Gendered experiences of people living with tuberculosis or leprosy: A global systematic review.

BACKGROUND: Classified as poverty-related diseases (PRD) leprosy and tuberculosis (TB) are long-standing mycobacterial diseases strongly linked to poverty, stigma, and social exclusion, disproportionately affecting vulnerable populations. Gender norms further shape how individuals experience illness, access to care, and coping strategies, but evidence remains fragmented and largely disease-specific. This systematic review synthesizes qualitative evidence on lived experiences of people affected by TB or leprosy worldwide and compares gender inequities across both diseases to identify shared social and structural determinants. METHODS/PRINCIPAL FINDINGS: A systematic review following PRISMA guidelines searched PubMed, Embase, Scopus, and Web of Science for peer-reviewed qualitative and mixed methods studies (1995-08/2025) reporting primary qualitative data on gendered experiences of people affected by TB or leprosy. Studies in all countries and languages were eligible. Screening and extraction were conducted using Rayyan. Inductive thematic synthesis was performed using MAXQDA. Quality was assessed using the CASP checklist. A total of 3204 records were identified, with 57 studies from 29 countries across five continents included. Across settings, women experienced greater barriers to diagnosis and care, more severe marital and familial consequences, higher stigma and social exclusion, and greater psychosocial burden than men. Men's experiences were shaped by norms of masculinity, particularly regarding economic provision and employment. Despite disease differences, psychosocial and socioeconomic impacts were similar across TB and leprosy, embedded in gendered social norms, power relations, and social determinants of health. CONCLUSIONS/SIGNIFICANCE: Gender-based inequities are pervasive across TB and leprosy globally. Comparing both diseases reveals shared social mechanisms beyond biomedical differences. Addressing them requires moving beyond biomedical models and integrating gender as a structural determinant of health. Gender-sensitive, participatory, and intersectional interventions are needed to improve early diagnosis, treatment adherence, and psychosocial and socioeconomic outcomes. REGISTRATION: Registered on Open Science Framework (OSF) on 01/09/2025.