UN-SDG Project – Tuberculosis in Men
Victoria Golab, Lily Hutt, Phoenix Parkhurst, and Lesly Gutierrez
Department of Sociology,
College of Southern Nevada
SOC 101: Principles of Sociology
Professor Flora Rudacille
December 7, 2025
Tuberculosis in Men UN-SDG Project – Tuberculosis in Men
Tuberculosis (TB) is a bacterial infection caused by Myobacterium tuberculosis (Hertz & Schneider, 2019, p. 225). When one thinks of tuberculosis, one often thinks of the past. Perhaps one imagines a 19th century sanatorium or a cowboy dying of this disease on a lonely mountain. However, in the interest of furthering UN-SDG Goal #3, Good Health and Well-Being, this paper will investigate the current prevalence of tuberculosis and where it is most common in the world today (United Nations, n.d.). In 2023, the global incidence of this disease was 134 cases per 100,000 population, a number that has been rising slightly since 2020 (World Health Organization, 2024, p. 2). Global prevalence is difficult to estimate due to disruptions in diagnosis and treatment during the COVID-19 pandemic and lack of available data from many high-burden countries (World Health Organization, 2024, p. 16).
The nature of TB’s association with human populations is complex, involving biological, socioeconomic, and behavioral determinants. TB disproportionately affects individuals in low and middle-income countries, where poverty, undernutrition, and overcrowding create favorable conditions for transmission. Men are more frequently diagnosed with TB than women, with a global male-to-female ratio of 1.7:1, suggesting the influence of gender-specific risk factors such as smoking, occupational exposure, social contacts, HIV coinfection, and biological differences (Mason et al., 2017, p. 221). This paper will explore this association in relation to UN-SDG Goal #5, Gender Equality (United Nations, n.d.). The Asia-Pacific region bears the highest TB burden, accounting for nearly 58% of all cases worldwide (Mason et al., 2017, p. 221). However, the association between tuberculosis and male gender appears to exist across all geographical regions.
Tuberculosis is found worldwide, with a significant impact across all regions. TB is most common in areas where poverty, overcrowding, and limited healthcare access are major issues. The highest rates of TB are found in South Asia, Southeast Asia, and sub-Saharan Africa (Dabitao & Bishai, 2023, pp. 149-150). Countries like India, China, Indonesia, the Philippines, Pakistan, and Nigeria report some of the largest numbers of TB cases. These regions do face challenges such as high population density, limited medical resources, and higher rates of HIV, which all increase TB spread. In contrast, TB rates in North America, Western Europe, and Australia are much lower. These areas have stronger healthcare systems, better access to medications, and more effective public health programs. TB cases in these regions are usually connected to travel, immigration from high-TB countries, or people with weakened immune systems. (Mason et al., 2017, p. 221). Eastern Europe and parts of Central Asia also struggle with TB, especially drug-resistant TB, which is harder to treat. Poor treatment completion, limited medical support, and economic instability contribute to these challenges.
Tuberculosis is a serious infectious disease that mainly affects the lungs, and smoking plays a major role in increasing the risk of developing it. It shows that people who smoke are more likely to breathe in TB bacteria and become infected: “...smoking and occupational exposures may put men at highest risk slightly later in life” (Mason et al., 2017, p. 227). Smokers are two to three times more likely to get TB than people who do not smoke. Another important factor is that smoking slows down the recovery from TB. Smokers with TB are more likely to develop complications and may require a longer treatment period. In severe cases, smoking can even increase the chance of death from TB because the body is not strong enough to fight the infection. Interestingly, even experiencing secondhand smoke can play a role in TB (Dabitao & Bishai, 2023, p. 14). People who live around smokers, especially children, are more likely to get TB because the smoke weakens their lungs even though they are not smoking. This shows that smoking does not just affect the individual who smokes; it can also affect everyone around them.
Another reason for higher tuberculosis rates in men is that men are simply more likely to come into contact with the disease. Tuberculosis is most prevalent in lower- and middle-income countries, where men and women often have different social roles. In such cultures, men are more likely to perform jobs that entail higher tuberculosis risk, such as mining (Hertz & Schneider, 2019, p. 226). They also “spend more time outside the home and have more social contacts” (Hertz & Schneider, 2019, p. 226). This is corroborated by Miller et al. (2021), who studied the interaction between social networks and tuberculosis in Kampala, Uganda and found that index cases (that is, participants recently diagnosed with tuberculosis) had more male contacts than controls (p. 7). This suggests that men’s position in their social networks may cause them to be exposed to tuberculosis cases more often than women and therefore become infected more often. In addition, prisons, especially in lower- and middle-income countries, are often hotbeds for tuberculosis (Mason et al., 2017, p. 227). Since men are more likely to be incarcerated than women, this represents another unique way in which this disease touches male individuals. All in all, it seems that men are more likely to find themselves in locations and situations where tuberculosis is prevalent, thus increasing their risk of contracting the illness and contributing to its perceived gender bias.
In addition to the previously mentioned risk factors, HIV infection can activate latent tuberculosis infection (LTBI), meaning that HIV and tuberculosis comorbidity is common (Hertz & Schneider, 2019, p. 237). LTBI is carried by ¼ of the population worldwide, but only ever develops into a more active type of TB if the immune system is deeply compromised. HIV tends to be one of the most common causes of weakened immune systems that leads to TB, and the common co-infection rate of HIV and TB has led to a stigmatization of TB in less developed countries.
Though tuberculosis is more prevalent among men, it is important, in the interest of UNSDG Goal #5, Gender Equality, to consider the unique impacts this disease has on women (United Nations, n.d.). Despite its higher prevalence in men, tuberculosis is “among the top five causes of female death in the world” (Hertz & Schneider, 2019, p. 226). Certain groups of women are particularly susceptible to tuberculosis. For instance, in a meta-analysis of seven high-income countries, tuberculosis rates were higher among boys and men in most age groups; however, at ages ten to fourteen, rates were significantly higher among girls (Peer et al., 2023, p. 10). The reasons for this are unclear, although the authors suggest that fluctuation in sex hormone levels during puberty may play a role (Peer et al., 2023, p. 12). Women in their reproductive years are also particularly susceptible to the illness because “pregnancy increases the risk of Tb disease progression” (Hertz & Schneider, 2019, p. 226). Additionally, women in southern and central sub-Saharan Africa experience a greater burden of tuberculosis than men due to unsafe sex and intimate partner violence, which increase their risk for HIV, and, due to the comorbidity of the two diseases, tuberculosis (Rowley & Mugala, 2022, p. 155). Finally, it is interesting to note that women are more vulnerable than men to extrapulmonary tuberculosis (EPTB), or tuberculosis affecting tissues outside of the lungs, though the reasons for this are unknown; for instance, one study in Ethiopia said the M:F ratio was as high as 1:2.9 (Dabitao & Bishai, 2023, pp. 149-150).
Women being affected by EPTB more than men is only one of many abnormalities pointing to the fact that TB has gender specific biological factors that we are not yet aware of. While sociocultural factors do certainly play a role, they alone cannot explain the gender Tuberculosis in Men 6 difference in TB cases. Even in animals, males are more susceptible (Dabitao & Bishai, 2023, p. 160). With EPTB being so common in women and pulmonary tuberculosis (PTB) being mostly in men, things just do not add up with the current scientific understanding. Current knowledge suggests that hormones may play a role, but it is too early to say anything for certain (Dabitao & Bishai, 2023, p. 162).
Overall tuberculosis remains a major global health challenge shaped by a complex combination of biological, social, and gender-based factors. Although the disease affects men at higher rates worldwide, this pattern cannot be explained by social and behavioral determinants alone. Biological influences possibly including hormonal differences likely contribute as well, although these mechanisms remain poorly understood (Dabitao & Bishai, 2023). At the same time, women face unique risks, especially those related to puberty, pregnancy, exposure to HIV, and higher risk of extrapulmonary TB (Hertz & Schneider, 2019; Peer et al., 2023; Rowley & Mugala, 2022). The continued interaction between tuberculosis and HIV further complicates global control efforts, as HIV infection increases the likelihood that latent tuberculosis will progress to active disease (Hertz & Schneider, 2019). Taken together, these factors show that reducing the global burden of tuberculosis requires addressing both the social conditions that promote transmission and the biological factors that shape different risks for men and women. Strengthening prevention, improving access to diagnosis and treatment, and pursuing research into sex-based biological differences are all essential to advancing UN SDG Goal #3, Good Health and Well Being, and Goal #5, Gender Equality (United Nations, n.d.).
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