Botswana

In Botswana, where the 1997 national serosurveillance data showed an HIV prevalence of 38.5% among pregnant women in urban areas, the government has had for more than 18 years a policy of actively promoting cooperation between modern and traditional medicine (WHO, 1991; Staugaard, 1985). Activities of the Ministry of Health/National AIDS Programme for traditional healers have included seminars on AIDS, and implementing the Botswana Dingaka AIDS Awareness and Training Project. This project took place between 1991 and 1993 with the objective of training traditional healers as trainers who would pass AIDS information on to other traditional healers in selected pilot areas, and promoting cooperation and collaboration between traditional and biomedical health services (see Table 1). The original training of trainers lasted two weeks and involved 12 healers in six districts of Botswana. Trained healers were then to travel together to other districts to train 40 other healers in each district. Once trained, newly trained healers were expected to train more healers, obtain condoms from health centres and distribute them to their clients and communities (Mbongwe & Mokganedi, 1993).

Four of the five workshops planned for the second-generation healers took place. However, funding was terminated after the first phase of the project, so neither group of healers was followed-up or formally evaluated for effectiveness of the training or for accomplishment of stated objectives within the duration of the project. However, an independent assessment of the Botswana Dingaka AIDS Awareness and Training Project, conducted in 1994, interviewed 32 traditional healers, 19 nurses and 20 medical doctors; 72% of the traditional healers interviewed stated that they had changed something in their practice in relation to the new information on AIDS and 80% said that, after training, they recommended condoms to their patients, while 31 of the 32 stated that they referred patients to clinics or to the hospital (Oja & Steen, 1996). Interestingly, 17 of 19 nurses interviewed claimed that they also referred patients to traditional healers, but only 7% of the medical doctors reported doing the same.

In a second assessment in 1995, three of the 12 first-generation healers interviewed said they were able to disseminate information in their communities, had referred patients to the hospital when their treatments failed, and had no hesitation in distributing condoms or talking about sexual issues with clients (King, 1995). All three healers also claimed they had many STD patients, yet had not, so far, had a patient whom they believed had AIDS. When asked how they would manage a person with AIDS, they all said there was nothing they could do, since they didn't have a treatment for AIDS. They were not aware of the clinical case definition of AIDS, and were not referring their clients for HIV testing and counselling. They did not see themselves playing a role in home-based care for persons living with HIV/AIDS (King, 1995).