Traditional, complementary and alternative medicine use by HIV patients a decade after public sector antiretroviral therapy roll out in South Africa: a cross sectional study.

Manimbulu Nlooto,Panjasaram Naidoo

doi:10.1186/s12906-016-1101-5

Abstract

BackgroundThe roll out of antiretroviral therapy in the South African public health sector in 2004 was preceded by the politicisation of HIV-infection which was used to promote traditional medicine for the management of HIV/AIDS. One decade has passed since; however, questions remain on the extent of the use of traditional, complementary and alternative medicine (TCAM) by HIV-infected patients. This study therefore aimed at investigating the prevalence of the use of African traditional medicine (ATM), complementary and alternative medicines (CAM) by adult patients in the eThekwini and UThukela Health Districts, South Africa.MethodsA cross- sectional study was carried out at 8 public health sector antiretroviral clinics using interviewer-administered semi-structured questionnaires. These were completed from April to October 2014 by adult patients who had been on antiretroviral therapy (ART) for at least three months. Use of TCAM by patients was analysed by descriptive statistics using frequency and percentages with standard error. Where the associated relative error was equal or greater to 0.50, the percentage was rejected as unstable. A p-value <0.05 was estimated as statistically significant.ResultsThe majority of the 1748 participants were Black Africans (1685/1748, 96.40 %, SE: 0.00045), followed by Coloured (39/1748, 2.23 %, SE: 0.02364), Indian (17/1748, 0.97 %, SE: 0.02377), and Whites (4/1748, 0.23 %, SE: 0.02324), p < 0.05. The prevalence of ATM use varied prior to (382/1748, 21.85 %) and after ART initiation (142/1748, 8.12 %), p <0.05, specifically by Black African females both before (14.41 %) and after uptake (5.49 %), p < 0.05. Overall, 35 Black Africans, one Coloured and one Indian (37/1748, 2.12 %) reported visiting CAM practitioners for their HIV condition and related symptoms post ART.ConclusionDespite a progressive implementation of a successful antiretroviral programme over the first decade of free antiretroviral therapy in the South African public health sector, the use of TCAM is still prevalent amongst a small percentage of HIV infected patients attending public healthcare sector antiretroviral clinics. Further research is needed to explore reasons for use and health benefits or risks experienced by the minority that uses both conventional antiretroviral therapy with TCAM.

Highlights

The roll out of antiretroviral therapy in the South African public health sector in 2004 was preceded by the politicisation of Human Immunodeficiency Virus (HIV)-infection which was used to promote traditional medicine for the management of HIV/ Acquired Immunodeficiency Syndromes (AIDS)
In South Africa, public sector healthcare is offered to patients with HIV-infection at different levels of the health care system: Primary Health Care (PHC) clinics, Community Health Centres (CHC), District Hospitals (DH), Regional Hospitals (RH), Academic Hospitals (AH) and Central Hospitals (CH)
The South African National Department of Health (NDOH) paid a rural allowance to healthcare professionals depending on the type of locality and place of health facilities; some metropolitan settlements have those types of locality qualifying for rural allowance like in normal rural areas

Summary

Introduction

The roll out of antiretroviral therapy in the South African public health sector in 2004 was preceded by the politicisation of HIV-infection which was used to promote traditional medicine for the management of HIV/ AIDS. One decade has passed since; questions remain on the extent of the use of traditional, complementary and alternative medicine (TCAM) by HIV-infected patients. This study aimed at investigating the prevalence of the use of African traditional medicine (ATM), complementary and alternative medicines (CAM) by adult patients in the eThekwini and UThukela Health Districts, South Africa. The politicisation of HIV and AIDS was used before 2004 to promote traditional, complementary and alternative medicines (TCAM) by senior government officials who advocated the use of treatment modalities outside the orthodox system of HIV treatment, such as lemon juice, beetroot and garlic [5]. One critical question remains on the prevalence of TCAM use a decade after easy access to ARV medicines was made possible by the government

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