Meeting health needs

In the previous lesson, we discussed the health equity perspective, which focuses on differences between groups on health outcomes, like becoming HIV-positive. The health needs perspective argues that these differences emerge because some groups have needs (health, social, economic) that are not being met in a timely manner.

Examples

For example, when a tertiary international student arrives in Australia, they haven’t been exposed to the sex education available to Australian high school students. They have not been exposed to mass public and community HIV campaigns and resources. They may be unaware of clinical and community services available to them. They have been exposed to different cultural narratives around dating and romance, sexual negotiation and consent. So we can conclude that newly-arrived international students have a need for HIV prevention education. If that need goes unmet, the student may experience difficulties accessing and practicing HIV prevention in their relationships and sexual encounters.

Another example: a heterosexual woman is diagnosed with HIV by a general practitioner (GP) who isn’t up-to-date on treatment guidelines and prevention science. The patient holds equally outdated and highly stigmatising views of HIV. The GP tells the patient she can be criminally prosecuted if she does not use condoms during sex. The diagnosis is extremely traumatic, as the patient now sees herself as dangerous and potentially criminal. The patient has an unmet need for education about Undetectable=Untransmittable (U=U) as well as accurate information about legal obligations.

Definition of a health need

There is a strong stigma in Australian society about ‘being needy’ or reliant on others. People with HIV may hold back on acknowledging and disclosing their health needs to avoid this stigma.

Here is a non-stigmatising definition of ‘health need’:

  • A person or group has a capacity to benefit from an existing intervention or service.

‘Intervention’ is very broad — it includes a resource, a campaign, a product, a treatment, or anything that could improve the health of the person receiving it.

Health needs are not always obvious

Peer navigators may need to use intuition and to pick up on very small cues that there may be an unmet health need. People with HIV who seek out HIV care and peer support may not be aware they have a health need in the first place.

Health needs may be:

  • Unrecognised — the patient does not know they could benefit from a service;
  • Recognised, but not requested — the patient knows they have a health need but does not ask for it to be met.

Meeting health needs in a timely way

It can take some time to meet a health need, even when the person with HIV recognises it and requests support. A client or patient may need to go through the stages of change before taking effective action to address the need.

Some people and groups may take longer to have their needs met. For example, a person with HIV who is dealing with insecurity of income and housing may need to expend energy on meeting more immediate needs, like managing household conflict, moving house, and advocating for safe and secure housing. It may take them longer to raise their HIV-related health needs, and to pursue a ‘fix’ for these needs, taking the appropriate steps along the way.

The challenges to meeting health needs in a timely way can explain why differences in health outcomes emerge between groups — a problem we discussed in the previous topic on health equity.

The time it takes to meet health needs is a driver of health inequities

When many people in a particular group are facing more immediate needs, it takes them longer to get their HIV-related health needs met, and over time, that group may report poorer outcomes related to those unmet health needs.

For instance, people in Aboriginal and Torres Strait Islander communities experience lower rates of secure housing, and the time Indigenous people with HIV spend on meeting housing needs is not available for meeting their HIV-related health needs. Thus, access to secure housing is a social determinant (a non-medical cause) of their poorer HIV outcomes.

When people are facing multiple complex needs (e.g. poverty, housing, welfare, drug and alcohol use), they may need additional and intensive support to address all of these needs before they can meet their HIV-related health needs as well. In this scenario, HIV peer navigators are likely to be working as part of a team of practitioners to support the client.

We may also undertake interventions that cater specifically to groups with poorer HIV-related outcomes, designed to address the social determinants that cause people in that group to delay getting their health needs met.

Further reading

Bruce Link and Jo Phelan (1995) Social conditions as fundamental causes of disease.

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