Gender norms tied to TB testing differences in Malawi

Tuberculosis remains a disease shaped not only by biology but by social life. Substantial evidence shows men have higher rates of TB and use TB services less than women. To explore one piece of that puzzle, Elizabeth Di Giacomo and colleagues carried out a secondary analysis of a community prevalence survey conducted before a community-based TB active case finding trial in Blantyre, Malawi. The team set out to understand whether people’s attitudes about gender roles — the everyday ideas about what men and women should do and be — were related to whether they had ever been tested for TB. To measure those attitudes they used a modified version of the Gender Equitable Men Scale (GEMS), a tool designed to capture views about gender equity. The survey found that gender inequitable views were common, reported by 56.1% of men and 55.8% of women. By pairing those attitude measures with information about past TB testing, the researchers aimed to see whether social beliefs about gender might help explain who gets tested and who does not.

Perceptions of gender norms were quantified using the modified Gender Equitable Men Scale (GEMS) and related to participants’ histories of TB testing. The association between a composite GEMS score and TB testing history was examined with logistic regression, adjusting for key sociodemographic factors: age, sex, wealth quantile, education, and HIV status. The overall model produced an odds ratio of OR = 1.12, 95% CI: 0.88-1.42, p=0.373, indicating no statistically clear association in the combined sample. A bivariate analysis showed no notable confounding by the listed covariates and no strong effect modification. When the researchers looked separately by sex, they found different patterns: among women there was no association between GEMS score and TB testing history, but among men higher GEMS scores — indicating less gender-equitable views — were associated with a greater likelihood of having been tested for TB across age groups. The analysis points to a sex-specific link between gender attitudes and testing behavior.

These findings do not claim to explain all the reasons behind who seeks TB testing, but they provide a focused clue: attitudes about gender may play out differently for men and women when it comes to TB testing. The fact that gender inequitable views were common in both sexes suggests social norms are widely held and could influence health behaviours in complex ways. The observed association among men, especially across age groups and with a note towards older men, highlights a group that public health programs may need to understand more deeply. The authors suggest this work lays the groundwork for future studies that investigate motives and patterns of TB-related behaviour, and for designing tailored public health strategies. If interventions are informed by measured norms like those from GEMS, they could be better targeted to reach populations who are under-tested or at higher risk, while avoiding one-size-fits-all approaches.