Abstract #236  -  Traditional healers, private practitioners and herbalists: Healthcare pluralism amongst rural HIV/ART patients in South Africa
Authors:   Presenting Author:   Dr Mosa Moshabela - University of Witwatersrand
Additional Authors:  Dr Mosa Moshabela, Dr Paul Pronyk, Prof Helen Schneider, Ms Niketa Williams, Dr Mark Lurie,
Aim: Rollout of ART to rural and underserved areas is essential. We know very little about patient utilization of alternative healthcare before and during ART use. Specific objectives of this study were to identify sources of healthcare, explore emerging patterns of using healthcare, and identify determinants of the various patterns identified.
Method / Issue: Longitudinal in-depth qualitative interviews were conducted monthly, for 9 months, with 34 adult ART patients in rural Mpumalanga. Participants were also interviewed at home. Informed consent and ethical procedures were followed.
Results / Comments: The decision to seek help is almost always preceded by a conscious period of delay – ranging from 1-12 months. Key factors in seeking healthcare were painful or disfiguring illness and advice from peers. Participants reported recognition of symptoms as possibly HIV-related, based on HIV information from radio, neighbors and relatives. Before accessing HIV services, patients seek healthcare from multiple service providers. Predominantly, primary health care clinics are used first, and hospitals next. Visits are also made to chemists, traditional healers, herbalists and private practitioners. Patients report sequential use – trying another form of healthcare when one has failed – and concurrent use: ‘trying everything’. The last and most enduring service is usually the ART clinic, and use of alternative healthcare subsides markedly after ART initiation. Patients exercise their right to choose based on experiences and outcomes of encounter with the different service points. They seek alternative healthcare when they feel that their needs are not being met. Goals in seeking healthcare are to feel better, be informed and inspired. Patients want to survive, function and to be able to provide for their families. Patients expect clear explanations, effective intervention, and loving care. They anticipate clear communication about future plans in order to sustain hope and motivation. Major problems arise when these expectations are not met. Despite high unemployment and dependence on state grants, patients will seek private or traditional healthcare when state services are considered ineffective or unsympathetic.
Discussion: Rollout of ART services is vital, but it is not enough. Rural HIV patients, despite extreme poverty, are seeking alternative forms of healthcare. Before ART initiation, use of multiple services is often related to denial of HIV-status or lack of HIV knowledge. Once on ART, patients are less likely to use traditional healers or herbalists, due to the extensive preparation for initiation and support for ART adherence. But patients will still seek other services when they feel that ART services are not meeting their needs. Lack of concrete HIV/AIDS awareness delays access to VCT and ART services. There is a need to publicly disseminate specific HIV messages targeted at rural populations, encouraging uptake of VCT. Families and peers of rural HIV/ART patients have tremendous influence on uptake and outcomes of therapy, and it is crucial that they themselves possess correct information. To relieve the already over-burdened health system, it is essential that Rural Health systems develop more effective linkages between formal and non-formal health services. This has the potential to improve HIV/AIDS case identification and patient mobilization for care.
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