South Africa has recently had a significant increase of HIV positive patients enrolled on anti-retroviral treatment (ART). In 2009, almost 90,000 children and 840,000 adults were enrolled in the public sector ART programme . By 2011, ART was extended to 650,000 more people, increasing the total number on treatment to almost 1.6 million. The National Strategic Plan on HIV, STIs and TB (2012–2016) aims to have at least 80% of a total of 5.3 million HIV infected individuals on ART . The burden of disease associated with untreated HIV and AIDS is significant and is particularly felt at rural bio-medical health facilities due to Human Resources for Health (HRH) shortages .
South Africa’s ratio of doctors per population is 50:100,000. The minimum requirement for a middle income country like South Africa is 180:100,000 according to World Health Organization (WHO) guidelines . In South Africa it is estimated that of all doctor graduates, only about 3% end up working in rural areas . With 40% of the population living in rural areas, HRH in rural bio-medical facilities are overburdened due to understaffing and the burden falls mainly onto nurses. This has negative implications; specifically, on the quality of HIV and AIDS services. Such challenges have prompted this research which aims to determine whether traditional healers (THs) are in a position to assist in HIV prevention and treatment services.
The ratio of THs is double (five per 1000) than that of bio-medical health care workers (2.3 per 1000) to the population in Africa . In a context of an increasing burden of disease within South Africa and the subsequent HIV-related burden on public health facilities [4–6], THs, could potentially be utilised to alleviate this strain. Research indicates that mortality rates remain high amongst HIV positive individuals due to late initiation on treatment programmes . Patients simply are not presenting themselves early enough to be initiated on treatment, especially in rural areas . THs, who often are the initial health system contact for HIV patients, could refer them to the public sector treatment programme sooner, which could subsequently reduce morbidity rates.
Historically, the reliance on THs for health care has long been a norm amongst Black African people in sub-Saharan Africa. Data suggests that 80% of the Black African population consult THs for most of their health care needs [7–9]. The motivation behind the high rates of usage results from the focus on holistic healing offered by THs . Holistic healing incorporates the healing of the mind, body, soul and restoration of harmony between the elements comprising the hierarchy of beings, the living and the living dead [8, 11]. THs understand that an individual is relational, implying that “for good health, [the] individual and community must always be conscious of the symbiotic relationships between the living and the ancestors” .
Most Black Africans consult THs and bio-medical practitioners concurrently [9, 10]. THs costs are usually much lower than bio-medical treatment . Regardless, “most Africans know that African priests, …… political leaders, kings, chiefs and even presidents all occasionally consult a traditional doctor at critical times in their lives” . THs have always been held in high esteem in African communities, due to their proximity to the community especially those in rural areas . In contrast, the bio-medical health system is often difficult to access, due to the distance to the nearest facility and the associated costs of getting there [12, 13]. Therefore, in the context of a lack of easily accessible bio-medical health facilities, high costs of transportation to these facilities and high rates of bio-medical staff attrition particularly in rural areas, THs could be used to assist in the HIV prevention and treatment effort.
It has been documented that over 60% of patients that THs attend to, have STIs and HIV and AIDS [13, 14]. However, THs are seen by many in the bio-medical system as unfit to assist in the correct diagnosis of symptoms and prevention and treatment of HIV and AIDS . Nurses were not willing to formally refer patients to THs whilst it was found that THs were open to referrals to public health facilities . This resistance by bio-medical practitioners to collaborate has been attributed to differences in paradigms , the unscientific nature of methods used by THs, their unsystematic management of the healing process, and an unwillingness of THs to share their knowledge . The stasis of bio-medical practitioners unwillingness to incorporate THs is concerning considering the increased burden of disease faced by health systems in Africa in the presence of the HIV epidemic.
In light of this situation, this paper attempts to answer the question as to whether THs are a suitable human resource to assist in the scaling up of HIV prevention and treatment services in South Africa. This involved assessing a sample of THs on their knowledge around effective HIV and AIDS prevention, diagnosis and treatment of symptoms and their willingness to interact with the bio-medical system.