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Sex Transm Infect. 2017 Jul;93(Suppl 3). pii: e052974. doi: 10.1136/sextrans-2016-052974.

Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa.

Author information

1
Department of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
2
Africa Health Research Institute, KwaZulu-Natal, South Africa.
3
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
4
Tanzanian National Institute of Medical Research, Mwanza, Tanzania.
5
Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi.
6
London School of Hygiene and Tropical Medicine, London, UK.
7
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
8
Biomedical Research and Training Institute, Harare, Zimbabwe.
9
Rakai Health Sciences Program, Rakai, Uganda.
10
Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.
11
University of Southampton, Southampton, UK.

Abstract

OBJECTIVES:

There are concerns that medical pluralism may delay patients' progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade.

METHODS:

We conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa. We interviewed 258 PLHIV at different stages of the HIV cascade-of-care, 48 family members of deceased PLHIV and 53 HIV healthcare workers. Interviews were conducted using shared standardised topic guides, and data managed through NVIVO 8/10/11. We conducted a thematic analysis of healthcare pathways and bottlenecks related to medical pluralism.

RESULTS:

Medical pluralism, manifesting across traditional, faith-based and biomedical health-worlds, contributed to the care cascade bottlenecks for PLHIV through three pathways of impact. First, access to HIV treatment was delayed through the nature of health-related beliefs, knowledge and patient journeys. Second, HIV treatment was interrupted by availability of alternative options, perceived failed treatment and exploitation of PLHIV by opportunistic traders and healers. Lastly, the mixing of biomedical healthcare providers and treatment with traditional and faith-based options fuelled tensions driven by fear of drug-to-drug interactions and mistrust between providers operating in different health-worlds.

CONCLUSION:

Medical pluralism contributes to delays and interruptions of care along the HIV cascade, and mistrust between health providers. Region-wide interventions and policies are urgently needed in sub-Saharan Africa to minimise potential harm and consequences of medical pluralism for PLHIV. The role of sociocultural beliefs in mediating bottlenecks necessitate adoption of culture-sensitive approaches intervention designs and policy reforms appropriate to the context of sub-Saharan Africa.

KEYWORDS:

Antiretroviral treatment; Faith healer; HIV; Health-seeking behaviour; Medical Pluralism; Sub-Saharan Africa; Traditional healer

PMID:
28736393
PMCID:
PMC5739844
DOI:
10.1136/sextrans-2016-052974
[Indexed for MEDLINE]
Free PMC Article

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