Meeting health needs

HPN Training (1) HIV Core Knowledge Meeting health needs

Overview

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. The longer a need goes unmet, the more that can go wrong.

Examples of unmet needs

Some unmet needs can create a risk of acquiring HIV.

When Eric arrived in Australia, he had experienced high school sex education that focused mainly on anatomy and heterosexual reproduction — ‘bits’ and ‘babies.’ HIV and same sex attraction were not discussed. As a teenager Eric was not using the ‘hookup’ apps where Hong Kong HIV agencies typically advertise prevention campaigns. In Australia, Eric lived in the outer suburbs where rent is affordable and he was not exposed to campaigns and services provided by Australian HIV agencies. Eric did not have a good understanding of how to protect himself from HIV, and it was only after he acquired HIV that he learned about the services that were available.

Other unmet needs may pose a threat to quality of life.

When Elizabeth was diagnosed, her doctor told her that she could be criminally prosecuted for having sex without protection, which (at the time) meant using condoms. This was legally incorrect — an HIV-negative partner can give informed consent to sex without protection. However, it left Elizabeth with a deep fear of prosecution and a strong sense that her body and sexual desires placed other people in danger. Elizabeth knows about U=U and feels frustrated that her viral load remains detectable (at a low level). She would like to feel more confident that sex does not place her partners at risk.

Exercise

What were some of Eric’s unmet needs?
What are some of Elizabeth’s unmet needs?

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 a 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.

The word ‘existing’ is an important part of the definition. Could we say someone has an unmet need for an HIV cure? An HIV cure technically exists but it is so difficult to achieve that it is not a practical option for the vast majority of people with HIV. So we are talking about available, practical and affordable interventions and services.

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. Alternatively they may be aware of a need but not seeking help with it.

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 a person with HIV recognises they have a need, it can take time to request support and take the required action to address it. For instance, a client may go through the stages of change before taking effective action to address the need.

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

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.

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 those more immediate needs, such as managing household conflict, moving house, and advocating for safe and secure housing. While they are dealing with their housing situation, 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.

When people in a particular group are commonly facing more pressing immediate needs, it takes them longer to address unmet HIV-related needs. Over time, that group may report poorer HIV outcomes.

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.

HPN Training (1) HIV Core Knowledge