Health Officials Look to Traditional Healers to Fight HIV/AIDS Among African Populations

About 80% of sub-Saharan Africans turn to traditional healers for medical help and advice, and a number of health officials and agencies are pushing for the integration of these healers into HIV/AIDS prevention and treatment efforts, Lingua Franca reports. Medical anthropologists generally divide traditional healers into two main categories -- herbalists and diviner-mediums, who work with the spiritual and mystical sides of healing. About two million traditional healers currently practice in Africa, and in some countries they outnumber "Western-style" medical practitioners by about 40 to one. Edward Green, an independent anthropologist and author of the 1994 book, "AIDS and STDs in Africa: Bridging the Gap Between Traditional Healing and Modern Medicine," has cited research that shows that although many Africans rely on doctors and hospitals to treat illness, most believe that traditional healers are "better than doctors" at curing STDs because their treatment examines both the spiritual and physical health of the patient. Many healers and their patients feel that spiritual health is "very important" when dealing with a terminal illness such as HIV. As a result, a number of healers are turning their attention to HIV/AIDS, and some say they have found plants that act as "natural antiretroviral[s]" to help slow or halt the onset of AIDS. For example, Dr. Kokou Coco Toudji-Bandje, "one of the best known" herbal healers in Africa, said that a remedy he calls Tobacoak's can "destro[y] HIV in the blood." Toudji-Bandje said that over the past decade, he has used Tobacoak's to treat over 3,000 people with HIV, and that "most" of these individuals have "gotten better," while others "have been completely cured."

More Collaboration Needed
Non-governmental organizations like the World Health Organization have supported collaboration between Western medical practitioners and traditional healers like Toudji-Bandje since the 1970s. Supporters of such interaction say that it is needed for a variety of reasons, including the "crippling" lack of doctors and nurses in developing nations and the belief that Western medical practices should not be "privileg[ed]" over indigenous, traditional healing knowledge. Green said that doctors and health educators should regard traditional healers as "an untapped resource," and in 1992 he established a program in South Africa to train 30 healers in HIV prevention. The program aimed to establish a chain of communication between healers, with each of the 30 participants later training 30 additional people, and so on. The training sessions described HIV in terms that were "culturally meaningful" and urged the healers to promote condom use to their patients. At the end of the program, Green found that healers' knowledge of HIV/AIDS had "significantly increased," they were willing to distribute condoms to their patients and they were "eager" to counsel patients about sexual promiscuity and safe sex. Another program, launched by a medical anthropologist working with Medecins Sans Frontieres, provided "intensiv[e]" training to traditional healers in Uganda. Later evaluations found that the rate of condom use in areas where the program had been active was 50%, compared to 17% in places without the program.

Skepticism
Many doctors who practice Western-style medicine express "frustration" with traditional healers and programs that aim to incorporate them into mainstream medical treatment practices. Collaborative programs between Western and traditional healers in Botswana, Malawi, Mozambique, Tanzania and Zambia have not succeeded in lowering these countries' HIV transmission rates, and some health officials have attributed this to the failure of healers to convince their patients to alter their sexual behavior. Some researchers say that local beliefs in witchcraft, sorcery and black magic have helped spread the opinion that HIV/AIDS is caused by an "enemy" who wishes ill upon a person. Such "personalistic" theories of disease, researchers say, have resulted in many people failing to change their sexual behaviors because they feel that HIV is caused by an external power. Although some healers believe HIV/AIDS can be caused by witchcraft, most healers are increasingly subscribing to the belief that disease is caused by "environmental factors," such as small insects or "impure" body fluids, rather than the "malign will of another human being or a deity." In addition, medical officials say that healers do not put the knowledge they gain in collaborative sessions with Western doctors into practice. Peter Ventevogel, a Dutch medical student who conducted research on healer training, said, "The healers don't write their knowledge down and systematically compare it with each other. The terms and beliefs differ in every village ... even in the same village. ... I respect traditional healers, but you can't just mix Western scientific medicine and traditional healers in a soup and expect to get something that makes any sense." Green said that he has found the contrary to be true, that healers "are eager to learn about Western medical ideas" and incorporate this learning into practice. However, most medical experts agree that training traditional healers to deal with HIV/AIDS is "no panacea," and that community-based prevention efforts, HIV testing programs and a "firm political commitment to stopping AIDS" are equally important to lower the spread of the disease (Steinglass, Lingua Franca, April 2001).

Integrating Healers Difficult in South Africa
Although traditional healers provide a "generally efficacious, cheap, individualized and culturally appropriate" method of treating illness and dispensing medical advice to people in sub-Saharan Africa, traditional healing in South Africa remains "marginzalized, poorly regulated and unsubsidized," the Lancet reports. Many health officials believe that the practice of traditional healing "is actually bearing the brunt of HIV/AIDS care and support in Africa," and that healers "have already proven beneficial in spreading HIV prevention messages" because they "fit the psychology" of the people they treat. However, the South African government has given "little obvious attention" to such healers, and enthusiasm for a traditional healers council "seems to have waned," the Lancet reports. In Nigeria, however, the National Institute for Pharmaceutical Research and Development and WHO have teamed up to launch a pilot trial examining the benefits of unwele, an herbal immunomodulator that "has proven anticachexia (anti-weight loss) and anti-HIV actions." While countries such as Nigeria and Ghana are moving to "fast track" the integration of traditional practices into mainstream health care, South Africa is making "slow progress." The South African Medicines Control Council will only be able to review the data from the Nigeria study after its African Traditional Medicines Committee is operational. "[C]onflicting agendas" are partly to blame for this delay, with South Africa's Health Ministry trying to eradicate "unsafe practices and toxic phytomedicines" on the one hand and healers fearing that regulation will bring "restriction without recognition of their skills and protection of their rights" on the other. But the "greatest barrier" to integration of Western-style and traditional practices is the "attitude of allopathic health care workers," who, according to the Global Initiative for Traditional Systems' Gerald Bodecker, need to realize that "technology is not the exclusive property of industrialized societies" (Morris, Lancet, 4/14).