Western and traditional African medicine—working together on AIDSBMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7519.785 (Published 29 September 2005) Cite this as: BMJ 2005;331:785
In southern Africa, antiretroviral drugs are a late entrant in an already vibrant market for AIDS treatments. Traditional medicine does not treat HIV infection as such but does provide many supportive therapies. Whatever its credibility in the eyes of university trained doctors, the “neo-traditional” management of AIDS has gained a space in the market. Recognition of this economic reality could be important for the success of antiretroviral treatment.
In South Africa's central Free State province 30% of householders said they would recommend a traditional healer to manage AIDS, and only half had even heard of antiretrovirals. The low uptake of free antiretrovirals in countries such as Botswana should be another clue that the treatment is not an easy fix. Among other problems, people need to know and to accept their HIV status before they can receive treatment. The conditions for disclosure are not good in southern Africa, where the fear of stigmatisation and economic loss is widespread.
I see modern approaches to AIDS reaching an invisible limit as they confront the traditional approaches
A dangerous gap exists between what university trained doctors or nurses know about antiretroviral treatment and the way ordinary people make sense of the treatment, especially in rural areas. Perhaps to manage expectations better, health services have communicated little to the general public about the specifics of antiretroviral treatment. Most people get their information from the mass media, and their understanding is not helped by mixed messages from senior politicians. The resulting misconceptions in the community affect adherence to the treatment (BMJ 2004;328: 242-2). Health workers' misunderstanding of and disrespect for views in the community do not help. Under-use or even misuse of antiretroviral treatment can discredit its importance (BMJ 2004;328: 280-2).
This gap in knowledge serves some interests. Leakage of antiretrovirals from the periphery of the health system, where accountability is weakest, is a profitable new economy. AIDS is too big a catastrophe, and its effect on health services too profound, for this situation to be allowed to continue. Might there be a place for a new solution that combines traditional and modern approaches?
In southern Africa we can learn from countries in other African regions about mutual respect between modern and traditional medicine. One small Ugandan initiative, for example, placed a traditional healer next to a modern doctor to provide consultations for patients with HIV or AIDS (www.thebody.com/bp/oct98/uganda.html).
Disrespect and lack of understanding are shown on both sides. University trained doctors are often patronising and intolerant of traditional medicine, and many traditional healers are no more tolerant of Western solutions. Mutual mistrust could be reduced by a two way translation of knowledge. In modern medicine, it makes no sense to share a course of antiretroviral treatment among family members or to stop taking antibiotics after some improvement is shown. In traditional medicine, by the same token, it makes no sense to consider the pharmaceutical effect of herbs or roots outside their spiritual context.
The standoff between modern and traditional approaches focuses the discourse on AIDS on tertiary prevention (minimising the worst consequences for people who are already affected). Yet even this can be a negative contribution. Restructured budgets to buy expensive antiretrovirals and the vertical management of treatment programmes can weaken primary care services.
We might ask about other aspects of tertiary prevention, such as medical attention other than antiretroviral treatment, care at home, care of orphans, or food security—or how investment in tertiary prevention can support and promote prevention at many levels. University trained doctors could consider the profound lessons we have learnt from ischaemic heart disease. This taught us the importance of secondary prevention (reducing the risk factors) and primary prevention (avoiding the risk factors)—both of which are crucial to managing AIDS.
As a sangoma (traditional healer) who is also medically qualified, I see modern approaches to AIDS reaching an invisible limit as they confront the traditional approaches. This is especially true in South Africa, where a neo-traditional resurgence is sweeping through society. Traditional approaches have reached a similar barrier as they confront Western medicine.
If we lack the common sense or morality to look for new approaches, perhaps the economic implications of failure to deal with AIDS will oblige us to reconsider. AIDS will not go away on its own, and we need to combine all resources to deal with it. We can step back from this understanding, into the comfort of our prejudice and profession. Or we can look for practical ways to change things.