The role of traditional medicine

Traditional healers represent a broad range of practices, including herbalism and spiritualism, as well as a range of individuals who call themselves diviners, priests and faith healers, among other terms. Although many of the initiatives reviewed here did not differentiate between these categories, the term 'traditional healer' used refers to either herbalists, spiritualists, or to those (the great majority of healers) involved in both practices.

African traditional healers mirror the great variety of cultures and belief systems on the continent, and possess equally heterogeneous experience, training and educational backgrounds. This diversity is further enhanced by their adaptations to the dramatic social changes that have affected much of the region since colonization, such as urbanization, population migration and displacement, and civil conflict (Good, 1987). The cost of traditional medical care varies with the nature of treatment, the type and severity of ailment and the relative wealth of the client (Porter, 1996; King et al, 1992). Whenever African healers' knowledge, attitudes, beliefs and practices about STDs and AIDS have been explored, findings have reflected the stage of the epidemic, the amount of information traditional healers have been exposed to, and their pre-existing belief systems about health and disease in general, and STDs and AIDS in particular.

Many traditional healers have treated STDs for generations, but their explanations of STDs and AIDS vary considerably across ethnic backgrounds with regard to the nature, causes and modes of transmission of these diseases. However, the concepts underlying these explanations appear remarkably similar across national and cultural boundaries. Perhaps the most striking example is the origin of STDs: healers in many settings, whether rural or urban, often ascribe these to transgressions of taboos related to birth, pregnancy, marriage and death (Green, 1992, 1994; King et al, 1993). At the same time, some of Africa's most serious diseases, including AIDS and other STDs, are often understood within a framework of contagion which could include invasion of the body by dangerous microorganisms, pollution or environmental dangers (Green, 1999).

While social research has shown that, in many countries, healers could name and describe numerous types of STDs (which do not always correspond to the biomedical definition of STDs), few of them consider AIDS an 'African' disease (Green, 1992a; Green et al, 1993). Traditional beliefs about the prevention of STDs or HIV/AIDS follow the logic of transmission and causation, and include limiting the number of sexual partners, wearing protective charms or tattoos, having 'strong blood', using condoms to reduce the risk of 'pollution', or undergoing a 'traditional vaccination' consisting of introducing herbs in skin incisions (Green, 1992a; Green et al, 1993; Nzima et al, 1996; Schoepf, 1992). In numerous cases now, condoms have been acceptable to traditional healers, especially when they fit into their belief system. For example, many African healers consider semen an important element to nourish a growing foetus and maintain the mother's health and beauty, but their concern for family and cultural survival can override this belief and allow them to promote condom use (Green et al, 1993; Schoepf, 1992).