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Emerging Infectious Diseases, Nov, 2004 by Mirta Roses Periago, Ricardo Fescina, Pilar Ramon-Pardo
In Latin America and the Caribbean, the death rate in the population aged 15 to 59 years old is higher in men than in women; in the poorest groups, however, the risk for death in men and women is nearly equal. In 13 Latin American and Caribbean countries, the death ratio between poor and not-poor populations is three times higher for men and seven times higher for women.
The higher ratio for women is partially explained because the number of deaths during the pregnancy and childbearing years is significantly higher in those at lower socioeconomic levels. This fact captures one of the greatest inequities in health, given that most childbirth-related deaths are preventable. Infections after childbirth and after abortions take a considerable toll in countries where maternal deaths are > 50 per 100,000 live births.
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An estimated 25 million cases of sexually transmitted infections (STI) occur each year in the Americas. An estimated 330,000 pregnant women have positive serologic test results for syphilis every year. The 3.1% maternal positive serologic rate suggests that this disease is a major contributor to illness in women and infant deaths. Moreover, the HIV infection rate in the Caribbean is rising faster among women than among men. Of all the HIV infections in the region, women account for 25% in Latin America and 35% in the Caribbean; the sex ratio in those countries where the epidemic is widespread approaches 1:1.
Communicable diseases in developing countries are largely diseases of poverty (2). The poor are at most risk because of their precarious living conditions, often inadequate health services, and lack of access to care. In many cultures, the lower value assigned to women translates into higher levels of suffering, with infectious diseases accounting for 33% of all causes of death among women (4).
A long history of gender discrimination also leads to inequalities that perpetuate a lack of access to resources and services for women and their children. Almost 70% of the 1.2 billion people worldwide living in extreme poverty are women (5), who experience more illness and are less likely to receive medical treatment. Women report 15% more health problems (diseases and accidents) than do men. Yet, women's use of the health services is only 2% higher than men's. Furthermore, this tendency for women to have even this modestly greater use of health services than men disappears in the lowest income quintile, where, paradoxically, the gender gap in health need is widest.
Health data from Guatemala (6) indicate that there is a persistent gap in access to health care between indigenous and nonindigenous groups. Indigenous groups get less prenatal care than nonindigenous groups (45% vs. 67%, respectively). For example, tetanus vaccination rates for indigenous and nonindigenous groups are 46% and 62%, respectively.
Ethnic origins, too, function as an invisible barrier that hinders access to health services. In the Municipality of Sao Paulo, the health system offers retrovirus treatment for HIV patients, which has decreased death rates. A closer look at the heath statistics of the municipality's department of health 2003 (7), however, shows that the risk for death from HIV/AIDS among black women is four times higher than that among Caucasian women.
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