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Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa

Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa
Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa

OBJECTIVES: There are concerns that medical pluralism may delay patients' progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade.

METHODS: We conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa. We interviewed 258 PLHIV at different stages of the HIV cascade-of-care, 48 family members of deceased PLHIV and 53 HIV healthcare workers. Interviews were conducted using shared standardised topic guides, and data managed through NVIVO 8/10/11. We conducted a thematic analysis of healthcare pathways and bottlenecks related to medical pluralism.

RESULTS: Medical pluralism, manifesting across traditional, faith-based and biomedical health-worlds, contributed to the care cascade bottlenecks for PLHIV through three pathways of impact. First, access to HIV treatment was delayed through the nature of health-related beliefs, knowledge and patient journeys. Second, HIV treatment was interrupted by availability of alternative options, perceived failed treatment and exploitation of PLHIV by opportunistic traders and healers. Lastly, the mixing of biomedical healthcare providers and treatment with traditional and faith-based options fuelled tensions driven by fear of drug-to-drug interactions and mistrust between providers operating in different health-worlds.

CONCLUSION: Medical pluralism contributes to delays and interruptions of care along the HIV cascade, and mistrust between health providers. Region-wide interventions and policies are urgently needed in sub-Saharan Africa to minimise potential harm and consequences of medical pluralism for PLHIV. The role of sociocultural beliefs in mediating bottlenecks necessitate adoption of culture-sensitive approaches intervention designs and policy reforms appropriate to the context of sub-Saharan Africa.

Journal Article
1368-4973
Moshabela, Mosa
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Bukenya, Dominic
cfe08bb0-b75b-4d17-94c4-f90309e40e34
Darong, Gabriel
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Wamoyi, Joyce
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McLean, Estelle
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Skovdal, Morten
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Ddaaki, William
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Ondeng'e, Kenneth
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Bonnington, Oliver
dba93617-8517-404e-9a51-ba2674b1edfc
Seeley, Janet
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Hosegood, Victoria
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Wringe, Alison
616301a6-4d77-4067-acd9-4eecfc6e47ac
Moshabela, Mosa
c33cf920-3319-4aab-a3ee-1e09291afaa1
Bukenya, Dominic
cfe08bb0-b75b-4d17-94c4-f90309e40e34
Darong, Gabriel
afe913a3-04e0-4d21-b1da-4a85f78b3cfd
Wamoyi, Joyce
09e1331b-bbc3-4e34-ae4d-dd21cb41c76d
McLean, Estelle
d26a1af6-e8d1-41dc-a72d-5518c6550592
Skovdal, Morten
2a44be7e-5a06-432e-a4d6-feb57b74bf9c
Ddaaki, William
57246cbf-1dc8-45f6-9131-2c1c3572c70d
Ondeng'e, Kenneth
a5c161d7-1e76-40a2-96c3-d133c3a4e013
Bonnington, Oliver
dba93617-8517-404e-9a51-ba2674b1edfc
Seeley, Janet
d054fcce-891e-492e-855e-ccdb122dc120
Hosegood, Victoria
c59a89d5-5edc-42dd-b282-f44458fd2993
Wringe, Alison
616301a6-4d77-4067-acd9-4eecfc6e47ac

Moshabela, Mosa, Bukenya, Dominic, Darong, Gabriel, Wamoyi, Joyce, McLean, Estelle, Skovdal, Morten, Ddaaki, William, Ondeng'e, Kenneth, Bonnington, Oliver, Seeley, Janet, Hosegood, Victoria and Wringe, Alison (2017) Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa. Sexually Transmitted Infections, 93 (Suppl 3), [e052974]. (doi:10.1136/sextrans-2016-052974).

Record type: Article

Abstract

OBJECTIVES: There are concerns that medical pluralism may delay patients' progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade.

METHODS: We conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa. We interviewed 258 PLHIV at different stages of the HIV cascade-of-care, 48 family members of deceased PLHIV and 53 HIV healthcare workers. Interviews were conducted using shared standardised topic guides, and data managed through NVIVO 8/10/11. We conducted a thematic analysis of healthcare pathways and bottlenecks related to medical pluralism.

RESULTS: Medical pluralism, manifesting across traditional, faith-based and biomedical health-worlds, contributed to the care cascade bottlenecks for PLHIV through three pathways of impact. First, access to HIV treatment was delayed through the nature of health-related beliefs, knowledge and patient journeys. Second, HIV treatment was interrupted by availability of alternative options, perceived failed treatment and exploitation of PLHIV by opportunistic traders and healers. Lastly, the mixing of biomedical healthcare providers and treatment with traditional and faith-based options fuelled tensions driven by fear of drug-to-drug interactions and mistrust between providers operating in different health-worlds.

CONCLUSION: Medical pluralism contributes to delays and interruptions of care along the HIV cascade, and mistrust between health providers. Region-wide interventions and policies are urgently needed in sub-Saharan Africa to minimise potential harm and consequences of medical pluralism for PLHIV. The role of sociocultural beliefs in mediating bottlenecks necessitate adoption of culture-sensitive approaches intervention designs and policy reforms appropriate to the context of sub-Saharan Africa.

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More information

Accepted/In Press date: 6 May 2017
e-pub ahead of print date: 23 July 2017
Published date: July 2017
Additional Information: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Keywords: Journal Article

Identifiers

Local EPrints ID: 413991
URI: http://eprints.soton.ac.uk/id/eprint/413991
ISSN: 1368-4973
PURE UUID: 186447ea-b0eb-483d-b131-de224c1120b2
ORCID for Victoria Hosegood: ORCID iD orcid.org/0000-0002-2244-2518

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Date deposited: 12 Sep 2017 16:31
Last modified: 17 Dec 2019 01:40

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