Gender responsiveness is central to our TB control strategy. Gender norms and stigma are key drivers of TB, presenting distinct opportunities for intervention. They vary across our populations: Tibetan refugees, Nepali, and Indian. Strict traditional expectations for men, women, and transgender people in these regions differentially predispose them to behavioral, socioeconomic, cultural, and structural risk factors.
Zero TB in Tibetan Kids uses several strategies to advance gender equality. We have routinely consulted with diverse female staff at the project sites since ZTB began in 2017, including home-mothers, nuns, and school nurses, to refine our gender empowerment programs. ZTB supports a dedicated team of female nurses and home-mothers; as physician-researchers and as community leaders, their buy-in is key to both operational research and service uptake in these settings. This is another reason why ZTB conducts women’s leadership trainings alongside technical ones. These workshops advance our overarching goals of capacity-building and long-term sustainability, since female administrators and staff hold great institutional knowledge and can continue to execute their training long after the mobile teams leave (7-year impact report for ZTB is in progress), thanks in part to our “train-the-trainer” model. ZTB’s multiple forms of menstrual health and hygiene education are likely to have this same effect and lead to other improvements across the children’s confidence, self-esteem, and overall mental health.
Such changes have an especially large impact at the beginning of the child’s life-course, and the settings of nunneries and boarding schools are very well-suited to peer education. Adult women and staff from all gender identities, on the other hand, can hold meaningful jobs that strengthen their leadership and clinical research skills, opening doors to more technical careers and preparing them to thrive there.
With Smart Kids Initiative (SKI), we are providing education on mental health illness and substance abuse that we will integrate with the lung health package and smoking cessation tool we are developing. While we generally find higher TB prevalence in males, adolescent girls and adult females may have specific drivers such as access to care, social stigma, indoor exposure to smoke, pubertal menstrual challenges, peer acceptance, etc. Our case-finding model reaches across gender to identify and address the gaps. Educational trainings including sensitization materials from SKI are available to all. Our approach can have an outsize impact on TB control in adolescents and young adults globally.
