Interface between biomedical and traditional systems of treatment and care among HIV positive fisher folk in two fishing communities on Lake Victoria, Uganda.

Christopher Tumwine,Stephen Bell,Peter Aggleton

doi:10.4314/ahs.v21i3.11

Abstract

Fisherfolk have been identified as a key population in the HIV response in Uganda due to high HIV prevalence and low engagement in HIV services. While studies have examined lifestyles and risk, much remains to be understood about help and health seeking experiences, including the combined use of biomedical and traditional health care. To examine the use of biomedical and traditional health care in two fishing communities around Lake Victoria in Uganda. Exploratory, in-depth qualitative study involving semi-structured interviews with 42 HIV positive fisherfolk. Prior to HIV diagnosis, participants who described becoming ill sought different forms of help including biomedical treatment prescribed by health workers or self-prescribed; biomedical and herbal medicines together; herbal medicines only; or no form of treatment. Following HIV diagnosis, the majority of participants used ART exclusively, while a smaller number used both ART and traditional care strategies, or reported times when they used alternative therapies instead of ART. Prior to HIV diagnosis, fisherfolk's health care seeking practices inhibited engagement with HIV testing and access to biomedical HIV treatment and care. After HIV diagnosis, most resorted only to using ART. Study findings provide insight into how fisherfolk's use of biomedical and traditional care prior to diagnosis influences subsequent engagement with HIV treatment. Efforts are needed to reach fisherfolk through everyday health seeking networks to ensure HIV is diagnosed and treated as early as possible.

Highlights

International studies on the effectiveness of biomedical treatment-based approaches to HIV prevention[1, 2], updated international guidelines[3, 4] and UNAIDS’ 90-9090 targets[5, 6] have led to an expansion of universal test and treat programmes[7]
With a focus on clinical pathways based on the HIV care continuum framework[8], these aim to move ‘key populations’ quickly through diagnosis and treatment initiation to engagement in ongoing care to ensure viral suppression[7]
The aim of this paper is to examine fisherfolks’ perspectives and experiences of the use of biomedical and traditional health care, prior to and after HIV diagnosis, and the impact that these practices have on HIV diagnosis and treatment initiation

Summary

Introduction

International studies on the effectiveness of biomedical treatment-based approaches to HIV prevention[1, 2], updated international guidelines[3, 4] and UNAIDS’ 90-9090 targets[5, 6] have led to an expansion of universal test and treat programmes[7]. The concurrent use of biomedical and traditional systems of health care for HIV is widely documented in Uganda[21] and other sub-Saharan settings 22, 23 In such contexts, ‘biomedical care’ may be defined as HIV care implemented in accordance with national HIV policies, involving the use of anti-retroviral therapy (ART) provided by biomedically trained health workers in clinical settings[22]. Prior to HIV diagnosis, fisherfolk’s health care seeking practices inhibited engagement with HIV testing and access to biomedical HIV treatment and care. Conclusion: Study findings provide insight into how fisherfolk’s use of biomedical and traditional care prior to diagnosis influences subsequent engagement with HIV treatment. Interface between biomedical and traditional systems of treatment and care among HIV positive fisherfolk in two fishing communities on Lake Victoria, Uganda. Afri Health Sci. 2021;21(3). 1040-1047. https://dx.doi.org/10.4314/ ahs.v21i3.11

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Methods

Conclusion