Concurrent use of traditional medicine and ART: Perspectives of patients, providers and traditional healers in Durban, South Africa

Abstract

The concurrent use of traditional African medicine (TAM) and allopathic medicine is not well understood for people living with HIV (PLHIV) in the era of antiretroviral therapy (ART). This cross-sectional, qualitative study examines perceptions of the concurrent use of TAM and ART among: i) patients receiving ART at the Sinikithemba HIV Clinic of McCord Hospital, in Durban, South Africa; ii) allopathic medical providers (doctors, nurses, HIV counsellors) from Sinikithemba; and iii) local traditional healers. Data were collected through in-depth interviews and focus group discussions with 26 participants between July and October, 2011. Patients in this study did not view TAM as an alternative to ART; rather, results show that patients employ TAM and ART for distinctly different needs. More research is needed to further understand the relationship between traditional and allopathic approaches to health care in South Africa, to improve cultural relevance in the provision and delivery of care for PLHIV, and to pragmatically address the concerns of healthcare providers and public health officials managing this intersection in South Africa and elsewhere.

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

“…Traditional forms of illness are understood to result from supernatural causes such as bewitchment or ancestral wrath [41,65,66]. Healing of illness largely involves divination, faith healing and traditional medicinal remedies [67–69].…”

“…A study conducted in KwaZulu-Natal found that, out of 11 THPs participating in the study, none said that they could cure HIV. A predominant belief among these THPs was that they could help patients with symptoms of HIV [41]. Other studies had previously suggested that THPs thought they could cure HIV/AIDS through different rituals and healing practices [49,65,74,75].…”

“…Indigenous belief systems drive significant levels of medical pluralism with the continued use of traditional healing alongside ART care, particularly in rural populations [38–40]. Even when people living with HIV (PLHIV) can access HIV treatment, they continue to use THPs to complement ART, and often find support from THPs and use traditional healing for reasons not directly related to the HIV [37,41,42]. Moreover, patients sought traditional care when they could not access ART [30,43].…”

“…These include THPs’ supportive role for encouraging safer sexual practices, HIV testing and treatment, and providing community-based HIV care [28]. In contrast, other studies have identified negative aspects of THP use in the context of HIV/AIDS, such as THPs lacking the skills and resources needed to manage HIV/AIDS [41,44,48–50]. Given the rapidly changing landscape of HIV care and management, it remains unclear how illness is managed by THPs among PLHIV.…”

Antiretroviral therapy initiation and adherence in rural South Africa: community health workers’ perspectives on barriers and facilitators

“…Furthermore, shifting to a chronic disease model of HIV care and facilitating ART initiation in both symptomatic and asymptomatic patients would benefit long-term engagement in care. Through the expansion of home-based care interventions (Decroo et al, 2014; Grimsrud, Lesosky, Kalombo, Bekker, & Myer, 2015), CHWs are uniquely positioned to help mitigate barriers to care such as stigma, denial, inadequate patient education, poor social support (Root & Whiteside, 2013; Zulliger et al, 2014), and patient preferences for alternative medicine (Appelbaum Belisle et al, 2015; Peltzer, Friend-du Preez, Ramlagan, Fomundam, & Anderson, 2010). …”