Abstract #46  -  The witch is dying too - The changing role of traditional healing in the times of antiretrovirals. A qualitative exploration in Kisesa, Tanzania
Authors:   Presenting Author:   Mr Benjamin Nhandi - National Institute For Medical Research
Additional Authors:  Mr Mark Urassa, Mr Benjamin Nhandi, Mrs Joanna Busza, Mrs Basia Zaba, Mr Jim Todd,
Aim: The role of traditional healers (THs) as providers of health services in Sub-Saharan Africa has been well documented. Less attention has received the impact of antiretroviral treatment (ART) availability on community’s perceptions of traditional healing. This study investigates community leaders’ and ART users’ opinions of THs three years after ART started to be available in a semi-rural Tanzanian ward.
Method / Issue: Qualitative tools were used including 86 semi-structured interviews with community leaders and ART users plus 5 group activities with members of Village Aids Committees. Content analysis was conducted with the aid of the software package NVIVO7.
Results / Comments: THs were entrusted to effectively treat a variety of afflictions including epilepsy, hookworms, infertility, malnutrition, mental problems and sexually transmitted diseases. Many villagers believed that AIDS symptoms were caused by witchcraft and that THs could provide effective treatment. In addition to “old” Aids-like diseases like “kondela” and “mpanga uche”, references were made to “a new medicine that the witches have just discovered” which “accelerates the speed of AIDS” or “makes you look as if you have AIDS”. A few respondents mentioned that a person could be affected simultaneously by both “real” AIDS (“ukumwi”) and witchcraft (“they may add you a traditional disease”). The use of THs was generalised and their positive role widely acknowledged but they were viewed as a very heterogeneous group. While some were respected villagers well knowledgeable about the use of curative herbs, among those performing divination (“ramli”) some were categorised as “cheaters” who “just pretend” and do “guess work”. Those claiming to cure HIV were frequently accused of delaying ART initiation and causing “deaths for money”. The practice of incisions and promotion of extramarital and intergenerational sex as a mean to treat HIV, infertility or attract fortune was also criticised. Growing tensions within families and neighbourhoods resulting from witchcraft accusations were also severely judged: “nowadays they butcher a witch with machetes. The major source behind this is THs”, “once they know the witches they kill them”. ART users - who had often used THs extensively before initiating treatment - were particularly critical and as the healer’s inability to provide long lasting treatment for HIV became growingly apparent, doubts about their effectiveness started to emerge in the wider community: “I am surprised, even the person suspected of being a witch is dying too”. While some THs insisted that they “never failed to treat a patient” others referred persons presenting HIV symptoms to health facilities. A greater involvement of THs in the local response to HIV was deemed as essential by most respondents who positively valued their capability to gather many people and offer holistic counselling.
Discussion: As ART have became more widely available the inability of THs to treat HIV symptoms is becoming increasingly evident. While opportunities of collaboration between the traditional and modern health sector exist, these are challenged by the recent ban of TH’s activities in the country. A better understanding of the wide heterogeneity of the traditional healing sector would be useful to inform policy development.
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