Traditional healers could play key role in ART rollout

Traditional healers could potentially be an important source of HIV treatment in some African settings, according a study published in the December 1^st edition of AIDS. Investigators from Zimbabwe and the University of Pennsylvania found that patients reported better quality of life after a visit to a traditional healer than did patients who accessed orthodox medical services.

“In the era of antiretroviral rollout, [traditional healers] could be an invaluable, community-based resource for linkage of HIV testing, education and prevention, and treatment for opportunistic infections such as tuberculosis”, comment the investigators.

It is estimated that there are 22 million HIV-positive individuals in sub-Saharan Africa. Although access to antiretrovirals is being rolled out in this region, it is thought that only 28% of those in need of anti-HIV drugs are receiving them.

Lack of a basic health infrastructure (such as a shortage of clinics and trained healthcare workers) is a major obstacle to the provision of HIV treatment in many African countries. There have therefore been calls for a community-based approach to the provision of HIV treatment involving traditional healers.

Traditional healers are an integral part of culture and society in Africa and are the main provider of health care in most of rural Africa. There is good evidence that many people with HIV in Africa turn to traditional healers.

Investigators sought to compare the self-perceived changes in quality of life in patients accessing traditional healers and those using western healthcare facilities. Their theory was that individuals using traditional healers would report higher quality of life. They believed that this may be because of the mental health benefits stemming from the “culturally contextualized psychological support of traditional healers”.

The researchers were hopeful that the results of their study would provide the cultural context for antiretroviral rollout programmes.

A total of 254 individuals accessing traditional (61%) and western (39%) health care in the Chipinge district of Zimbabwe were included in the study. At both baseline and a month after accessing health care, individuals completed questionnaires to assess their self-perceived quality of life. Two questionnaires were used. The first assessed general quality of life, the second was designed to obtain information on HIV-related quality of life issues.

All the patients had symptoms suggestive of HIV infection, including weight loss, chronic diarrhoea, persistent fever, chronic cough, swollen glands, and shingles.

There were important baseline differences between the patients accessing traditional healers and those using western medicine. Those using the traditional healer were more likely to be unemployed (14% vs. 24%), were less likely to have an education beyond primary level.

Furthermore, at baseline those using traditional healers reported better self-perceived quality of life on 16 of the 19 measures assessed, including general health perception, physical function, social function, pain, mental health and health distress.

One month after visiting the healthcare provider, those using traditional healers one again reported higher perceived quality of life on the majority of measures (14 of 19). This included the majority of general quality of life measures (overall function, health worries, illness mastery, medication worries, financial worries, provider trust) and HIV-related dimensions (general health perceptions, physical function, role function, pain, energy/fatigue, health distress, mental health and overall quality of life).

“Our findings may reflect the fact that traditional healers…provide psychosocial support and a familiar context for health care”, comment the investigators. As traditional healers are used by 80% of HIV-positive individuals in southern Africa the investigators believe they “may prove to be the most accessible and cost-effect way to bolster access to health care for resource-poor areas and improve quality of life for those living and dying with HIV/AIDS.”