Sarah had just turned 32 and was in her first semester at university when her world began to crumble. This could not have come at a worse time as she has always looked forward to doing a Health Studies degree. Her friends and family were alarmed at the sudden moodiness, insomnia, fatigue, headaches, confusion, joint and muscle pain, flu like symptoms and above all, the enduring feeling of tiredness she complained of.

Sarah suddenly changed from a happy young woman to someone who battled daily episodes of what she called extreme tiredness and anxiety. In the first three weeks of starting university, her friend Rose put this down to overworking at university and firmly told her to “slacken up a bit”. Although she tried a new relaxation regime suggested by her friend Rose, she still complained of daily episodes of overwhelming tiredness and flu like symptoms. Her weekly part-time care work thinned out due to this overwhelming tiredness; this is in spite of following the suggested relaxation technique. Her partner, Harry suggested she take ginger and lemon for the flu like symptoms but nothing seemed to work. Eventually, after four weeks of procrastinating, she went to see the GP. However, before then, being from a mixed English-African parentage, her paternal grandmother Iyabo an African gave her some herbs supposing this to be a problem of a weakened immune system. She prescribed ginger, a cocktail of horny goat weed and other herbs to will restore Sarah’s health. When she went to see her GP who was nearing retirement- Doctor Jones, suspected depression and put her on anti-depressants, however 6 months on, things didn’t improve. She failed a number of core modules at university and also gave me her part time job due to inability to cope. She was so miserable and confused as the medication prescribed by the doctor was not working. Her Sister Helen suggested she go to a genito-urinary medicine clinic for an HIV test as she thought her symptoms were similar to those encountered by a newly diagnosed friend of hers. While Sarah resisted at first, for fear of finding out her status, she eventually went and the test confirmed she was HIV positive which left her further distraught. Her partner Harry was tested and was negative. Soon after, he broke up with her citing irreconcilable differences. Sarah found it difficult to cope on her own and because her CD4 count was low (CD4 cells are a type of white blood cells which fight infection and their count indicates the stage of HIV or AIDS in a patient), she was immediately put on antiretroviral drugs used in the treatment of HIV infection. For the first 6 months, she found it very difficult to adjust to the side effects of the medication which included tiredness and nausea. She also spent a lot time wondering how and when she had been infected with the virus. She also wondered why her GP had not referred her for the HIV test. Fearing that her friends and family would abandon her like her partner, she didn’t disclose her HIV status to them. She however started feeling better and more positive about life with the help of a support group for people living with HIV which she attended weekly. While she was told by her HIV consultant at the hospital that it is important to eat a balanced diet including fruits and vegetables, for the medication to effectively work, she struggles to buy these due to her limited income on benefits. Even though she feels much better, Sarah still has her bad and good days with the medication. She still hasn’t disclosed her status to family and friends, but hopes to do so someday soon.
1. Discuss the advantages of the biomedical model of health with regards to understanding the case study above. What about the disadvantages? You should also cite other relevant examples to illustrate your answer, underpinned by relevant academic sources.
2. Individuals such as Sarah, her family and friends have their own interpretations about their symptoms and what action, if any, should be taken. Explain these ideas with reference to the case study and research on lay perspectives.
3. What are the implications of enacted stigma on the health and wellbeing of those who are stigmatised? Discuss with reference to the case study and other research studies while citing other specific health conditions that are stigmatised.
4. In line with Sarah’s illness experience above, how true is McKeown’s (1976) claim that, the historical role of medicine has been overstated?

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