Non-medical factors have serious implications for diseases and impact people in many different ways. For those being served by public health programs, these new understandings need to be included in prevention and treatment for healthcare to be effective.
Non-Medical Factors & Challenges Faced in Ghana
It is helpful to discuss non-medical factors of HIV and AIDS. Current factors affecting HIV and AIDS in Ghana include the social effects of stigma, as well as economic difficulties, especially for those in rural areas. These two are often linked, as it is common for PLHIV to base healthcare decisions on social and economic need. Other non-medical factors include the political nature of public health management, and ability to coordinate efforts. Such factors have a relationship which impacts the functionality, accessibility and scope of public health initiatives.
Although initiatives may make use of the resources and staff available, there appears not to always be a dedicated focus on non-medical factors and the roles they play in prevention or treatment of HIV. Healthcare and general wellbeing have
“links to development which extend beyond the framework of health systems. Poverty, social and gender inequality and weakened health systems all play an important role in the spread of the disease” (Nambiar et al., 2007, p. 7).
Advances in prevention and treatment have lead to HIV being considered a chronic, lifelong illness alongside diabetes and hypertension, rather than a fatal disease. However, many factors contribute to the difficulties in administering healthcare to PLHIV. Although there has been increased access to biomedical interventions, psychosocial treatment has not increased at the same rate. Social exclusion and support, unemployment, food and transport all contribute to a person’s health status (Laar et al., 2015). Social exclusion or inability to access care can be linked to stigma and discrimination, but also to an inability of facilities to provide a broad range of care beyond medical interventions. Healthcare-seeking behaviour is adversely affected by experienced discrimination, however, fear and stigma avoidance can also prevent access to care. Stigma avoidance plays a key role in the day-to-day life of PLHIV in Ghana, and is connected to economic difficulty.
Fees for medicines, food, and related services such as laboratory costs or clinic expenses for infections and other illness add a considerable financial burden (Kwansa, 2010). Such costs significantly affect PLHIV in poverty, women, or those who have been ostracised from family or community for disclosing their HIV status. Disclosure to family or friends is encouraged by healthcare practitioners. It strengthens social support because families are the primary caregivers for PLHIV. However, where family members are not supportive of HIV diagnosis, PLHIV can lose their support network. This creates a barrier and a strong motivation for PLHIV to avoid others discovering their status.
Without family support, PLHIV must cover costs themselves, and are further susceptible to psychological and economic vulnerability. This in turn impacts the burden of medical facilities to offer care that moves beyond medical assistance and into the realm of counselling, education, and psychosocial support. For many PLHIV, this may mean only a medical professional has knowledge of their status. If unwell, PLHIV may be unable to work, or restricted to bed, and therefore unable to collect medications or visit a doctor. While initiatives exist that involve specific psychosocial interventions, and even home-based visitation. This greatly increases the need for staff and resources. This has implications for the burden on medical facilities, and can undermine medical-focused public health management and funding.
There is also a significant barrier when it comes to social views of medicine. Seeking healthcare from a medical clinic may not be the first step for many people. Cultural beliefs, inappropriate treatment from healthcare practitioners and inadequate knowledge all contribute to a breakdown of patient-professional relationships. Apart from this, there is a high level of motivation, particularly in rural areas, for PLHIV to seek alternative treatments, including traditional healing, herbal medicine, or spiritual care. People seeking care outside of medical facilities adds another dimension to public health considerations, and creates more need for public health programs to be aware of the choices people are making and why.
While not all challenges are discussed here, it is clear that there can be various barriers facing PLHIV that require a dedicated public health response – perhaps a response outside of healthcare provision. Without social initiatives and culturally sensitive programs that understand and incorporate non-medical factors into HIV interventions, the public health response may continue to face difficulties. While consideration of non-medical factors is increasing within public health in developing countries like Ghana, there is still a way to go in ensuring that sectors related to health are supported with health outcomes in mind.
Kwansa, B. K. (2010). Complex negotiations: ?spiritual? therapy and living with HIV in Ghana. African Journal of AIDS Research, 9(4), 449–458. https://doi.org/10.2989/16085906.2010.545662
Laar, A., Manu, A., Laar, M., El-Adas, A., Amenyah, R., Atuahene, K., … Quakyi, I. (2015). Coping strategies of HIV-affected households in Ghana. BMC Public Health, 15(1). https://doi.org/10.1186/s12889-015-1418-x
Nambiar, B., Lewycka, S., Mwansambo, C., & Costello, A. (2007). Planning health care in developing countries. Anaesthesia, 62 (Suppl. 1), 5-10.