The discussion surrounding a cure for HIV & AIDS has raged the planet since HIV & AIDS was discovered in the early 1980s. Part of the debate has centred on the efficacy of traditional medicines in curing the disease. While the Western medical system refutes claims that there is a cure for HIV & AIDS, many traditional healers, especially on the African continent, have grabbed headlines for bold claims that they have cures for the disease. In the process they have attracted much criticism from all corners of the medical fraternity,⁽²) senior government officials and health ministers, as well as some religious leaders.

Despite the negative sentiments against traditional healers in favour of the conventional medical system, the developing world, especially Africa and China, constitutes the largest market for the production, selling and consumption of traditional medicine. An estimated 70% to 95% of citizens in the developing world are using traditional and herbal medicine to address the primary and secondary care management of their health needs and concerns.⁽³⁾ Nevertheless, support for traditional healing has been lacking from governments in Africa, especially with regard to HIV & AIDS, albeit a huge proportion of their national budgets being spent on conventional medical systems.⁽⁴⁾ What Government officials and health policy makers have ignored is the important role that traditional medical practitioners can play in strengthening and supporting the fight against HIV & AIDS.⁽⁵⁾

This CAI discussion paper explores the role traditional healers have played and have yet to play in the fight against HIV & AIDS. It will address the gaps between the two health systems, examine the damage caused by the two warring sides, and finish with the policy implications that should be considered.

The causes for medical clashes and misunderstandings

The clashes between the western medical system and traditional medicine are more ideological than scientific in nature. Proponents of the conventional medical system have looked down upon traditional healers. According to Liverpool et al. (2004), “Historically, most western-trained doctors viewed traditional healers with scepticism and disdain.”⁽⁶⁾ This negative attitude is compounded by the perpetual negative portrayal of traditional healing systems in the mainstream media, which nurses stereotypes and causes the system to be shunned.⁽⁷⁾ When HIV & AIDS became prevalent in the developing world, many of the patients turned to their traditional healers for help, despite being discouraged by their doctors who recommended that they distance themselves from “superstitious” and “quackery” traditions.⁽⁸⁾ In return, many traditional healers fought back because they felt that the conventional doctors wanted to monopolise the market of HIV positive patients.⁽⁹⁾

In South Africa alone, there are over 200,000 traditional healers while there are only 25,000 biomedical doctors thus making traditional healers more accessible to many people.⁽¹⁰⁾ It has been reported that many patients contact their traditional healers first upon learning that they are HIV positive. In a study conducted in Soweto, South Africa, it is reported that over 75% of patients who visit hospitals and clinics for HIV & AIDS medical check-ups confess to visiting their traditional healers prior to going to a hospital or clinic.⁽¹¹⁾ Due to the limited number of doctors, the amount of time doctors spend with patients is limited and therefore many poor people rely on traditional healers who do more than providing patients with medicine. Traditional healers “go beyond just treating the disease. First and foremost they ‘connect’ both collectively and individually…(and)… lead the people to their own healing.”⁽¹²⁾ In addition, Liverpool et al. (2004) note that, “the economic and time considerations of modern medical healthcare delivery often limit doctors’ capacity to address the spiritual and emotional needs of their patients.”⁽¹³⁾ Therefore many poor HIV & AIDS patients prefer traditional doctors to biomedical doctors for going an extra mile in treating their illness. Furthermore, when ARVs were introduced they were very expensive for individuals in many parts of Africa, and numerous patients resorted to traditional medicine, which is more affordable and more accessible.⁽¹⁴⁾

In recent years particularly, there has been an unprecedented boom in the production of traditional medicine. It is reported that the worldwide traditional healing industry is now worth more than US$ 83 billion annually, as estimated in 2008.⁽¹⁵⁾ Some of these traditional medicines have contributed significantly to increasing the strength of the immune systems of critically ill people and improved their appetite for food, which is important for the treatment of HIV & AIDS.⁽¹⁶⁾ Given their relatively low prices, an increasing number of patients are using them along with their ARV medication, despite unceasing warning from medical doctors that for maximum efficacy, ARVs should not be used with other “unscientifically proven” medicines.⁽¹⁷⁾

The cost of the clashes

Among other things, the fight between biomedical doctors and traditional healers has resulted in a number of patients who were initially using ARV drugs to discontinue their use,⁽¹⁸⁾ because they strongly believe that the traditional medicine is sufficient to treat and even to cure the disease.⁽¹⁹⁾ This has cost many governments and donor agencies a lot of money because once a patient has started ARV treatment they should take the medication for life. As ARV treatment is provided as a combination drug therapy, the first combination should be taken until it needs to be substituted for medical reasons. Once a patient defaults on one combination for a long period, different types of ARV drugs, which are more expensive and more toxic to the body than the previous, may have to be prescribed.⁽²⁰⁾ Moreover, many of the HIV & AIDS patients who default on medication are unlikely to live as long as they might on the correct treatment because they may use medicines or herbs that are counterproductive to ARVs, thereby reducing the efficacy of the latter, while at the same time placing enormous pressure on their liver.⁽²¹⁾

Due to misunderstandings between the two medical systems, extreme views have taken root with HIV & AIDS denialists who argue that HIV & AIDS can be cured through using African traditional medicines. For example, in early to mid-2000, the former President of South Africa, Thabo Mbeki, and the Health Minister at the time, Manto Tshabalala-Msimang, grabbed international news headlines by purporting that HIV does not cause AIDS and that AIDS could be treated by eating certain herbs and fruits.⁽²²⁾ The Treatment Action Campaign, an activist organisation that was founded in 1998 to pressure the South African government to be more responsive towards addressing the problem of HIV & AIDS, has argued that the denialism shown by Thabo Mbeki has led to confusion regarding whether HIV & AIDS are in fact related and consequently, the death of many people.⁽²³⁾ Due to incoherent messages being dished out by both traditional healers and biomedical practitioners, the general population is caught at crossroads with the devastating effects of a ballooning number of HIV & AIDS patients.⁽²⁴⁾

Exacerbating the issue is the problem of poor regulation over traditional healers, which has made it impossible for health authorities to closely monitor traditional healing systems and establish a set of practices and standards.⁽²⁵⁾ Despite pro-traditional healing legislation having been enacted in a number of African countries, traditional healing is still largely unregulated. A lack of regulation and development has had a negative effect on traditional health practitioners and their patients due to the absence of precedents to follow. Authorities still rely on their general understanding of how conventional medical practitioners are regulated.⁽²⁶⁾ According to World Health Organisation’s ‘The World Medicines Situation Report 2011’, it is very difficult to develop a conventional regulatory framework that can be used worldwide because unlike in the biomedical system, “the diverse descriptions and classifications of traditional medicines in many countries, herbal and other traditional medicinal products are often subject to equally divergent, concurrent levels of certification: a single medicinal plant may be simultaneously defined and regulated under several different regulatory instruments.”⁽²⁷⁾

Many traditional healers continue to use divergent approaches in treating their HIV & AIDS patients due to lack of international regulations and requirements. A lack of regulation has resulted in some traditional healers producing ‘miracle’ cures for HIV & AIDS with devastating effects on the patients.⁽²⁸⁾ In 2011 it was reported that a former Lutheran priest in Tanzania sold a “cure-all” herb and he was seeing a minimum of 2000 HIV & AIDS patients per day with some patients dying in the queue to see him.⁽²⁹⁾

Though much legislation has been and continues to be enacted in a number of African countries regarding integrating traditional healers in the mainstream healthcare system, the fight between the two health systems is unrelenting. The battle has been exacerbated by failure from both parties to learn from each other’s strengths and weaknesses.⁽³⁰⁾

What needs to be done

Traditional healers can play a crucial role in the fight and management of HIV & AIDS and other diseases. As indicated above, traditional healers are highly respected members of their respective societies and are generally more easily accessible and cheaper than western medicine practitioners. Considering their access to and influence on patients, traditional healers need to be included into the conventional medical system. For this to happen and for mutual respect to develop, the sector of society for whom traditional medicine is “quackery” needs to learn about the practice of traditional medicine and, in the process, potentially acquire knowledge from them.⁽³¹⁾ In countries like China for example, before anyone can become a biomedical practitioner it is mandatory to first go through traditional health training for at least one year.⁽³²⁾ A requirement like this could be introduced in Africa in order for biomedical practitioners to gain an understanding of the methods used in traditional medicine in order for successful collaboration to occur between the two.

One way to integrate traditional healers into the mainstream healthcare system is to place traditional healers in hospitals and primary/community healthcare centres. Millions of Africans have not developed the habit of going to health centres due to decades of colonialism and cultural imperialism.⁽³³⁾ Placing traditional healers in conventional medical systems could allow easy referral and encouragement from traditional healers to biomedical practitioners and may lead patients to become more comfortable and accustomed to the environment. Similarly, many traditional healers have failed to blossom due to being choked by cultural imperialism and power of multinational pharmaceutical industry.⁽³⁴⁾ Adding traditional healers to the HIV & AIDS care team of doctors, nurses and counsellors will allow them to work successfully and ensure that patients who normally consult their traditional healers first,⁽³⁵⁾ are within reach for easy monitoring and conventional medical check-ups. Research has indeed indicated that given enough support, traditional healers are more likely to report changes in their practices and initiate community public health activities.⁽³⁶⁾ For example, in South Africa, at the Morehouse School of Medicine in collaboration with Alexandra Health Centre, it was found that after conducting a week-long HIV & STD prevention programme for traditional healers, many of them considered the workshops highly beneficial and there was “an increased demand for HIV & AIDS related services in their respective area of practice.”⁽³⁷⁾

An overarching approach could be for policymakers to ensure that traditional healers get regular state funding based on them following a set of policies agreed by both the policymakers and themselves. This could make traditional healers more accountable and potentially more responsive to government and donor policies and regulations regarding HIV & AIDS and other diseases. It may also improve traditional healing infrastructure and service by providing traditional healers with various training workshops to better their practice. It has been noted that traditional healers need better shelter for their patients because they “…are available to see patients 24 hours of the day.”⁽³⁸⁾ In this way, traditional healers will be given the best financial, technical and infrastructural assistance possible, in order for them to serve millions of their faithful patients and followers, physically and emotionally, in the most effective way.

Concluding remarks

In light of some of the incidents, the traditional healing system deserves some of the negative publicity it has received from the mainstream media. However it is undeniable that traditional healers hold sway in determining people’s response and attitude towards conventional treatment and medicines. Therefore, increasing the financial, technical and infrastructural support provided to traditional healers should be made a reality by governments, donors etc, because traditional healers have more influence and are more accessible than the western medical system.⁽³⁹⁾ Similarly, conventional medical providers can learn a lot from traditional healthcare, particularly catering for the patients’ emotional and spiritual needs, as these needs are just important as patient’s physical needs.⁽⁴⁰⁾ Such cooperation will help to decrease the clashes and misunderstandings between the two fields. Furthermore, it could aid making the traditional medical system more up-to-date and transparent, increase the uptake of conventional medicine, and above all, result in HIV & AIDS services that holistically care for patients’ needs.

NOTES:

(1)Contact Malefetsane Soai through Consultancy Africa Intelligence’s HIV & AIDS Unit (officesa@consultancyafrica.com).
(2)Richter, M., ‘Traditional medicines and traditional healers in South Africa’, Wits University - Discussion paper prepared for the Treatment Action Campaign and AIDS Law Project, 27 November 2003, http://www.healthlink.org.za.
(3)Robinson, M.M. and Zhang, X., ‘Traditional medicines: Global situation, issues and challenges’, The World Medicines Situation, World Health Organization: Geneva, 2011, http://www.who.int.
(4) Liverpool, J., et al., 2004. Western medicine and traditional healers: Partners in the fight against HIV/AIDS. Journal of the National Medical Association, 96(6), pp. 822-825, http://www.ncbi.nlm.nih.gov.
(5) Ibid; Robinson, M.M. and Zhang, X., ‘Traditional medicines: Global situation, issues and challenges’, The World Medicines Situation, World Health Organization: Geneva, 2011, http://www.who.int.
(6) Ibid.
(7) Ibid.
(8) Ibid.
(9) Watson, J., 2005. Traditional healers fight for recognition in South Africa’s AIDS crisis. Nature Medicine, 11(6).
(10) ‘Traditional medicine, culture, and health’, AIDS Foundation of South Africa, http://www.aids.org.za; Matomela, N., ‘Recognition for traditional healers’, South Africa, 15 September 2004, http://www.southafrica.info.
(11) Ibid.
(12) Liverpool, J., et al., 2004. Western medicine and traditional healers: Partners in the fight against HIV/AIDS. Journal of the National Medical Association, 96(6), pp. 822-825, http://www.ncbi.nlm.nih.gov.
(13) Ibid.
(14) Liverpool, J., et al., 2004. Western medicine and traditional healers: Partners in the fight against HIV/AIDS. Journal of the National Medical Association, 96(6), pp. 822-825, http://www.ncbi.nlm.nih.gov.
(15) Robinson, M.M. and Zhang, X., ‘Traditional medicines: Global situation, issues and challenges’, The World Medicines Situation, World Health Organization: Geneva, 2011, http://www.who.int.
(16) Ibid.
(17) Calixto, J.B., 2000. Efficacy, safety, quality control, marketing and regulatory guidelines for herbal medicines (phytotherapeutic agents). Brazilian Journal of Medicine and Biological Research, 33, pp.179-189, http://www.ncbi.nlm.nih.gov; Amon, J.J., 2008. Dangerous medicines: Unproven AIDS cures and counterfeit antiretroviral drugs. Globalization and Health, 4(5), http://www.globalizationandhealth.com.
(18) Ibid.
(19) ‘Tanzania: Authorities urge caution on popular “cure-all” herb’, IRINNews, 4 April 2011, http://www.plusnews.org.
(20) Dzilla, C., ‘The cost of defaulting on medication’, Media for Environment, Science, Health & Agriculture, 2011.
(21) Ibid.
(22) ‘History of HIV & AIDS in South Africa’, Avert, http://www.avert.org; Heywood, M. and Cornell, M., 1998. Human rights and AIDS in South Africa: From right margin to left margin. Health and Human Rights, 2(4), pp.60-82, http://www.ncbi.nlm.nih.gov.
(23) Ibid.
(24) Liverpool, J., et al., 2004. Western medicine and traditional healers: Partners in the fight against HIV/AIDS. Journal of the National Medical Association, 96(6), pp. 822-825, http://www.ncbi.nlm.nih.gov.
(25) Matomela, N., ‘Recognition for traditional healers’, South Africa, 15 September 2004, http://www.southafrica.info.
(26) Ibid.
(27) Robinson, M.M. and Zhang, X., ‘Traditional medicines: Global situation, issues and challenges’, The World Medicines Situation, World Health Organization: Geneva, 2011, http://www.who.int, p.4.
(28) Amon, J.J., 2008. Dangerous medicines: Unproven AIDS cures and counterfeit antiretroviral drugs. Globalization and Health, 4(5), http://www.globalizationandhealth.com; ‘HIV/AIDS: Five faces we were watching in 2011’, IRIN News, http://www.irinnews.org.
(29) ‘Tanzania: Authorities urge caution on popular “cure-all” herb’, IRINNews, 4 April 2011, http://www.plusnews.org; ‘Zimbabwe healer moots magic chastity potion’, Mail & Guardian, 10 October 2001 healthlink.org.za/uploads/files/TAC_Law_Proj.pdf
(30) Somma, D.B. and Bodiang, C., ‘The cultural approach to HIV/AIDS prevention’, Social Development Division’s Health Desk, 2003, http://www.sdc-health.ch.
(31) Robinson, M.M. and Zhang, X., ‘Traditional medicines: Global situation, issues and challenges’, The World Medicines Situation, World Health Organization: Geneva, 2011, http://www.who.int, p.1; Liverpool, J., et al., 2004. Western medicine and traditional healers: Partners in the fight against HIV/AIDS. Journal of the National Medical Association, 96(6), pp. 822-825, http://www.ncbi.nlm.nih.gov.
(32) Robinson, M.M. and Zhang, X., ‘Traditional medicines: Global situation, issues and challenges’, The World Medicines Situation, World Health Organization: Geneva, 2011, http://www.who.int.
(33) Ibid.
(34) Ibid.
(35) Liverpool, J., et al., 2004. Western medicine and traditional healers: Partners in the fight against HIV/AIDS. Journal of the National Medical Association, 96(6), pp. 822-825, http://www.ncbi.nlm.nih.gov.
(36) Ibid.
(37) Ibid.
(38) Ibid.
(39) Ibid.
(40) Somma, D.B. and Bodiang, C., ‘The cultural approach to HIV/AIDS prevention’, Social Development Division’s Health Desk, 2003, http://www.sdc-health.ch; Liverpool, J., et al., 2004. Western medicine and traditional healers: Partners in the fight against HIV/AIDS. Journal of the National Medical Association, 96(6), pp. 822-825, http://www.ncbi.nlm.nih.gov.

Written by Malefetsane Soai ⁽¹⁾