Tuberculosis is a Women’s Health Issue

In a world of 24-hour news cycles, the two weeks separating International Women's Day (March 8th) and World TB Day (March 24th) is an informational ocean.

This year, the theme of World TB Day is “Reach the 3 million”, with 3 million being the number of people around the world who have TB, but do not receive the care they need. Many of these unreached are undoubtedly women – about 2.9 million women become sick with the ancient disease every year, and 410,000 die as a result.

But rarely do we bridge the gap and talk about TB as a women’s issue – a major oversight obscuring the fact that TB is a leading cause of death among the world’s women.

Busi Beko is one of the millions of women affected by TB. 

I met her last year in the Médecins Sans Frontières (MSF) offices in Khayelitsha, a township in Cape Town, South Africa, where she worked as a counsellor. Her story is painful but hopeful, and highlights the unique impact of TB on women.

Busi discovered she was HIV positive while she was pregnant. Although she also exhibited signs of TB, she couldn’t cough up enough phlegm needed for diagnosis, and she also couldn’t have an x-ray done because she was pregnant.

“I was dying,” said Busi. “I was losing weight and thin, but my stomach was growing bigger and bigger…I would go home from the doctors and look at the date and say I’m not going to get to Christmas this year.”

As her condition worsened, Busi signed consent forms to have an x-ray done, which showed she indeed had TB. But after taking treatment for five months, she only became sicker. Further tests showed Busi had multi-drug resistant TB (MDR-TB), a form of TB that is resistant to at least two of the most common TB drugs. Soon after, her infant daughter was also diagnosed with drug-resistant TB.

“I felt judged,” said Busi. “They asked me ‘how did this baby get MDR-TB?’”

Busi and her daughter were both admitted to the hospital, but Busi was discharged after three weeks because there were no beds available for her. “I was crying because I was leaving my baby behind,” she said.

After eight long months apart, Busi’s daugher was discharged from the hospital and both were eventually cured after almost two years of grueling treatment regimens that included painful injections and multiple pills every day.

You can read Busi’s story, in her own words, here.  It reminds me of something once said by Carol Nawina Nyirenda, a TB and HIV advocate from Zambia: “As women, we usually carry the dual burden of being infected and at the same time caring for our infected and affected family members and loved ones.”

Like many other diseases, TB places a heavy burden on women. Statistically, women are less likely to seek medical help than men, often due to issues such as illiteracy or being worried about the impact on their family. Socially, the stigma of having TB falls more heavily on women than men – just as Busi experienced judgment when her baby was diagnosed with TB.

Women are also disproportionately impacted by TB-HIV co-infection. In 2011, almost 60 percent of people living with HIV in the region were women – putting them at a much higher risk of contracting TB. Women of reproductive age are also more susceptible to contracting TB, which places pregnant women like Busi, and their babies, at risk.

So what can we do? Together, the TB community and maternal and child health community can work together on a common agenda to improve TB diagnosis, care, and treatment for women. TB programs can work to remove the barriers that prevent women from accessing treatment, and TB services can be integrated into HIV, family planning, and maternal and child health services.

In the end, Busi’s story had a joyful ending, but there are still many women around the world who aren’t accessing the care they need. Let's bridge the gap, and address TB as a women's health issue.