Page 313 - HIVMED_v21_i1.indb

Page 7 of 8 Original Research

Unemployment, gender, age and distance to a healthcare Having two or more NCDs was markedly associated with
facility are well-known key determinants of health. In this more days spent without undertaking usual daily activities
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study, significant associations were found between these key and more money spent on medication, compared with cases
determinants of health and the ability to purchase prescribed with one NCD. Having more than one NCD naturally
medication, as well as days spent without carrying out usual translates to more money needed to purchase medication,
daily activities because of illness. This finding can be thus increasing the possibility of inability to purchase the
explained in part by the fact that the majority of employed required medication, especially given the fact that the
participants in the study were men, below the age of 60 years. majority of the participants were either unemployed or had
Given that antihypertensives and diabetic medications were an unstable source of income. Without access to prescribed
largely accessible through out-of-pocket payment, medication to manage their health, patients would be
employment enables those with NCDs to purchase the predisposed to poorer health outcomes as indicated by
prescribed medications and take control of their health. In productive days lost because of illness observed in this study.
patriarchal societies, such as Zimbabwe, opportunities for Patients were more likely to opt for alternative medication
income and control of resources are biased towards the male from informal sources to manage their health in the face of
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gender compared with females. The female gender and limited or no income to purchase prescribed medication.
unemployment are inextricably linked together in such
societies, predisposing unemployed female participants to Use of alternative medication was commonly reported
negative health outcome, as observed in this study. among cases as compared with controls. However, use of
alternative medication was not associated with positive
On the other hand, the lower proportion of male participants improvements on days spent without undertaking daily
and the fewer number of days these male participants spent activities because of sickness. Use of alternative medication
without undertaking usual daily activities because of illness, may have been influenced to some extent by the cases’
compared with female participants, needs further inquiry. inability to purchase NCD medication, forcing patients to
Observed findings could have been influenced in part by resort to cheaper alternatives to manage ill health. This could
poor health seeking behaviours, which are commonly be assumed, given that the controls did not report use of
associated with the male gender. Because of their alternative medication for management of HIV other than
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masculinity, characteristic of men, participants might ART. Common alternative medication included home
deliberately under-report the number of days they spent remedies and traditional herbs that are readily available at
without carrying out usual daily activities. Perhaps, the lower costs. Toxicity, maximum safe dosage and clinical
perception of serious ill health in men might be different efficacy for these treatment options are usually not known,
from that in women. 12,13,14 thus potentially predisposing the users to other unknown
negative health consequences. Future studies should assess
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In general, cases were found to spend more days without the various types and sources of alternative medications
undertaking usual daily activities because of illness compared commonly used by this patient population to gain a better
with controls. A study conducted in Namibia found similar understanding about this issue.
results, where sickness because of HTN and DM was the top
cause of absenteeism among workers in the formal sector. Higher out-of-pocket medication and transport expenses
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Cases aged 60–69 years and ≥ 70 years were more likely to faced by cases can push patients to employ various coping
spend more days without carrying out usual daily activities mechanisms, including cutting back on medication use to
or tasks because of illness. They were more at risk of not being adopt traditional medication or forgoing other basic
able to purchase NCD medication, compared with other age necessities including food. Finally, we need further enquiry
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categories, and compared with similar age categories in to better understand challenges experienced by people with
controls, after controlling for potential confounders. HIV-NCD comorbidity (especially the difficulties faced in
accessing medication and care) and the coping mechanisms
Productivity days lost because of illness are linked with that they employ in dealing with these challenges.
lower income or loss of employment or limited opportunities
for work, which translates to lack of income to purchase the Study limitations
needed medication. A study conducted in USA found out-
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of-pocket medication costs to be a significant challenge faced • Measurement of the outcome variable, ‘number of days
by older adults with DM, often forcing them to cut back on spent by participants without doing usual daily activities
medication use, forgoing food or other basic necessities or or tasks’, was based on self-reported responses by
borrowing money. The age group ≥60 years is usually participants and not objectively ascertained. Although
associated with retirement and diminished ability and effort was put in corroborating individual responses with
opportunities for employment. When medication for NCDs further follow-up questions, there is a possibility that
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has to be purchased through out-of-pocket payments, this variations in personal characteristics could have affected
age group is at risk because of inability to afford medication how participants responded to ill health (to do or not to
and consequently face a greater risk for the observed poorer do usual daily tasks). Again, recall bias cannot be ruled
health outcomes. out in the measurement of this variable. However, we

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