Traditional health practitioners’ management of HIV/AIDS in rural South Africa in the era of widespread antiretroviral therapy

Abstract

Background: Traditional health practitioners (THPs) have been identified as a key local resource in the fight against human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in South Africa. However, their approaches to the treatment of people living with HIV (PLHIV) have been met with scepticism by some biomedical practitioners amid increasing access to antiretroviral therapy (ART). Objective: In light of this ambivalence, this study aims to document and identify treatment approaches of THPs to the management of illness among PLHIV in the current era of widespread access to ART. Methods: The study was conducted as part of a larger trial of Treatment as Prevention (TasP) in rural northern Kwa-Zulu Natal, intended to treat PLHIV regardless of CD4 count. Nine THPs were enrolled using purposive and snowballing techniques. Repeat group discussions, triangulated with community walks and photovoice techniques, were conducted. A thematic analysis approach was used to analyse the data. Results: Eight of the nine THPs had received training in biomedical aspects of HIV. THPs showed a multilayered decision-making process in managing illness among PLHIV, influenced by the attributes and choices of the THPs. THPs assessed and managed illness among PLHIV based on THP training in HIV/AIDS, THP type, as well as knowledge and experience in the traditional healing practice. Management of illness depended on the patients’ report of their HIV status or willingness to test for HIV. Conclusions: THPs’ approaches to illness in PLHIV appear to be shifting in light of increasing exposure to HIV/AIDS-related information. Importantly, disclosure of HIV status plays a major role in THPs’ management of illness among PLHIV, as well as linkage to HIV testing and care for their patients. Therefore, THPs can potentially enhance the success of ART for PLHIV when HIV status is known.

Clinical Outcomes and Retention Among HIV-Infected Adolescents and Adults Initiated on Protease Inhibitors Antiretroviral Therapy Regimen in Dar ES Salaam; A Longitudinal Retrospective Descriptive Study

“…On the other hand, PLHIV who presented with WHO clinical stage III & IV at the time of switching to the second line were less likely to be retained to care similar to other studies reporting poor retention among sicker patients [38] who may be too sick to attend to HIV clinics or may have died and the death not reported at the attending clinic. Some patients with advanced HIV disease are more likely to seek alternative traditional health practitioners and leave medical care in an African setting [39,40], some may be returned to their domicile places waiting to die there as it was found in West Africa [41].…”

Navigating Multiple Sources of Healing in the Context of HIV/AIDS and Wide Availability of Antiretroviral Treatment: A Qualitative Study of Community Participants’ Perceptions and Experiences in Rural South Africa

“…For example, participants reported that THPs trained in HIV/AIDS offered traditional healing services that did not put those who contacted THPs at risk of contracting HIV/AIDS. Available data on HIV/AIDS-trained THPs demonstrate their ability to provide community-based HIV care, promoting and distributing condoms, and coordinating ART adherence support groups ( 59 , 66 , 67 ). However, other studies have shown that utilization of both biomedical and traditional healing systems among PLHIV predicts non-ART use ( 28 , 68 ).…”

“…They pointed out that when one was using traditional and biomedical health systems concurrently or alternatively, it was important to consult with THPs who were registered and trained in HIV/AIDS. Analysis of data from THPs in the same setting found that THPs who had not received formal HIV training were considered HIV incompetent ( 59 ). It was easy to identify trained THPs as they had certificates hung on the walls of their consultation rooms, and most of them performed safer practices due to years of encounters with HIV-positive patients.…”

Improving South African medical curricula related to traditional health systems

“…[5,7] Furthermore, THPs represent an area of under-utilised potential in the fight against HIV/AIDS, particularly due to their overwhelming willingness to engage in HIV/AIDS training and refer patients to biomedical facilities when necessary. [6,8] Discouragingly, however, the tension between biomedicine and TM, largely due to historical injustices, gaps in scientific evidence and mistrust, has resulted in a fragmented and inefficient health system. [6,9,10] Medical schools provide a prime location to combat these challenges, ideally fostering understanding and integration of the two health systems.…”