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| Barrier type | Gender-related themesa |
| Gender similarities | Gender differences |
|
| Individual level | | |
| Financial | Both genders cite finances as a key barrier to seeking care; cost of TB treatment and diagnosis is a shared burden; economic burden affects both genders; cost of healthcare is a gender-wide deterrent to seeking services; and no gender difference in debt is incurred for treatment | Finances have a greater burden on men since they are breadwinners; TB treatment means time away from work and lost earning potential. Less financial independence for women reliant upon families or in-laws; family resource allocation preferring men and children’s health above that of women; women’s lack of financial autonomy a barrier to accessing care and care decision-making; men with greater access to money and treatment decision-making power; direct treatment costs for women sometimes greater than those for men |
| Physical | Distance from work and home to treatment facilities was reported as a barrier to accessing care; long traveling times to hospitals is a barrier | Distance from work to treatment affects men more heavily |
| Stigma | Adverse marital impact of TB-related stigma for both men and women (prospects and spousal support); both genders naming young unmarried people as the group at highest risk of stigma; both genders reporting hiding their diagnosis or describing their disease vaguely for fear of stigma; fear of social isolation reported by both genders; TB stigmatized, but not as much as AIDS; TB stigma not eliminated after treatment | Females expect more stigma in family and reported more isolation, psychosocial consequences, fear of divorce, losing spouses, or compromised marital prospects for unmarried children; TB in women is associated with loose and immoral behavior, leading to greater burden of stigma and more difficulty getting married; women are more likely to hide their diagnosis or delay seeking treatment because of stigma
Men expect more stigma at work, sexual relationships, ability to marry |
| Health literacy | Low education level correlating with greater fear of TB and social isolation; widespread community beliefs that TB is incurable or that TB patients cannot have healthy children; community perceptions that even treated TB can harm offspring, leading to limited marriage prospects | Higher proportion of females displaying prejudice towards TB due to limited knowledge; women and the young with less knowledge than men and the elderly; men with greater formal education and TB knowledge than young and older women; women more likely to regard TB as fatal or incurable; women with limited knowledge in health seeking; men knowing more about HIV/TB transmission than women |
| Sociodemographic barriers | None | Women need to ask permission from husbands or elders to seek treatment; treatment of children and men is prioritized; diagnosed women receive less family support than men; women are expected to care for husbands with TB, whereas men are not expected to care for wives with TB; more males report that family members have a positive attitude towards their disease; men in societies where masculine resilience is valued are more likely to delay seeking treatment |
Provider/system
level | Both genders report long waiting times and poor conditions of TB facilities, unreliability of TB diagnostics as barriers; several studies reported government facilities as gender-neutral and fair | Women are more affected by lack of privacy in health facilities; women are more likely to perceive female health care workers as sympathetic and adhere to treatment; DOTS is more distressing for women; women are more likely to consult traditional healers, self-medicate, or use private physicians over government facilities |
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