Health seeking and sexual behaviour in patients with sexually transmitted infections: the importance of traditional healers in Thyolo, Malawi

Abstract

Objectives: To describe health seeking and sexual behaviour including condom use among patients presenting with sexually transmitted infections (STIs) and, to identify sociodemographic and behavioural risk factors associated with "no condom use" during the symptomatic period. Methods: A cross sectional study of consecutive new STI cases presenting at the district STI clinic in Thyolo, Malawi. They were interviewed by STI counsellors after obtaining informed consent. All patients were treated according to national guidelines. Results: Out of 498 new STI clients, 53% had taken some form of medication before coming to the STI clinic, the most frequent alternative source being the traditional healer (37%). 46% of all clients reported sex during the symptomatic period (median 14 days), the majority (74%) not using condoms. 90% of all those who had not used condoms resided in villages and had seen only the traditional healer. Significant risk factors associated with "no condom use" included visiting a traditional healer, being female, having less than 8 years of school education, and being resident in villages. Genital ulcer disease (GUD) was the most common STI in males (49%) while in females this comprised 27% of STIs. Conclusions: These findings, and especially the extremely high GUD prevalence is of particular concern, considering the high national HIV prevalence in Malawi (9%) and the implications for STI and HIV transmission. There is an urgent need to integrate traditional healers in control activities, encourage their role in promoting safer sexual behaviour, and to reorient or even change existing strategies on condom promotion and STI control. S exually transmitted infections (STIs) are known to facilitate the sexual transmission of HIV 1 2 and effective STI case management is known to reduce the incidence of HIV.3 Malawi has both high HIV and high STI rates. The national HIV prevalence in Malawi is 9%, while among antenatal women the syphilis seroprevalence is estimated at 2-10%. 4 In 1990, 42% of antenatal clinic attendees were diagnosed with at least one STI and HIV infection rates among patients with STIs range from 53-83%.5 STI control in Malawi is therefore of major public health importance.An important determinant of effective STI control is the health seeking behaviour of people with STIs who may seek care from alternative sources (outside an official STI clinic) such as traditional healers, private clinics, pharmacists, and market vendors.Traditional healers in particular are well reputed in African rural communities and are often considered to be the most appropriate initial point of contact for help when symptoms of STIs are thought to be linked to traditional beliefs and related perceptions. 6 Knowledge about the relative importance of these alternative providers in STI control could encourage better collaboration with some of these groups, encourage early referral for effective antibiotic treatment, and help remove or reduce potential barriers to STI control.Control of STIs involves not only pro...

Sexually transmitted infections and sexual behaviour among commercial sex workers in a rural district of Malawi

“…The ® nding that GUDs constituted a considerable proportion of STIs in the study population is of particular concern as they facilitate the acquisition and transmission of HIV by acting as portals of entry 4 . Very high GUD rates of up to 49% in male STI patients presenting to the Thyolo District Hospital STI clinic have also been reported 14 . The additional ® nding that GUD was associated with unprotected sex among CSWs merits that the National AIDS Commission develops a speci® c focus for decreasing the incidence and prevalence of GUDs.…”

Reasons for unsatisfactory acceptance of antiretroviral treatment in the urban Kibera slum, Kenya

“…While many believe that traditional medicine is the key to fighting HIV in Africa (Homsy et al, 2004), others point to harmful customs that not only delay the seeking of evidencebase care, but that could even aggravate the disease and kill patients (Munk, 1997). Despite the fact that traditional medicine is the primary source of health care in sub-Saharan Africa, it has received little attention (Mills et al, 2005;Zachariah et al, 2002). Recently, WHO acknowledged the importance of integrating indigenous medicine with the national health care system (Homsy et al, & Kabatesi, 2004;WHO, 2002) a process that has already begun in South Africa (Morris, 2001).…”

HIV/AIDS/STI/TB knowledge, beliefs and practices of traditional healers in KwaZulu-Natal, South Africa

“…Ndulo, 2001;Peltzer, 1998Peltzer, , 2000aPeltzer, , 2003Wilkinson & Wilkinson, 1998;Zachariah et al, 2002). Most commonly treated conditions among urban healers (Peltzer, 2001) and rural traditional healers (Peltzer, 1998) in Limpopo Province, South Africa, were after children's diseases sexually transmitted diseases like Tshofela/droop (Gonorrhoea), Lekhutlo (ailment of a male who had intercourse with an 'impure women'), Thosola (Syphilis), and assumed AIDS cases (Peltzer, 2001).…”