|Collaboration with Traditional Healers in HIV/AIDS Prevention and Care in Sub-Saharan Africa - A literature review (UNAIDS, 2000, 64 p.)|
HIV/AIDS is now the number one overall cause of death in Africa, and has moved up to fourth place among all causes of death worldwide, according to the latest annual World Health Report.
As the epidemic continues to ravage the developing world, it becomes increasingly evident that diverse strategies to confront the wide-ranging and complex social, cultural, environmental and economic contexts in which HIV continues to spread must be researched, tested, evaluated, adapted and adopted. The majority of populations in developing countries have access to traditional health care and it is widely accepted that about 80% of people in Africa rely on traditional medicine for many of their health care needs. Traditional healers are well known in the communities where they work for their expertise in treating many sexually transmitted diseases1 (Green, 1994). Consequently, the World Health Organization (WHO) has advocated the inclusion of traditional healers in National AIDS programmes since the early 1990s.
1 Researchers in some countries have noted that some other illnesses and conditions not classified as sexually transmitted in biomedical nosology may be locally regarded as such by traditional healers and their clients (Green, 1994).
The aim of this report was to give a brief update on AIDS and traditional medicine in Africa, and to review initiatives that have attempted collaboration between traditional and biomedical practitioners for HIV prevention. There is, however, a dearth of research actually testing the impact of involving traditional healers in HIV prevention efforts. Most reports - even evaluation reports - often state only achievements and findings. This review first looked as broadly as possible at all interventions involving traditional healers in HIV/AIDS prevention and care in sub-Saharan Africa. Eight projects that most closely met UNAIDS Best Practice criteria (effective and ethical interventions that are efficient, sustainable, and relevant for HIV prevention in the resource-constrained settings of sub-Saharan Africa) were then selected and compared.
In addition to the UNAIDS criteria, supplementary standards were defined that are specific to traditional medicine/biomedicine collaborative projects. Data were collected through published and unpublished literature, through personal contacts, e-mail correspondence, circulation of a questionnaire and by attending the First International Conference on AIDS and Traditional Medicine in Dakar, Senegal, in March 1999.
The report is organized into four sections. The first section gives a brief update on AIDS in Africa and is followed by background information on African traditional medicine. This includes strengths and limitations of traditional medicine and healers with respect to collaboration with biomedicine, and the continuing policy debate on the integration, cooperation, and collaboration of traditional medicine with national health care systems. The second section reviews collaborations between traditional medicine and biomedicine for HIV prevention, including a comprehensive table of collaborative initiatives. The third section analyses traditional medicine/biomedicine collaborative projects with reference to the UNAIDS Best Practice Criteria of effectiveness, efficiency, relevance, ethical soundness and sustainability, and adds suggested specific criteria for these types of projects. As many projects had not reported specifically on these criteria, a list of issues to consider in order to conform to Best Practices was included in each subsection. Finally, since this continues to be an extremely exploratory field, the last section identifies needs for further research on collaboration between health sectors.