Gender and/or sexuality: A wild card in the health sector

"The biologist sees hormones; the epidemiologist, risk factors; and the sociologist, social role and structural constraints."

—Constance A Nathanson

When we talk about gender disparity and gender-biases in the health sector, do we see these as issues that need to be addressed and resolved? Or do we merely utilise them as political agendas or tools?

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the world. While HPV infection can lead to cervical cancer in women, it is of particular concern among people living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). HPV is more persistent and more difficult to treat when concomitant with HIV.

In Britain, the National Health Service's (NHS) comprehensive public health service under government administration included three categories of who should get the HPV vaccine: 1) Children aged between 12-13 years; 2) Men under 45 years of age who have sex with men; and 3) "Other" people at higher risk from HPV. However, according to a recent fact sheet developed by the World Health Organization (WHO), globally, it is estimated that 625,600 women and 69,400 men get HPV-related cancer each year. So, I can't help but pose the question of why women are not included as the priority key population by the NHS, despite being the most vulnerable.

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In Bangladesh, the latest HPV vaccine campaign was launched recently. It is aligned with the WHO's target of fully vaccinating 90 percent of 15-year-old girls as part of the global strategy of eliminating cervical cancer by 2030. On the other side of this are People Living with HIV (PLHIV), who are at an increased risk of HPV infection, But in the vaccine campaign, there was no mention of men and boys as part of the target population.

As of 2021, Bangladesh detected 8,761 AIDS cases, and 1,588 of those patients died. At least 729 new AIDS cases were detected and 188 patients died of AIDS in the country in 2021. About 26 percent of them were of the general population, 20 percent were migrants, eight percent were intravenous drug users, 26 percent were Rohingya refugees, nine percent were MSM (men having sex with men), seven percent were male sex workers, two percent were members of the transgender community, and two percent were female sex workers.

The same scenario occurred in neighbouring India, too. Cervical and anal cancers caused by HPV types 16 and 18 now preventable using the bivalent Cervarix vaccine and the quadrivalent Gardasil vaccine (which additionally covers HPV types 6 and 11). In India, both Cervarix and Gardasil are licensed for use in women. In the US, Gardasil is now also approved for use in boys and men aged 11–26 years. But the HPV vaccine is not yet approved in India for men or boys.

The epidemiology of human papillomavirus in women has been documented well, while less is known about the epidemiology of HPV in men. According to a recent study in The Lancet Global Health, almost one in three men worldwide are infected with at least one genital HPV type and around one in five men are infected with one or more high-risk HPV types. Research shows that HPV prevalence is high in men over the age of 15 years and that sexually active men, regardless of age, are an important reservoir of HPV genital infection.

We often tend to pin-point gender disparity in the health sector, and we often represent women as victims of such irregularities. We often forget that power, policies, and gender share an intrinsic connection with geography, we often overlook the power of geopolitics. This made me think of Foucault's tremendous work on power. Michel Foucault talked about "normalising power" ("normal" being the key word), which is power that determines what we see as normal, and constructs our view of the world and of ourselves. In that way, it shapes our beliefs and decisions, while simultaneously giving us the idea that these are our own beliefs. This normalising power ensures that we don't steal or get involved in violent acts (unlike repressive power), and makes sure we do what the institutions tell us. Under such power, we often don't question the obvious discrepancies.

Getting back to the initial question, we need to ask why, for the same phenomenon, the results varied so exponentially in the West and in the Global South. In terms of the Sustainable Development Goals, to "leave no one behind" means an all-inclusive approach, rather than a tactic of "selective equality."

S Arzooman Chowdhury is an MPhil student at the University of Cambridge.

Views expressed in this article are the author's own.

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