A sex and gender perspective for neglected zoonotic diseases

Sex-driven and gender-driven diversities in health and diseases should be considered to promote equitable and more effective health for all. Nevertheless, these diversities are not sufficiently taken into consideration when approaching diseases, including infectious diseases. Neglected infectious diseases (NIDs) are a group of diseases, more prevalent in - but not limited to - tropical areas, that are almost absent from the global health agenda. NIDs are related to poverty, associated with stigma and social exclusion and prone to perpetuate health inequities from different perspectives including sex and gender. There is consensus that women and men are differently affected by NIDs. Many epidemiological studies have shown that being a man is a risk factor for several infectious diseases; a number of evidences indicate that sex-related hormonal and chromosomal factors contribute to distinct host’s response to infections in males and females. Conversely, women and girls experience a greater share of the NID burden due to their disproportionate poverty, illiteracy, lower education and social status particularly in low- and middle-income countries. More generally, different professional and environmental exposure can also influence dissimilar disease burden in men and women, but these aspects are seldom considered in clinical practice and in epidemiological surveillance. This opinion paper has the objective of describing the role of sex and gender-based differences for the management and control of NIDs with the scope of orientating research, clinical management and public health strategies towards a gender- and sex- balanced approach. Various NIDs will be examined as examples (case studies) to describe the biological features as well as organizational structures in healthcare and cultural aspects that should be considered for a gender-neutral management of these diseases as well as for the development of individualized anti-infectious treatments that take sex-specific host factors into account. An increased focus on sex together with gender diversities in health and health care services for NIDs is crucial to develop personalized and targeted therapeutic approaches but also to maximize the impact of interventions and public health strategies aimed at eliminating some of them by 2030.