Beyond the Bite

How Gender Shapes the Hidden Story of Cutaneous Leishmaniasis in Colombia

2,903

Reported Cases (2025)

29.57

Per 100,000 at Risk

20.2%

Military Cases

56.6%

General Population

More Than Just a Parasite

In the humid, tropical regions of Colombia, a tiny sand fly—no bigger than a third of a mosquito—carries a parasite that leaves behind more than just physical scars.

Each year, thousands of Colombians develop skin lesions of cutaneous leishmaniasis, a disease that has long been considered a male problem, primarily affecting soldiers, farmers, and others who work in forested areas.

But beneath the surface of official health statistics lies a more complex reality, one where gender roles, healthcare access, and biological differences intertwine to create strikingly different experiences of this disease for men and women.

Traditional View

Primarily affects men in outdoor occupations like military, farming, and mining

Hidden Reality

Women face equal exposure but different barriers to diagnosis and treatment

The Data Reveals Hidden Patterns

Population Group Number of Cases Percentage of Total Key Characteristics
Military Personnel 587 20.2% Men aged 18-44 (average 24.2 years)
Farmers 528 18.2% Mixed gender, occupational exposure
Miners 145 5.0% Occupational exposure in endemic areas
General Population 1,643 56.6% Includes women and children, often underdiagnosed

Source: Adapted from Outbreak News Today (2025) 1

A Paradigm-Shifting Study

2001 Colombian Investigation

Groundbreaking research from PECET employed multi-faceted approaches including field epidemiological studies and delayed hypersensitivity skin tests 2 .

Methodology Breakthrough

Unlike previous research relying on reported cases, this investigation actively sought infections in communities, providing more accurate prevalence data 2 .

Key Findings

Researchers discovered equal proportions of men and women with both active leishmaniasis and positive skin tests indicating prior contact with the parasite from early childhood 2 .

Domestic Transmission

Transmission occurring closer to homes than previously assumed

Healthcare Access

Gender-linked differences in access rather than differential exposure

Data Distortion

National statistics reflecting healthcare access patterns rather than true infection distribution

The Biological Dimension

Sex-Based Immune Variations

Emerging evidence suggests biological factors contribute to differential experiences of leishmaniasis 5 .

  • Sex hormones influence immune response to pathogens
  • Genetic factors on sex chromosomes affect susceptibility
  • Differences in skin physiology between males and females
  • Variations in immune cell populations and activation states
Complex Interactions

Biological differences interact with social and environmental factors, creating a complex web of determinants that shape:

  • Who gets sick
  • Disease severity
  • Treatment outcomes
  • Long-term consequences

Life After Lesions: The Psychosocial Burden

A systematic review of qualitative studies revealed that psychosocial consequences of the disease are profoundly shaped by gender norms and expectations 9 .

Greater Stigma

Women experience heavier social penalties from lesions and scarring

Gendered Impacts
  • Women experience greater stigma from active lesions and resulting scars
  • Marriage prospects may be significantly diminished for women with visible scars
  • Social isolation and mental health impacts appear more pronounced in women
  • Body image concerns disproportionately affect female patients
Health-Seeking Behaviors
  • Women tend to be more constrained due to household responsibilities and mobility restrictions
  • Men are more likely to resort to aggressive self-treatments
  • Economic implications vary by gender
  • Fear of social consequences may delay women from seeking treatment

Toward Gender-Responsive Control

Active Case Detection

Include screening of women and children in endemic areas

Healthcare Worker Training

Address unconscious biases in diagnosis and reporting

Peridomestic Vector Control

Recognize transmission near homes

Integrated Interventions

Address both biological and social dimensions

By recognizing that leishmaniasis is not just a biological phenomenon but a biosocial one, control programs can better serve all Colombians affected by this disease—regardless of gender.

References