Addressing Sex and Gender in Epidemic-prone Infectious Diseases

This World Health Organization (WHO) document brings together findings from a broad range of disciplines to explore the role of gender and sex in the transmission and control of epidemic-prone infectious diseases. It discusses evidence of differences in the infectious disease process between males and females, and aims to show how, by taking such differences into account, it is possible to improve the understanding of the epidemiology and the clinical course and outcome of diseases, aid in their detection and treatment, and increase public participation in and the effectiveness of prevention and control activities.

The first section of the paper provides a general overview of the interrelationships between sex, gender, and infectious disease, illustrated with examples of how these work at each stage of the life-cycle (infants, children, adults, pregnant women, and the elderly). Examples of biological, anatomical, and social/economic differences that affect who becomes ill and the course and outcome of illness include variance in: access to immunisation; exposures (because of gender roles); nutritional status; and access to and use of preventive and curative health care, including differences in the speed with which males and females get treatment outside the home.

The second section, which again uses a life-cycle approach, offers a detailed discussion and analysis of selected examples of epidemic-prone infectious diseases (dengue, Ebola haemorrhagic fever (EHF), and severe acute respiratory syndrome, or SARS). For instance, regarding EHF, the reader of this report learns that: "There is anecdotal evidence that the increased burden for females caring for the sick has been well understood by some populations, and that females are deliberately asked to care for the sick to protect males from becoming sick. For example, during a recent outbreak in the Congo in October 2003, an international investigator asked a group of men how they avoided contracting EHF, and they responded that they made sure that women cared for the sick - thus protecting males from infection....The preparation of bodies for burial has been found to play a role in the transmission of EHF. In some societies this activity is heavily influenced by gender norms. In Gulu, Uganda, for example, the paternal aunt of the deceased or another female relative on the father's side is responsible for washing the body of the deceased, a practice that is likely to have contributed to the high proportion of female cases in the 2000-2001 outbreak..."