Gender and Medicines In HIV/AIDS, Tuberculosis, and Malaria in Low- and Middle-Income Countries: A Systematic Review
Abstract
Medicines are essential tools that improve health in low and middle-income countries, and numerous studies have established their impact in the management of HIV/AIDS, tuberculosis, and malaria. Studies suggest that there are socioeconomic, geographic, institutional, and sectoral differences in medicine access and use, yet few explore gender differences, and no systematic review is available to summarize such differences.
Objectives: To systematically search and summarize literature that describes gender differences in medicine access and use in HIV/AIDS, tuberculosis, and malaria in low- and middle-income countries and to highlight opportunities for further research.
Design: Systematic review of published literature
Setting and study population: Studies that describe gender differences in the HIV/AIDS, tuberculosis, and malaria population in low- and middle-income countries
Outcome measures: We developed a conceptual framework that highlights six core access domains and three domains of socioeconomic determinants linked to gender and medicines. Key characteristics of each article were abstracted and presented to understand the direction of gender differences by each domain.
Results: We included 126 articles in our final review. The extant literature provides limited evidence about gender-related differences. Existing evidence is characterized by a predominant focus on gender and HIV access to medicines and adherence, a body of research supported primarily by international donors. No clear patterns of difference between men and women in access or adherence emerge from the literature in these areas. Most studies are focused on gender issues in HIV care (n=77), while smaller numbers address TB (n=33) and malaria (n=13). Most studies use a cross-sectional research design (n=54) while some are cohort studies (n=31) and others use qualitative methods (n=30). Very few studies focused on acceptability of treatment (n=4), and household affordability (n=1). More articles were focused on patients in Africa (n=77) and Southeast Asia (n=23) while some focused on patients in the Americas (n=7), the Western Pacific (n=2), and the Eastern Mediterranean (n=1).
Conclusion: We found no clear pattern in gender differences in treatment based on the conceptual framework in our study. The evidence is dominated by gender studies on HIV treatment and such studies are dependent on funds from international donors. Governments in low and middle income countries are encouraged to allocate funds for gender studies on HIV, TB and malaria treatment. Treatment guidelines in each region must be reviewed to integrate a gender perspective. Knowledge and skills are needed around research methods and tools to mainstream gender
Citation
Carapinha, J.; Ross-Degnan, D.; Vialle-Valentin, C.; Wagner, A. Gender and Medicines In HIV/AIDS, Tuberculosis, and Malaria in Low- and Middle-Income Countries: A Systematic Review. Presented at Third International Conference for Improving Use of Medicines (ICIUM2011), Antalya, Turkey, 14-18 November, 2011. (2011) 13 pp.
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