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Open Access Research article

Gender-related factors influencing tuberculosis control in shantytowns: a qualitative study

Dami A Onifade12, Angela M Bayer1, Rosario Montoya13, Marie Haro13, Jessica Alva13, Jessica Franco13, Rosario Sosa13, Betty Valiente13, Enit Valera13, Carolyn M Ford1, Colleen D Acosta1 and Carlton A Evans123*

Author Affiliations

1 Asociación Benéfica PRISMA, Carlos Gonzales 251 Maranga, San Miguel, Lima, Peru

2 Wellcome Centre for Clinical Tropical Medicine & Dept of Infectious Diseases & Immunity, Imperial College London, Hammersmith Hospital Campus, W12 0NN, UK

3 Laboratorio de Investigación y Desarrollo, Departamento de Microbiologia, Universidad Peruana Cayetano Heredia Facultad de Ciencias y Filosofía, Av. Honorio Delgado #430 - Urb. Ingeniería, San Martin de Porres, Lima, Peru

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BMC Public Health 2010, 10:381  doi:10.1186/1471-2458-10-381

Published: 29 June 2010

Abstract

Background

There is evidence that female gender is associated with reduced likelihood of tuberculosis diagnosis and successful treatment. This study aimed to characterize gender-related barriers to tuberculosis control in Peruvian shantytowns.

Methods

We investigated attitudes and experiences relating gender to tuberculosis using the grounded theory approach to describe beliefs amongst key tuberculosis control stakeholders. These issues were explored in 22 semi-structured interviews and in four focus group discussions with 26 tuberculosis patients and 17 healthcare workers.

Results

We found that the tuberculosis program was perceived not to be gender discriminatory and provided equal tuberculosis diagnostic and treatment care to men and women. This contrasted with stereotypical gender roles in the broader community context and a commonly expressed belief amongst patients and healthcare workers that female health inherently has a lower priority than male health. This belief was principally associated with men's predominant role in the household economy and limited employment for women in this setting. Women were also generally reported to experience the adverse psychosocial and economic consequences of tuberculosis diagnosis more than men.

Conclusions

There was a common perception that women's tuberculosis care was of secondary importance to that of men. This reflected societal gender values and occurred despite apparent gender equality in care provision. The greatest opportunities for improving women's access to tuberculosis care appear to be in improving social, political and economic structures, more than tuberculosis program modification.