases for whom diagnostic laparoscopy was performed. The prevalence of sexually transmitted diseases was low: Chlamydia trachomatis was found in 0.2%; and Neisseria gonorrhoeae was cultured from the cervix in only four cases. Neither of these infections was detected in laparoscopic aspirates. The prevalence of HIV1/2 infections in unlinked samples was 1.9%. Sexually transmitted diseases were not major factors leading to gynaecological morbidity. Heterosexual spread of HIV infection to this population of married women is still relatively low but needs to be carefully monitored. The gynaecological morbidity detected may be a consequence of widespread use of invasive methods of fertility regulation.