HIV/AIDS and Traditional Medicine

 Overview of HIV/AIDS (Stats)

Stacey Links PhD Researcher Receptor Approach

The HIV/AIDS pandemic, which broke out during the early 1980s has become an issue that has gained increased attention in all fields within a short amount of time.  The explosion of cases of the virus has had enormous effects not only medically speaking, but additionally across legal, social and particularly economic aspects of society.  To give a brief overview of the degree of the pandemic and its enormity: In 2011, there were approximately 34 million people living with HIV/AIDS worldwide. With this, Sub-Saharan Africa (Hereafter SSA) has been the worst affected accounting for more than two-thirds of all HIV/AIDS cases while South and South East Asia come in as the second most affected region.  In 2010, 69% of all HIV cases were in SSA, while 66% of all deaths related to HIV/AIDS were from SSA.  Globally speaking, South Africa is home to the largest population with HIV/AIDS.  To give some insight into the gravity of the problem by way of comparison, in South and South-East Asia in 2011 there were approximately 5million people recorded as living with HIV/AIDS.  South Africa, as a single country alone has 5.9million people living with HIV/AIDS.  This is of course merely a statistical insight into the enormity of the problem but nevertheless concisely indicates the gravity and depth of the pandemic.

HIV/AIDS as a virus is of course not geographically contained nor does it solely affect the developing world.  With that being said, there nevertheless exists a clear divergence in factors present in the developed and developing world.  These factors have affected the virus’s growth and path of development in distinct ways within these two regions. 

What has remained problematic in the developing world, however, are the discrepancies between the public and private domains regarding discussions on HIV/AIDS. In SSA the issue of HIV/AIDS has been relatively visible in the public sphere.  Publically speaking, by way of the dissemination of information, campaigns, rallies, and overall visibility, the issue of HIV/AIDS has been seemingly, albeit surprising to some, at the forefront of medical and social debate.  In the private sphere however, a very different story unfolds.  It is here in the private sphere that the ills and dangers of stigmatization and secrecy emerge. This stigma exists in a variety of forms, and is useful to deal with as a distinct phenomenon in its existence and functioning within society.  But first I will briefly lay out the issues surrounding traditional medicine and conventional biomedicine before getting to the issue of stigmatization. 

Traditional Medicine (TM) versus Medical Practitioners (MPs)

The issue of healthcare and support is of course critical in all societies and relates directly to the issue of HIV/AIDS.  Over time societies have developed unique and sociocultural relevant strategies to assist their populations with issues concerning health care.  In these developments it has been apparent that sociocultural frameworks relevant to each society are key in the development and sustainability of long-lasting and thorough health care systems.  African societies, like many other developed and developing societies, in this respect also had and still have their own uniquely embedded health care systems in the form of traditional medicinal practices.  Perhaps these systems were not formally codified in the way in which they were in other societies, however this does not assume that we can discount the existence and influence, which these systems had and still have on contemporary society and practices.  These systems existed in pre-colonial times, and have persisted well into the post-colonial era.  As is seen in the developing world, especially Africa and China, these societies make up the largest market for traditional medicine, be that in the form of selling, producing or consuming such traditional medicines.  Nevertheless, despite the use of such traditional systems by an estimated 70-95% of citizens in the developing world, as with many developing societies, the turn to a liberal, democratic trajectory for development and change has unfortunately neglected these traditional mechanisms as being worthy of constituting central importance to national or even regional health care strategies.  This has in many cases resulted in the privileging of modern health care systems at the expense of locally embedded and culturally legitimate systems.[1]  As a result, traditional medicinal practices have suffered from very little attention, recognition and thus development. In the context of the HIV/AIDS pandemic it has resulted in severe consequences for both those suffering from the disease as well as the broader society at large. 

The dismissal or non-recognition of these traditional mechanisms presents a grave danger particularly in cases such as South Africa for example, where 80% of the population relies on traditional medicine and the statistics of traditional healers versus biomedical doctors is 200,000 compared to 25,000 (or 8:1).  This is a significant portion of the population that in first instance relies on traditional mechanisms.  The reasons for this heavy reliance on traditional mechanisms are multifold.  On the one hand the heavy reliance relates to their accessibility vis a vis biomedical services.  This accessibility concerns both monetary accessibility and logistical, and/or physical accessibility.   On the other hand people tend to be culturally driven, and subsequently feel more comfortable adhering to traditional health mechanisms.  Additionally, these mechanisms tend to be perceived as far more holistic and all encompassing as opposed to their ‘clinical’ biomedical counterparts and are thus preferred - as they perform not only a medical role but also a social role.  It has been noted that, “The economic and time considerations of modern medical healthcare delivery often limit doctors’ capacity to address the spiritual and emotional needs of their patients.”[2] In this sense traditional healers go beyond strictly treating the medical, and additionally include methods, which connect both on collective and individual levels, moving outside of the framework of clinical consultations. 

Problematic in the African landscape in particular with regards to Traditional Medical Systems is that unlike in China where a relatively standardized and unified system has emerged, in the form of TCM (Traditional Chinese Medicine) the African case hosts a multitude of systems, which are not necessarily coordinated, unified or monitored.  This is a massive challenge for the African case and will have to be carefully explored to achieve any type of cohesive or appropriate approach.   The heterogeneity of these cases must be a major consideration in any approach that is developed.  Additionally, the limitations of traditional mechanisms, just as the limitations and shortcomings of biomedical systems, cannot be ignored.  This is pivotal to underscore, particularly in life-threatening instances such as HIV/AIDS. 

Cultural Assumptions and Divergences in the Debate

The issues surrounding HIV/AIDS in the case of SSA have in many ways been overshadowed by sociocultural aspects and have thus not solely been limited to the more logistical questions of access to medicine.  A concerning development has been that sociocultural aspects with regards to HIV/AIDS and Africa have been identified as being responsible for the rapid spread of the disease.  Here it would be worthwhile to briefly touch on what is meant by these sociocultural aspects.  Generally these aspects are seen to be practices which are culturally grounded and particular to African society.  By highlighting the cultural specificities as the ‘culprits’ what has resulted (in my opinion unjustly so) is the placing of blame (of the rate of spread and infection in Africa) specifically on local cultural elements.  In this framework local culture becomes an easy target, or scapegoat to pinpoint HIV/AIDS exacerbation on.  Simultaneously this plays into broader discourses of the ‘local’ as diametrically opposed to the more ‘insightful’ or ‘developed’ Western approaches.  Framing the debates of HIV/AIDS and more generally access to medicine in this way has resulted in local customs and other traditional methods of healing being seen as not only being counter-intuitive for society, but also assumed to be intrinsically detrimental toward society’s development and progression. 

Problematic too is that “the cultural practices which are seen as barriers to AIDS prevention are completely decontextualized and their importance for people’s identities is overlooked.” This de-contextualization of practices has left them in many cases misunderstood and singled out as being the cause for or hindrance to the development of solutions for the epidemic when in fact the closer inspection of these practices could unveil significant existing embedded support systems which could greatly help in addressing many of the issues related to HIV/AIDS.

Myth Creation as a Hurdle to HIV/AIDS and Consequence of Stigmatization

As we know, there of course have been scientific and medical advancements with regards to ARVs and improved access to therapy, however in spite of this, the issue of HIV/AIDS remains a very real problem for many and affects millions of lives daily.   A large part of the problem however is not only related to access to medicine, but also the perpetuation of myth and stigmatization related to the disease.  These myths relate to both the methods of contraction and cures for the disease.  One such widely cited myth in South Africa for example is that having sexual intercourse with a virgin is a cure for the infected person.  Such myths are pursued and seen as tangible and viable options for many, not necessarily because of a lack of information, but largely because of the desperation, no doubt, that stigmatization of those living with the disease brings. 

Stigmatization thus occurs on a number of levels, particularly in the private sphere, and as a result perpetuates the practice of seeking out ‘quick’ fix solutions.  Particularly dangerous then, is the coupling of stigmatization with a lack of access to medicine, such as the necessary ARV therapy.  This combination of factors eliminates the possibility of leading a ‘normal’ and unhindered life in broader society and discredits it as a viable option.  

It has also resulted in the disease virtually becoming ‘fatal’ in developing countries, when in fact medically speaking, it need not be.     Universal access to prevention, treatment, care and support are therefore largely conglomerated at the center of the problem with myth creation as a coping mechanism for infected individuals as well as society and stigmatization as both a defense mechanism, enabling uninfected members of society to distance themselves from the problem and an effect multiplier (exacerbating) to the problem.  Assuming socio-cultural aspects as the perpetrators in the fight against HIV/AIDS is therefore false. The focus of our efforts should instead be on issues relating to access to medicine, myth creation and stigmatization as an effect multiplier.  In this light, traditional social institutions such as traditional medical systems can be vehicles through which issues of myth creation and stigmatization are not only understood but also addressed in order to promote sustainable and helpful practices. 

Academic Discourse and the voice of the ‘South’

The divergence in medical approaches in the ‘West’ versus the global ‘South’, or Traditional Systems of Medicine versus Conventional Biomedical Systems do not stop here.  This divergence, one could say, plays into or is part of a broader and more fundamental divergence between North vs South discourses.  The specific case of HIV/AIDS and traditional medicine versus biomedical systems are but a few in a host of other issues which form part of a greater debate and that is the West versus the Rest discussion which is also embedded in academic frameworks. 

These relatively unknown insights and perspectives that stem from non-western realities need to be incorporated into academic discourse, particularly in contentious fields such as international human rights.  It is necessary and critical that we open up discourse and allow for varied perspectives in order to best inform our approaches and sensitivities particularly with regards to such delicate issues. 

The example discussed here today of Traditional Healthcare Mechanisms reflects the urgent need for a more critical approach to issues not only of health and security but also in the broader discussion of International Human Rights.  Recognition of the sometimes skewed and unbalanced information and viewpoints which one-sided research has espoused should alert us to the potential dire consequences and costs of such approaches - such as that seen in the case of Traditional Medicine and HIV/AIDS which we have briefly reviewed.  Unfortunately the majority of work has, up to this point, in its dominance, only explained or accounted for a few limited realities.  Bridging this divide is therefore crucial and should be prioritized in deepening our insights about each other’s societies. More importantly, however, should be the focus on creating sustainable and culturally appropriate solutions, which place the dignity of people at its core. 

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[1] Soai, Malefetsane. 2013. “Medical Practitioner versus Traditional Healers: Implications for HIV & AIDS Policy.”

[2] Liverpool et al

Guest Post by Stacey Links (Stacey is a PhD Researcher on the Receptor Approach at the School of Human Rights Research, Utrecht) (This is an excerpt which forms part of a larger research paper on the topic of traditional medicine and HIV/AIDS stigma in Africa and China)