Aug 31 2010
Using Traditional Healers to Treat AIDS in Africa
There is an AIDS epidemic in Africa, and efforts to fight it are hampered by the endemic social problems of that continent. Chief among them are the lack of sufficient modern health resources, the spread of destructive rumors and myths about HIV/AIDS, and even the persistence of HIV denial in Africa (although this last factor is better than in the past).
The World Health Organization (WHO) and the International HIV/AIDS Alliance are teaming up with the Traditional Health Practitioners Association of Zambia (THPAZ) to address the first problem – the lack of health services. Most Zambians use traditional healers for primary health care. The WHO has therefore decided to utilize traditional healers in the fight against AIDS. There are interesting pros and cons to this policy, but it must first be recognized that there is no ideal solution to the problem. The resources to provide optimal modern health care to treat and prevent HIV/AIDS (which would need to include a massive education program) in Zambia and the rest of Africa simply do not exist. One might argue that the world should provide those resources, but let’s put that issue aside and focus on what to do in the meantime.
The arguments given in favor of this WHO strategy are:
Traditional healers far outnumber biomedical workers in the rural areas.
They are consulted, not only because they are closer and more affordable than their Western-trained counterparts, but also because they are embedded, extensively and firmly, within Ugandan culture.
Traditional healers are highly respected and widely consulted by communities.
In the various articles I read discussing this issue, even those entirely favorable to the idea, conspicuously absent is any mention of whether or not the interventions provided by traditional healers are safe and effective. It’s not even an afterthought – it’s as if it is a non-issue.
However, if we are to focus on the potential benefits of such a policy we could envision a program to train traditional healers essentially to implement a science-based program of counseling and basic health care while also using them to funnel patients to modern health treatments. In addition traditional healers could be trained how not to interfere with modern treatments – for example by not giving herbs that might reduce the effectiveness of anti-HIV drugs. Also they will need to be educated so that they do not spread myths and misconceptions, and in fact so that they can help to counter them. Until such an education program is in full swing, however, the policy of using traditional healers is likely to be counter-productive. As one report notes:
According to the 2006 survey by THPAZ, only 13 percent of the traditional healers in the country had been in contact with modern medical doctors or facilities.
In essence the goal is to use an existing infrastructure of trusted primary care providers (traditional healers) to get them to help the HIV/AIDS program, rather than hinder it. The only alternative strategy would be to replace this infrastructure with a modern science-based medical system – ideal but not realistic. These two strategies are also not mutually exclusive – efforts can be made to maximize the availability of modern health care in the region, while using traditional healers to fill the gap, or at least make sure they are not working against the system.
But there are significant pitfalls to using traditional healers. I have already stated some – most have had no contact with modern medical doctors. By all accounts traditional healers in the region rely upon treatments that are worthless at best, and may even be harmful. There is every likelihood that despite some modern medical education, many traditional methods will be retained.
The biggest pitfall of a partnership is that it will be used as a sign of validation of traditional healing methods, whether or not they are safe and effective. Already there are attempts to validate herbal treatments for HIV/AIDS in Africa. Dr Sekagya Yahaya Hills is a dentist and traditional healer who is promoting herbal remedies as effective in treating HIV/AIDS. Not surprisingly we are seeing the same pattern as elsewhere with the promotion of herbs as drugs – preliminary small studies of poor design being used to justify unlikely treatments. Many herbs are, in fact, drugs but they contain a mixture of chemicals that are not purified, are not quantified, and have unknown bioavailability (as well has half-life and other pharmacological properties). This makes them very poor drugs. The experience in the US is likely to be typical – herbs that seemed promising in preliminary studies have almost all been useless when studied in large well-controlled trials. In addition they have drug-drug interactions and potential side effects and toxicities that were no apparent before being carefully studied.
Treating HIV is very challenging, and it is also a recent plague on humanity. It seems very unlikely that any traditionally used herb would be safe and effective against HIV. Despite the low probability, it is reasonable to test candidate herbs (as long as it is done ethically) but only well-controlled studies should be performed.
What is very likely to happen is that traditional healers, propped up by an alliance with the WHO, will stick to their traditional methods, supported by those like Dr. Sekagya Yahaya Hills, who will use bad science as a rubber stamp to endorse traditional treatments.
It is a real dilemma – a devil’s bargain. It seems necessary and potentially useful to enlist the help of traditional healers, given the realities on the ground in Africa. But the potential to do more harm than good is extreme. The WHO should therefore go into any such collaboration with their eyes wide open, and not naive to the power of cultural belief, the highly sophisticated anti-scientific propaganda of the CAM movement, and the potential for reliance upon bad science. The WHO should therefore focus on regulation, which is an admitted problem:
The other concern is a weak regulation of traditional medicine, leaving people living with HIV open to abuse by unscrupulous healers who promote cures for AIDS or persuade their patients to cease life-prolonging drugs such as the antiretroviral treatment.
Therefore any such partnership should be contingent on careful scientific scrutiny and improved regulations. Otherwise this program will likely become an epic example of the axiom that the road to ruin is paved with good intentions.
8 Responses to “Using Traditional Healers to Treat AIDS in Africa”
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Thanks for covering this Steve, it’s certainly important.
While I agree there are some risks to the WHO’s approach, I think you’re somewhat overstating them. The South African government has been taking a very similar approach for a while now, and it seems to have done some good. Even with SA’s relatively good health system, people *will* still consult traditional healers. It’s not as if they *need* validation from science, since they don’t have a reputation problem. And, given that people will consult these healers anyway, it’s important to at least try to establish a minimum standard of care. Educating healers about, say, the causes and symptoms of AIDS increases the probability of them referring patients who need it to mainstream medicine. (It helps that there is a comprehensive AIDS treatment system in SA).
I am always in favor of practical plans. And when you are looking at culture where traditional medicine is the predominant one, you can’t very well overcome that in a hurry. So trying to use it to your favor, seems worth a try.
I think there will be positive and negative side.
Ideally, those traditional practitioners who agree and become educated will create a ripple effect in the whole culture of more acceptance of modern medicine which will obviously have long term positive effects.
Even in those traditionalists who accept the education – its likely that whatever education they get will be watered down and mixed in with their own beliefs. If you look at the attempts to convert local beliefs to Christianity most of the converted end up making a kind of blended old god/new god religion. That blending might turn out to be more destructive to the actual treatment than not.
I hope it works and since it appears to have been successful in SA it sound like it might be. Also any improvement is better than stagnation.
I think the biggest problem is that HIV is a long term treatment problem. How can you possibly get those treatments going without the infrastructure, I don’t know. If there a vaccination it would be so much simpler. Oh well, no point in wishing for what hasn’t happened yet.
The stigma of AIDS/HIV involves misconceptions in Africa that it is a homosexual disease. The traditional healers need to be taught that the disease as it expresses itself in Africa is a heterosexual disease. Also, the male populace in fear of the disease have been using very young girls for sexual intercourse to avoid it. The result is that the HIV positive males have spread the disease to kids and the next generation.
To clarify, I agree that it seems like they have no choice but to enlist the existing infrastructure of traditional healers. My hope is, however, that they will do so with an eye to the pitfalls rather than being naive to them. They can use regulation and standard of care so that they don’t compromise on the science or even be made to appear as if they are endorsing pseudoscience.
What is almost certainly true is that advocates of traditional interventions will use the relationship with the WHO inappropriately as an endorsement of pseudoscience. That has happened 100% of the time in similar situations in my experience, to the stunned chagrin of the naive regulators.
I have treated patients in both Ethiopia and Uganda as volunteer health worker. In the poor African cultures you are dealing with a problem that goes deeper than the western view of traditional and science based medicine. It is more like trying to teach medieval western Europeans about germ theory. Science in a equal unknown comparable to magic. They do not understand that science has evidence magic does not. For example when treating children for dehydration and cholera mothers would pull IV Catheters out of their children’s arm. They did it because they saw the children that died all had IV’s in them. They took it as a talisman of death. They did not understand that we had limited supplies and only the sickest got that treatment. They felt we were rich white people and had unlimited resources. Until a local tribal medicine man supported the idea that the treatment was to prevent death they would leave them in. So you see they may not accept any HIV treatment without the approval of the tribal medicine leader. There may be no choice but to be at the mercy of local medicine men to have any impact at all. Preventing traditional scam medicine may be impossible. We can’t do it effectively in the west with western educated citizens. In Africa effective treatment means accepting whatever tribal medicine will let you do.
Steve
I wonder if they have tried to get local people who have been helped by HIV medication, involved to present their anecdotal success stories as a way of relating to their peers.
I have just finished “The Fever: How Malaria Has Ruled Humankind for 500,000 Years” by Sonia Shah (strongly recommended).
There’s a similar problem to that of HIV infection with malaria. It’s difficult to motivate rural populations to take preventative measures to avoid contracting malaria, when the link between being bitten by mosquitos and the onset of malaria isn’t obvious, and more obvious links, coincidental or not, such as over-exertion the day before an attack, may have occurred.
Rural populations usually use traditional healers first when aid is sought, not because it’s cheaper, but because it is more accessible, with healers being in the same village, and the nearest clinic might be 50 or 60 km away, requiring considerable motivation for a parent (if it’s a child who is sick) to seek medical treatment, with the parents lacking even the most basic forms of transport. Medical treatment often is at too late a stage, which doesn’t help other parents to seek treatment for their children when needed.
At least malaria has the advantage that it’s a disease that can be managed in the short term with drugs. Treatment of HIV infection has the disadvantage that treatment is long-term, and if treated early, the patient doesn’t have symptoms.
There may be some hope for this project. I did some online searching and came up with this information which I also posted under the same article on SBM.
Evidently, THPAZ may be a cooperative partner in this effort.
They have already condemned some traditional practices that are ineffective and might contribute to the spread of HIV/AIDS.
http://cc.bingj.com/cache.aspx?q=THPAZ&d=4990172301821417&mkt=en-US&setlang=en-US&w=a7c16ba5,f82867c1
They are also one of the partner organizations that the International HIV/AIDS Alliance is already working with in Zambia through the Antiretroval Community Education and Referral Project (ACER).
http://pdf.usaid.gov/pdf_docs/PNADL431.pdf
Also, I have an aunt who worked as a medical professional at Mukinge Hospital in northwestern Zambia for many years training nurses. That hospital has already been involved in a pilot project to educate people in preventive measures and provide ARV therapy.
Since she just got back from a visit to Zambia, I am attempting to elicit a current on-the-ground report from her.