Traditional healer treatment of HIV persists in the era of ART: a mixed methods study from rural South Africa

Carolyn M Audet,Ryan G Wagner,Sizzy Ngobeni

doi:10.1186/s12906-017-1934-6

Abstract

BackgroundHuman immunodeficiency virus (HIV) substantially contributes to the burden of disease and health care provision in sub-Saharan Africa, where traditional healers play a major role in care, due to both their accessibility and acceptability. In rural, northeastern South Africa, people living with HIV often ping-pong between traditional healers and allopathic providers.MethodsWe conducted 27 in-depth interviews and 133 surveys with a random sample of traditional healers living in Bushbuckridge, South Africa, where anti-retroviral therapy (ART) is publicly available, to learn: (1) healer perspectives about which HIV patients they choose to treat; (2) the type of treatment offered; (3) outcomes expected, and; (4) the cost of delivering treatment.ResultsHealers were mostly female (77%), older (median: 58.0 years; interquartile range [IQR]: 50–67), with low levels of formal education (median: 3.7 years; IQR: 3.2–4.2). Thirty-nine healers (30%) reported being able to cure HIV in an adult patients whose (CD4) count was >350cells/mm3. If an HIV-infected patient preferred traditional treatment, healers differentiated two categories of known HIV-infected patients, CD4+ cell counts <350 or ≥350 cells/mm3. Patients with low CD4 counts were routinely referred back to the health facility. Healers who reported offering/performing a traditional cure for HIV had practiced for less time (mean = 16.9 vs. 22.8 years; p = 0.03), treated more patients (mean 8.7 vs. 4.8 per month; p = 0.03), and had lower levels of education (mean = 2.8 vs. 4.1 years; p = 0.017) when compared to healers who reported not treating HIV-infected patients. Healers charged a median of 92 USD to treat patients with HIV.ConclusionTraditional healers referred suspected HIV-infected patients to standard allopathic care, yet continued to treat HIV-infected patients with higher CD4 counts. A greater emphasis on patient education and healer engagement is warranted.

Highlights

Human immunodeficiency virus (HIV) substantially contributes to the burden of disease and health care provision in sub-Saharan Africa, where traditional healers play a major role in care, due to both their accessibility and acceptability
In rural subSaharan Africa, people living with HIV frequently seek allopathic clinical services while they concurrently receive treatment from traditional healers [2,3,4,5,6]
South Africa, 69% of HIV infected patients report routinely visiting both types of practitioners to treat their HIV disease, opportunistic infections (Tuberculosis, Kaposi’s sarcoma), and side effects from antiretroviral medication (ART) [2]

Summary

Introduction

Human immunodeficiency virus (HIV) substantially contributes to the burden of disease and health care provision in sub-Saharan Africa, where traditional healers play a major role in care, due to both their accessibility and acceptability. Northeastern South Africa, people living with HIV often ping-pong between traditional healers and allopathic providers. In rural subSaharan Africa, people living with HIV frequently seek allopathic clinical services while they concurrently receive treatment from traditional healers [2,3,4,5,6]. In the rural Bushbuckridge sub-district of Mpumalanga Province, South Africa, 69% of HIV infected patients report routinely visiting both types of practitioners to treat their HIV disease, opportunistic infections (Tuberculosis, Kaposi’s sarcoma), and side effects from antiretroviral medication (ART) [2]. Medical pluralism is common among patients dealing with a variety of chronic and acute ailments, including HIV, leading to poorer health outcomes among individuals who delay or abandon allopathic treatment for biomedical conditions [10, 14,15,16,17,18]. There is no legal framework to control healer treatment of HIV, with those claiming the ability to cure the disease censured by provincial or district health offices and by their own healer organizations

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