Gender-responsive infectious disease models: Guidelines and systematic scoping review

Sex and gender influence infectious disease outcomes through biological and social mechanisms. Gender norms, roles, and behaviors affect exposure, care-seeking, and service access, yet many infectious disease models overlook these factors.

To provide guidance to researchers considering sex/gender in epidemiological models, we propose structured guidelines for developing gender-responsive infectious disease models, adapted from an established monitoring and evaluation framework. Recommendations include: 1) using sex/gender-disaggregated or sex/gender-specific populations; 2) incorporating an additional social stratifier (e.g., age, race/ethnicity); 3) maintaining stratification in results; 4) addressing the needs, rights, and preferences of gender groups; and 5) grounding models in context with participation from target groups. To provide examples, we conducted a scoping review using these criteria, drawing from HIV, COVID-19, and malaria literature.

Of 7303 studies screened, 45 met inclusion criteria. Most modeled HIV (96%), used compartmental (73%) or agent-based (22%) approaches, and included sexual orientation or occupation as an additional stratifier. Studies contextualized their models by discussing local healthcare systems, unequal access to care, stigma, gender norms in partnership dynamics, and occupational risk.

Gender-responsive modeling is feasible but uncommon beyond sexually transmitted infections. Applying intersectional, context-specific approaches can reveal disparities and inform equitable, efficient interventions. These guidelines can be adapted to address other health disparities.