Gender and medicines access and use among adults with chronic illnesses in South Africa: A human rights perspective

The Universal Declaration of Human Rights affirms an individual's right to health and essential medicines are a crucial element in improving health. Part of South Africa's extensive legislative framework promotes medicines access and use, and since the first democratic elections in 1994, key Constitutional Court cases have shaped health as a human right. The World Health Organization has called for the inclusion of a gender perspective in national essential medicines programs. However, little is known on gender and medicines among patients with chronic conditions in low- and middle-income countries, including South Africa. There is no empirical evidence that describes the contextual (neighborhood) and compositional (individual) effects on medicines use among men and women with chronic conditions in South Africa, and there is no available gender analysis of South Africa's medicines policy and whether it complies with international human rights law.;A mixed-methods approach was used to investigate gender disparities in medicines access and use among adults with chronic conditions in South Africa. A multidimensional conceptual framework theorized, from a gender perspective, the influence of various individual and neighborhood factors on medicines access and use. A systematic literature review summarizes gender studies on medicines access and use among patients with HIV/AIDS and TB in low- and middle-income countries. South Africa's 2003 Demographic and Health Survey data were examined, using a cross-sectional design to assess, from a gender perspective, the influence of individual and neighborhood factors on medicines access and use with multilevel logistic regression models. An analysis of South Africa's medicines policy identified whether a gender perspective was included and benchmarked current legislation with international human rights law.;Existing evidence focuses mostly on gender and access to medicines and adherence among HIV patients. Contrary to prevailing hypotheses, most studies reported no statistically significant gender differences for either class of outcomes. The few studies that did document gender differences took no clear direction, and favored women slightly more than men. In South Africa, among adults with a chronic condition, men are significantly less likely to use medicines compared to women after adjusting for all individual- and neighborhood-level predictors (Men, Predicted Probability (Pr) = 0.460 vs. Women, Pr = 0.533, p = 0.001), in part because men are significantly less likely to visit any health care facility compared to women (Male beta = - 0.467, p < 0.001). Men in the middle and fourth quintiles of neighborhood socioeconomic status were significantly less likely to use medicines compared to women (Middle, Men, Pr = 0.348 vs. Women, Pr = 0.562, p = 0.000; Fourth, Men, Pr = 0.433 vs. Women, Pr = 0.535, p = 0.045). South Africa's medicines policy is gender-blind at best, and if left as is, is likely to create or perpetuate rather than redress gender differences in access to and utilization of health care facilities and medicines. South Africa has the obligation under international human rights law to ensure that such facilities can be accessed by men and women on a non-discriminatory basis.;Further research on medicines availability, affordability, adequacy, and acceptability is required to affirm or negate hypotheses on gender differences. Future research on chronic conditions should use medical records, longitudinal data, investigate health-seeking behavior, particularly among men, and experiment with different definitions for neighborhood. South Africa's medicines policy needs to be reviewed and aligned with the minimum core obligations contained in General Comment 14, ICESCR. Gender-sensitive indicators based on a right to health conceptual framework will be needed to develop a body of evidence and to integrate such information into the policy making process.