Background & Significance

Human immunodeficiency virus (HIV) is a virus that compromises people’s immune system and can turn into acquired immunodeficiency syndrome (AIDS) if it is not treated (CDC, 2021). Nearly two-thirds of worldwide HIV infections occur in Africa (Fofana & Mehmet, 2022). Even though sexually transmitted infections (STIs) can be prevented with safe sex practices and abstinence, rates are still increasing with a 1.7% prevalence rate with variations by region in Ghana (Ali et. al, 2019). It is interesting to note that the HIV prevalence rate in women between the ages of 15 to 49 is higher than the country’s prevalence rate at 2.4%, compared to men between the ages of 15-49 years old, which is 1.1%. (Fofana & Mehmet, 2022). The key populations that are most impacted by HIV/AIDS are adolescent girls and young women under the age of 15 years (.9%), female sex workers and their clients (6.9%), men who have sex with men (18.1%), people in prisons and other closed settings (2.3%), people who inject drugs, people who identify as transgender, and serodiscordant couples, which is when one partner is HIV-negative and the other is HIV-positive (Ali et. al, 2019). Back in 2017, HIV incidence rates in Ghana increased by 36% from 1.1% to 1.5%, indicating that there is need to take action to help prevent further spread in the country (Owusu, 2020).

Child Family Health International has been working on infectious disease prevention within Ghana, specifically HIV/AIDS. The prevalence of HIV in Greater Accra is at 2.5% (Ali et. al, 2019). Cape Coast is in the Eastern region, which has the highest prevalence at 2.8% (Ali et. al, 2019). Both rates are higher than the prevalence rate of the general population of Ghana, which is at 1.6% (Ali et. al, 2019). 14 thousand people died from HIV/AIDS related causes in Ghana back in 2020 (Statista, 2021). The high prevalence of their HIV epidemic is in key populations including female sex workers (FSW) and men who have sex with men (MSM) (Ali et. al, 2019). Ghana is aiming to achieve the United Nations Programme on HIV/AIDS, where 90% of HIV positive people know their status, 90% of the diagnosed are on treatment, and 90% on treatment are virally suppressed (Ali et. al, 2019). Ghana has made efforts to reduce the prevalence of HIV/AIDS through interventions including easy access to barrier methods and affordable testing, and free HIV/AIDS treatment for people living with HIV/AIDS (PLWHA). However, there is evidence that there is an increasing prevalence rate in the country (Fenny et. al, 2017). Certain populations have a disproportionately high prevalence including adolescent girls and young women, sex workers and their clients, men who have sex with men, people in prisons and other closed settings, people who inject drugs, people who identify as transgender, and serodiscordant couples, which is when one partner is HIV-negative, and the other is HIV-positive. A health-related need that should be addressed is to raise awareness about the importance of the new injectable pre-exposure prophylaxis (PrEP) to reduce HIV infection.

Child Family Health International is a non-profit organization located at 1135 San Pablo Ave #929, El Cerrito, CA 94530 however, their internship program that I completed was a virtual practicum.

Mission Statement

The mission statement of the organization is “Child Family Health International is dedicated to transformative Global Health Education programs, research, and thought leadership emphasizing community leadership, global citizenship, and ethical engagement” (CFHI, n.d.). The organization’s vision states “we exist because Global and Planetary Health are foundational and essential pursuits. To achieve our ideals, we must seek understanding while embracing humility, diversity, the primacy of local communities, and sustainable approaches utilizing reflective practices that challenge neocolonial assumptions” (CFHI, n.d.).

Organization as an Internship Site

Child Family Health International was established in 1992 and is recognized by the United Nations for being a standard-setting non-profit organization (CFHI, n.d.). They offer education programs, research, and “thought leadership” for students across twelve different countries located around the world. They have over forty programs serving millions of people globally (CFHI, n.d.). CFHI was the perfect site to complete an internship as they are well-known for their ethical and unique approaches for their global health interventions. Through their website and their awards and accomplishments, it is shown that they are competent and are wanting to improve overall health to its fullest potential.

Agency Supervisor

Dr. Charles Nwobu is a Public Health Physician and Medical Program Director for Ghana and served as my agency supervisor. Dr. Nwobu received a Bachelor of Medical Sciences and a Bachelor of Medicine at the University of Ghana. He attended The Royal College of Physicians of Ireland where he received a professional/post graduate diploma in pediatrics. Most recently, he attained a Master of Science in Public Health at the University of London and a Master of Science in Medical Education at the University of Warwick. He has ten years of experience working in a clinical/medical practice setting and thirteen years of experience working in public and global health settings. He has been with Child Family Health International since 2015, where he works as the Program Director for Ghana. He serves as the primary on-site partner, working with preceptors to execute the clinical and public health aspects of the programs in Ghana. He also oversees the budgets and allocation of resources and works to network with the organization’s partnerships to achieve the goals and objectives.

Community-Based Partner Groups

Child Family Health International is affiliated with many organizations including American Medical Student Association (AMSA), American Medical Women’s Association (AMWA), Better Volunteering, and Canopy Innovations (CFHI, n.d.). These partnerships help pre-medical and medical students have better access to working for Child Family Health International and receiving scholarships (CFHI, n.d.). CFHI is also a member of many organizations including Better Volunteering, Better Care (BVBC), Building Bridges Coalition, Consortium of Universities for Global Health (CUGH), and Global Health Council (GHC) (CFHI, n.d.). They offer services in partnership with the Planned Parenthood Association of Ghana (PPAG), located in Cape Coast and Princess Marie Louise Children’s Hospital, located in Accra. The PPAG was founded in 1967 and is the leading non-governmental organization that provides sexual and reproductive health services in Ghana (Planned Parenthood Association of Ghana, n.d.). The Princess Marie Louise Children’s Hospital was founded in 1926 and is known for being one of the leading child health care providers in Ghana. The Princess Marie Louise Children’s Hospital offers services to prevent and manage childhood illness.

Programs

Child Family Health International in Ghana offers services in partnership with the Planned Parenthood Association of Ghana (PPAG), located in Cape Coast and Princess Marie Louise Children’s Hospital, located in Accra. The PPAG was founded in 1967 and is the leading non-governmental organization that provides sexual and reproductive health services in Ghana (Planned Parenthood Association of Ghana, n.d.). The Princess Marie Louise Children’s Hospital was founded in 1926 and is known for being one of the leading child health care providers in Ghana. The Princess Marie Louise Children’s Hospital offers services to prevent and manage childhood illness.

Accomplishments and Goals

Back in 2019, Child Family Health International accepted an award from Diversity Abroad for Excellence in Diversity & Inclusion in International Education (Diversity Abroad, 2019). Since 1992, the organization has been awarded the National Society for Experiential Education Award of Excellence for Outstanding Leader in Experiential Education: Community-Based Organization (CFHI, 2018). In 2016, GuideStar awarded Child Family Health International with the Platinum GuideStar Nonprofit Profile Seal of Transparency for their clear and important information shared with the public (CFHI, 2016). Their goal is to pave a path forward that is intentional while also allowing creativity, flexibility, inclusion, and adaptability to shifting trends, realities, and opportunities, ultimately optimizing their impacts and influence (CFHI, n.d.).

Demographics

Child Family Health International focused on promoting health among community members residing in both Accra and Cape Coast, Ghana. Accra is the capital and largest city in Ghana, with an urban population of 2.27 million, while the Greater Accra Metropolitan Area (GAMA) has approximately 4 million residents (World Population Review, 2022). The city is nearly split between males and females, however there is a slightly higher population of males (50.9%) (World Population Review, 2022). Approximately 56% of the people living in Accra are under the age of 24 years (World Population Review, 2022). The majority of the population is made of up Christians at 83%, Muslims at 10.2%, and 4.6% reported to have no religion (World Population Review, 2022). About 58% of the population live in one of the low-income housing areas that are in Accra (World Population Review, 2022). Cape Coast has a much smaller population of only 143,015 residents (World Population Review, 2022). The population is majority females at approximately 52%, which differs from most of the cities in the country (Ghana Districts, n.d.). The international poverty rate in Ghana was estimated to be 11.3% in 2021, where the poverty line was set at 1.90 U.S. dollars (Statista, n.d.).

Impacting Social Determinants of Health

Evidence proves that there are significant differences in HIV/AIDS knowledge in Ghana amongst the men and women, where women are less likely to have knowledge on the diseases, compared to the male population (Fenny et. al, 2017). In 2014, 59% of adults in Ghana had HIV/AIDS knowledge, which has decreased significantly over a ten-year period from 68% (Fenny et. al, 2017). This could be due to HIV/AIDS stigma and discrimination, the quality of their health care access, or even the decreased mass media campaigns in the country. In the Greater Accra region, only 44.18% of a sample had a comprehensive understanding of HIV/AIDS (Guure, 2014). People living with HIV/AIDS (PLWHA) are not well-informed on the disease they are living with, which can contribute to the increased rates that are occurring presently. It is important to protect themselves and others by having proper education and taking HIV medicine, known as antiretroviral therapy (ART). Evidence shows that PLWHA with less knowledge of HIV were less likely to adhere to their treatment (Addo, 2022).

It is essential for PLWHA to take their HIV medicines every day and exactly as prescribed for them to stay healthy. Only 44.6% of PLWHA in Ghana are adhering to their antiretroviral therapy (Addo, 2022). This could be attributed to various factors, for example, lack of transportation to the ART center (Addo, 2022). In one sample of PLWHA in Ghana, 88.4% needed to use a vehicle to transport to receive their treatment, however, it took 90% of those individuals to drive anywhere from 30 minutes to an hour (Addo, 2022). Seventy-four percent of them agreed that the transportation costs were too high (Addo, 2022). ART should be emphasized in intervention programs since it is essential for viral suppression and will help prevent the disease from developing into AIDS. Educating the population and increasing the adherence to ART by having community health workers deliver their treatment will help improve their lives and decrease the spread of the disease.

While the urban areas have the most hospitals, clinics, and pharmacies in the country, the rural areas have poor access to health care, leading them to travel far for care or rely on traditional African medicines (International Trade Administration, 2022). Location may also be an impacting social determinant on the community’s comprehensive HIV/AIDS knowledge in Ghana. Residents living in urban areas are more likely to have knowledge on HIV/AIDS, compared to residents that live in rural areas (Fenny et. al, 2017). In addition, evidence suggests that there is a relationship between educational levels and awareness levels of modes of transmission of HIV/AIDS. The results indicate that people in Ghana with no formal education are more likely to have inadequate knowledge on HIV/AIDS, compared to those that had any level of formal education (Fenny et. al, 2017).

Health-Related Needs

HIV/AIDS is a preventable sexually transmitted infection through abstinence, correctly utilizing condoms, and never sharing needles (CDC, 2021). Lack of education is a barrier to community members if they are sexually active and especially if they are men having sex with other men. Since young adults are greatly affected by HIV/AIDS, educational programs should be required for students to attend to help decrease rates. Being that there is not a cure for HIV/AIDS, education can serve as a social vaccination in an effort to fight the disease. Studies have shown that HIV/AIDS educational programs can reduce sexual behaviors among young adults. Education can be disseminated to increase awareness and knowledge of HIV/AIDS to stay away from risk behaviors. Pre-exposure prophylaxis (PrEP) is proven to be a highly effective HIV prevention method when used correctly. Typically, PrEP has been taken through the form of a pill, but injectable PrEP is effective for a longer period of time than the pill forms. There is a low awareness of both oral and injectable PrEP among high-risk populations, which is another reason why there should be educational programs to offer these preventative measures.

Another health-related need is access to HIV/AIDS social support. If people are lacking physical or emotional support, they may be less likely to get tested, regardless of the HIV testing sites that are available in surrounding areas. Social support also has been found to increase adherence to antiviral (ART) therapy among people struggling with HIV.

Best Practices

The best practices for addressing the health-related needs are intervention programs that include educational seminars, HIV testing, and linkage to treatment and care (CDC, 2021). The educational programs have proven to be effective in decreasing the risk of contracting and transmitting HIV by providing people with the necessary information and skills. HIV testing has been proven to prevent the spread of HIV since most people will change their sexual behaviors if they know they have been in contact with someone who has HIV. Linkage to treatment and care is necessary for individuals who live with HIV. Individuals must know their status and should plan accordingly with their healthcare professionals.

The Princess Marie Louise Children’s Hospital offers services at their HIV/Special Clinic that provides family centered care, as well as care for people living with HIV in the community. They provide medicine for newly diagnosed patients as well as post-exposure prophylaxis and pre-exposure prophylaxis for key populations. HIV positive cases also come here for their evaluation, treatment, and reviews of their medications. While these services are working towards decreasing incidence and prevalence rates of HIV, the program is missing out on opportunities to hold seminars to educate young adults at schools within the city, since they are a population that is greatly at risk to contract AIDS.