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This paper presents a gender perspective on outbreaks 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 between men and women 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.
Differences between males and females arise because of biological, i.e. sex differences and as a consequence of gender-based roles, behaviour and power. Considerable confusion surrounds the use of the words sex and gender. By and large, sex refers to biological differences between males and females whereas gender refers to differences between males and females that are determined by societal and cultural factors. It is worth noting, however, that although the distinction between these two concepts is important, it is not always easy to attribute differences in disease processes uniquely to either sex or gender, since sex and gender are not independent of one another. Therefore, the effects of both sex and gender are considered in this paper.
Despite the potential importance of differences in sex and gender for the transmission, course and outcome of some infectious diseases, little has been written about the implications of sex and gender for the surveillance of and response to outbreaks, especially for diseases that are not sexually transmitted. One reason for the lack of attention to this topic is that key contributions to knowledge about the relationships of sex and gender to infectious diseases have been made by a variety of disciplines, including epidemiology, medical and biological sciences, social sciences and demography. The fact that each discipline tends to work in isolation is a barrier to the application of research in outbreak settings. The current paper brings together findings from a broad range of disciplines so that they can be used during an outbreak. Some of the findings discussed in this paper have already been translated into recommendations for WHO operational responses to outbreaks.