Moshabela Dominic Bukenya Gabriel Darong Joyce Wamoyi Thembelihle Zuma Jenny Renju Constance Nyamukapa William Ddaaki Oliver Bonnington Janet Seeley Vicky ID: 528162
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Slide1
Mosa
Moshabela, Dominic Bukenya, Gabriel Darong, Joyce Wamoyi, Thembelihle Zuma, Jenny Renju, Constance Nyamukapa, William Ddaaki, Oliver Bonnington, Janet Seeley, Vicky Hoosegood, Alison Wringe
Promise or Peril? The Nature of Medical Pluralism along the Cascade of Care for HIV/AIDS in Eastern and Southern Africa
Abstract No. WEPDD0101Slide2
Introduction
Using more than one medical systemSwitching between modalities of careHindering progress through the cascadePLHIV experiences across medical systemsQualitative study in seven HDSSTable 1: Participants
and Study Sites in six African countriesHCW
Diagnosed no ART
On ART
No longer in care
Kisesa
(Tanzania)
8
6185Karonga (Malawi)59274Rakai (Uganda)616146Kyambaliwa (Uganda)58164Kisumu (Kenya)810156Manicaland (Zimbabwe)4133511uMkhanyakude (South Africa)1810176TOTAL547214242
uMkhanyakude
Manicaland
Karonga
Kisesa
Kisumu
Masaka
Rakai
Sores, pus and pain from 2001
#
Local district hospital (2001)
*
Local clinic (2003)
Offered VCT but refused (2003)
*
Traditional Healer: 5 months
Diagnosis was Witchcraft: 2004
*
Prophet 1 (Paid R50 fee) (2004)
*
Prophet 2 (Paid R90 fee) (2004)
*
Chemist (Paid R45 fee) (2004)
HIV test done & diagnosed (2004)
Local district Hospital (2004)
HIV clinic (2004)
ART was initiated in 2005
#
Temporary symptomatic relief
*
Treatment and care ineffective Slide3
Results
Healthcare for PLHIV involves faith healers, pastors and prophets, traditional healers and herbalists, public sector clinics and hospitals, and private sector doctors,
pharmacies and chemists PLHIV engage in medical pluralism largely because of the nature of their health worlds, be it traditional or religious – based on interpretation of their
illness and symptoms, as well as social influence
“…traditional healers have had an
awakening…when you are infected with the virus, they will tell you to follow up with the
proper medication
.”
“I have taken the medicine for HIV and the
HIV is unrelenting. That only implies that this is witchcraft. That is why I kept going to the traditional doctors.”“There are some traditional healers who will tell you to stop the treatment. They say they have discovered some herbs which cure the disease.” “Okay it’s true, there are some who are bewitched. He goes to a traditional healer and gets healed, but that disease comes in so many different ways…”“The doctor said: “It is better you take her from here and go seek some traditional medicines.” I took my wife, and we went to a traditional healer.” IMPLICATIONS Treatment delaysExcessive costsTreatment interruptionsDrug-drug interactionsConflicting messages.Slide4
Conclusions
PLHIV across Africa use multiple sources & systems of healthcare Explained by health worlds & social systems of support for ill-healthPLHIV compensate for aspects of healthcare needed but not received Other PLHIV attempt to substitute ART services, in the quest for cureMedical pluralism may act as a bottleneck along the cascade of care May delay
HIV testing & ART initiation, & interfere with adherence Unresolved tensions between biomedical & other systems of careNeed for collaborative
engagements to promote health outcomes
Thank you
This study was supported by the
Wellcome
Trust (085477/Z/08/Z)
and the Bill and Melinda Gates Foundation (OPP1082114.