http://www.healaids.

com/

HEAL was founded in 1982 and our sole purpose at that time was to provide
information and support for alternative and holistic approaches to "AIDS" and
related conditions.

As a result of our years of direct experience however, we have also come to

discover that so far as "AIDS" goes, we have been subject to the most heinous and
genocidal fraud in medical history. And that to escape it, one must view not only
"AIDS", but all health and healthcare within an entirely different, life-affirming and
self-empowering perspective. Making this life-saving information available has since
become our primary goal, and this website is one result of our efforts.

"AIDS" is not a death sentence. Due to the 1993 definition, a distinction must be
made between the 50% of "AIDS" cases where people are actually sick, and the
50% who are not. (Just being HIV+ and having low T-cells is not necessarily a sign of
illness, let alone serious illness, although many of these people are eventually made
sick by the toxic treatments they are given unnecessarily.) Imagine the greater
number of recoveries if, instead of being scared to death, people were encouraged
to both expect their natural birth right - health - and to utilize safe, effective, holistic
treatments as a means to it.

Testing positive to "HIV" antibodies is even more misleading because all positive
tests are likely to be false positives. The June 1993 issue of the prestigious journal
Bio/Technology published a review declaring the test to be scientifically invalid.
Additionally, seropositive people do not necessarily develop "AIDS" and
seronegative people may nonetheless develop "AIDS".

"AIDS" is a multifactorial problem; it is defined by the Centers for Disease Control as

28 old diseases in the presence of "antibodies to HIV". The truth is that histories of
medical and "recreational" drug abuse, chronic infections, chronically poor nutrition,
environmental poisoning and intense, chronic stress are each sufficient in and of
themselves to cause "immune deficiencies" and serious, life-threatening conditions.
These "risk factors" are the real factors to address and, when honestly assessed and
addressed, can lead to recoveries.
At worst, an HIV positive test result is a wake-up call, not a death sentence. If there
actually is a true "positive" test result, it may indicate a high degree of "antigenic
stress", i.e., an individual may have a considerable amount of foreign proteins and
substances in their system.

The information on this website can assist you in taking steps toward creating for
yourself some sort of physical/ emotional/ psychospiritual detoxification which, in
addition to rebuilding your health, can help to considerably reduce the toxin load,
thereby undermining the likelihood of any future health complications.

If you are not in this category, the information here can still assist you in simply
maintaining your health, and restoring it if ever you have any of the more
"common" health challenges to deal with. Keep in mind that most of today's serious
illnesses can be prevented simply by addressing minor illnesses with non-toxic and
natural approaches in the first place.

Along with the modern "plagues" of pollution, love deprivation, malnutrition and a
lack of sanitation, the chronic use of modern medicine may well be a major
chemical cause of many of the degenerative conditions associated with the 20th
century.

If you already have "AIDS", that is, if you have the physical clinical symptoms
associated with what they call "AIDS", here too there are numerous approaches to
detoxification, many listed and discussed here, that can help you turn your situation
around. It takes time and energy to do it, but many have come to HEAL meetings
with "AIDS" related symptoms and have completely reversed their condition and
regained their health, evidenced not only by subjective feelings but by clinical and
laboratory results.

They have done this largely through an alternative and holistic approach which
precludes the use of toxic, immunosuppressive drugs, but which includes physical,
emotional, psychological and spiritual efforts. The best therapies in the world are
meaningless if not applied within the over-all context of eliminating toxicities and
deficiencies from the way we satisfy our basic human needs for love, sexual love,
nourishing foodstuffs, full-bodied rest, shelter, and a sense of accomplishment. And
fulfillment of these needs falls right in the realm of our own self-responsibility.
The "treatment" information which is provided here is meant to be an overview: to
give you an idea of ways to bolster the "immune system", to help inhibit pathogenic
activity in the body, and to enhance your overall health and well-being with
methods that are non-toxic and have few or no side effects. While HEAL does not
officially endorse or promote anything, we feel that if you take your time, study the
available information and listen to your own intuition, you will be able to make the
right choices and pursue the right course.

Some of the alternative and holistic approaches we have investigated include

acupuncture, Chinese and western herbology, nutritional therapy and
supplementation, chiropractic, hypnotherapy, homeopathy, Ayurvedic medicine,
Natural Hygiene, low-frequency magnetic energy, macrobiotics, water therapies,
meditation and visualization, uropathy, body work, the typhoid vaccine protocol, AL
721, oxygen therapies, chelation therapy, "Homeopathic Immuno-Therapy" (HIT),
syphilis link, etc.

In choosing healthcare practitioners, we urge you to use great caution. If someone

assumes, explicitly or implicitly, that you have an unsolvable and "always fatal"
problem, they will not help you. Treat all practitioners as your advisors, not as
authorities who will supply you with "the answer". Most doctors are much too busy
and have much too much invested in their medical belief systems to be learning
about the many alternative and effective things that people are doing for
themselves. Utilize their expertise, but do not count on them to heal you. You must
learn to count on yourself!

Your greatest help will come from personal responsibility and self-empowerment.

Educate yourself, educate yourself, educate yourself. This, coupled with an

approach to life which actively recognizes that health and healing are an expression
of working with nature rather than against it, will enable you to access the practical
tools, both within you and without you, that are essential to restoring and/or
maintaining a productive and meaningful life, health and happiness.
Weeks after scientists said they were able to effectively rid a child of the HIV she
was born with, another 14 people have been revealed to be "functionally cured" of
the virus.

The 14 patients received antiretroviral treatment within 10 weeks of infection. Asier

Sez-Cirin of the Institute Pasteur in Paris, the lead investigator, said that this type
of early treatment can control and eradicate infection in 5%-15% of people with HIV;
the 14 people were part of a group of 70, whose treatment had been administered
earlier than a typical treatment regimen. Each person in the group of 70 had
interrupted treatment, either by choosing to stop taking the medication, or by
ending a clinical trial for medication.

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Most of the people in the group of 70 reverted to having high viral levels once they
stopped taking medication, but 14 people were able to stay off of medication for at
least three years without the virus rebounding. Those people still have HIV in their
blood, but the viral levels are so low that their bodies can counter the HIV naturally,
without medication. An early treatment plan prevents the virus from finding
reservoirs to hide in the body, according to the full report published in the journal
PLoS. One of the 14 people has been off medication for as long as 10 years, though
the average among this group is seven years without medication.

The people in the group of 14 are not part of the 1% of humans immune to HIV.
Instead these 14 had severe symptoms, which promoted early treatment.

"Paradoxically, doing badly helped them do better later," Sez-Cirin said.

The scientists involved are not calling this a cure, but a "sustained remission that
doesn't require therapy" or a "functional cure," according to Anthony Fauci, MD of
the National Institutes of Allergy and Infectious Diseases.
"You haven't eradicated the virus, but interestingly, when you stop therapy, even
though the virus is still there and you can measure it, it doesn't come back with a
vengeance and cause disease in the person," Fauci said according to CNN.

Andrew Ball, senior advisor on HIV and AIDS strategy at the World Health
Organization in Geneva, told New Scientist that this area has been an entry point in
developing a more effective functional cure for a broader market.

"The big challenge is identifying people very early in their infection," Ball said in
New Scientist. There's a good rationale for being tested early and the latest results
may give some encouragement to do that."

African traditional healers and curing HIV/AIDS

JOHANNESBURG, South Africa In South Africa, many people utilize and believe in
the strength of traditional healers. There are several types sangomas (who speak
to the ancestors, diviners) or inyangas (herbalists), traditional birth attendants,
iingcibi (traditional surgeons) and those who practice one of the various forms of
West African voodoo. For centuries, people have obtained medical advice, remedies
and cures from these healers for all manner of aliment.

Traditional healing in South Africa is seen as either a holistic or symbolic form of

restoring health which is deeply embedded in the beliefs of some cultures.
According to Robert Thornton from WITS University in Johannesburg, Healing is
understood by its practitioners to be a profession, not a religion or even a spiritual
exercise. He says that there are six disciplines divination, herbs, control of
ancestral spirits, the cult of foreign ndzawe spirits, drumming and dancing, and
training of new sangomas.

Traditional healers sangomas in particular are highly regarded and can play
large social and political roles in their communities. In South Africa, there are
currently about 200,000 traditional healers and close to 70% of South Africans
consult them. In 2004, the Traditional Health Practitioners Bill was passed by
Parliament to ensure that only registered healers are able to practice medicine, and
to bar them from the diagnosis or treatment of diseases such as HIV/AIDS and
cancer.

South Africa has one of the highest HIV/AIDS rates in the world with close to 5.7
million people infected thats over 10% of the total population. In the population
aged 15-49, the rates are as high as 19.7% in women and 17.3% in men (according
to Statistics South Africas 2010 estimates). It is believed that up to 300,000 South
Africans have died of AIDS.

Can traditional healers cure HIV? According to Professor Robert Thornton, a clear
distinction needs to be made between the words cure and treat. There is
considerable confusion about this due to the fact that some methods and herbs
appear to treat the symptoms of HIV, but not cure the infection itself.

The concept of sexuality needs to be understood in order to stop the spread of HIV
and other sexually-transmitted infections. Based on a study done by the Human
Sciences Research Council in 2006, in order to to assess the role traditional healers
can play in the prevention of HIV infection, it was determined that current measures
were not enough to encourage correct behaviours. It was found that most healers
had correct knowledge of the major HIV transmission routes (multiple sexual
partners, blood contact, reusing needles or razors), prevention methods (condom
use), and that antiretroviral treatment has to be taken for life. However, their
knowledge was poorer on other HIV transmission routes (breast feeding, oral sex
and dry sex), and their overall knowledge of issue was also poor. This is frightening,
given that such a large contingent of the population go to traditional healers looking
for advice, help and treatment.

According to Marlise Ricther, there is a great need for traditional healers to have a
crucial role to play in the health system in South Africa and help with
strengthening and supporting the national response to HIV. Does this mean that
traditional healers should be giving out condoms, promoting safe sex and educating
patients on the hazards of the virus? Should healers be realistic with the people
they treat? Or should they themselves have training on the virus in order to advise
their patients in the best way possible?
While a traditional healer is able to strengthen immunities and treat severe
symptoms of AIDS with herbal remedies, they are by no means able to cure it. It is
imperative that healers convey this to their patients. If an HIV-positive person starts
feeling better due to an improved immune system, they are still infected with HIV
and need to be aware of their behaviours and adjust them accordingly.

Of the traditional healers contacted for this article, four out of five claim to be able
to cure HIV. Not treat cure. Each of these healers declined to comment when they
were told an article was being written. One gentleman who was adamant that his
herbal concoction would cure anyone with the virus is based in the very upmarket
Johannesburg suburb of Sandton.

UNDP program on HIV/AIDS prevention in Bangladesh

Traditional healers in preventing HIV/AIDS: Roles and Scopes

Von Shariful Islam, Amadou Moreau

Traditional healers are the preferred and most accessible health care providers in
the developing countries. With increasing threat of HIV epidemic and critical
shortage of human resources for health it is essential that traditional healers are
included in the HIV/AIDS prevention program. This paper presents the roles of
traditional healers in HIV/AIDS prevention and scopes for including them in the
national AIDS prevention and control program.

Traditional healers play a great role in the health care delivery systems in the
developing countries. In some parts of Africa, Asia and Latin America traditional
healers are far more in number than the modern medicine practitioners and are
widely accepted in the society as the first level of contact and trusted health care
providers. The World Health Organization (WHO) (2002) has estimated that up to
80% of Africas population makes use of traditional healers: for many people it is the
only health system available to them. With increasing threat of HIV epidemic and
critical shortage of human resources for health it is essential that traditional healers
are included in the HIV/AIDS prevention and control program.

Traditional Healers are consulted first

In developing world, cultural practices, social attitudes and economic conditions
facilitate the spread of HIV/AIDS and complicate prevention. Social stigmas
surrounding sexual transmitted diseases (STDs) and AIDS keep many from turning
to the public health system for testing and treatment. And as a result many people
in developing countries continue to consult traditional healers when afflicted with
STDs. Many people still believe that AIDS is due to witchcraft and a fetish conspiracy
against the infected person and traditional healers may be one of the principal
sources of care utilized by people suffering from HIV/AIDS.

Bangladesh has made significant progress in recent times in many of its social
development indicators particularly in health. A major constraint identified towards
reaching the MDGs and other national health goals is the issue of shortages in the
health workforce and the uneven skill mix. Bangladesh has a pluralistic health
system and issue of particular concern is the role of non-state health workforce. Like
most transitional societies, a wide range of therapeutic choices are available in
Bangladesh, ranging from self care to traditional and western medicine. Traditional
healers in Bangladesh are very often the first medical contact, particularly in the
rural area and sometimes the only source of treatment. There are several types of
healers according to their means of practice, like spiritual healers, faith healers,
herbalists, bonesetters, kabiraj, practitioners of folk medicine and traditional birth
attendants. Some herbal practitioners and traditional birth attendants (TBA) are
recognized by the government, after receiving training from an approved institution.
Other traditional methods are widely practiced in the country, though not
acceptable by law. It is estimated that 70-75% population of the country still use
traditional medicine for management of their different health problems where there
are only 2 doctors for 10,000 population compared to 70 traditional healers (The
State of Health in Bangladesh, 2007).

Common misunderstandings and myths

In Bangladesh, about 30% of STD clients do not have any STD symptoms and
perceive themselves as having other Sexual Health problems (Chowdhury et al).
The traditional healers in Bangladesh, primarily focuses on treatment of sexual
dysfunction and illnesses as due to greater acceptance by the people who believe
that traditional healers can help men become sexually stronger and cure impotency.
Treatment for both male and female is mainly in the form of traditional and herbal
remedies, often combined with homeopathic and other methods, primarily based on
common misunderstandings and myths propagated by literature that is used to
advertise the services of traditional healers and common beliefs. These messages
are widely and freely available in the country, which constructs the perception on
STDs among the people of Bangladesh.
Advertisements on different daily newspapers on traditional medicines mostly
accounted for the conditions related to sex and sexuality. Claims on increasing
sexual power, enlargement of male sexual organs and beautification of female
breasts were quite common in most of the advertisements. The most commonly
cited medicament in the herbal advertisements was some all-in-one power oil found
in various brand names such as Special HP Power Oil, Special SP Genital and
Erection power Massage Oil. Other remedies offered in these advertisements
include various tablets, creams and lotions prepared from assorted herbs and
plants. Many of those manifestations were nothing but common myths or beliefs on
sex and sexuality such as nocturnal emission, side effects of masturbation,
deformity of penis, thinning of semen and others. Study indicated that the anxiety
related to sex and sexuality may be reinforced by ignorant individuals and
malpractices of Traditional Healers. Apart from these, choice and use of words in
these advertisements were provoking and appealing in most of the cases. One such
example from the herbal system can cited for instance as follows:

A single course (seven days) use of the special massage oil can make the male
genitalia as strong as iron rod and as thick as the wrist. It causes instant erection of
the genitalia to defeat the sexual partners easily. Even a 60 years old man can be as
young as 25 years and will get complete satisfaction in coitus. This power oil
provides the stamina for love making several times a day. Both married and
unmarried people can apply it. This remedy is tested and appreciated by millions of
people. This is entirely devoid of side-effects and makes the skin of genitalia fairer.
Success is 100% guaranteed. (Islam/Farah 2008)

Sexual myths abound, but the facts still remain lesser known. As sex continues to
be deemed as taboo in the society, not to be talked about overtly, nagging doubts
about sex is what makes people inquisitive as they end up picking up myths from
random sources. These pervasive myths can act as the biggest wreckers, ruining
the fun of a sexual act and leading to traditional healers. While nobody knows
where the erroneous beliefs originated from, these myths still make their way into
peoples bedroom. 7 out of 10 patients with impotency and premature ejaculation
issues attribute their problem to the masturbation habits. Most men associate their
value with their organ size and also with their macho personality, thus they
erroneously believe that the dimensions of their penis are of great importance for
sexual techniques and gratification.
The common complaints that bring patients to them are sexually transmitted
diseases (STDs) and so called sexual weakness. Providing correct information
about HIV transmission and prevention are the fundamentals for HIV/AIDS
prevention. It is not much known about the knowledge among traditional healers
concerning STDs and HIV/AIDS although a number of them are involved in advising
laboratory investigations and using antibiotics and vitamins for treatment.

UNDP initiated a Health Pilot initiative in the Chittagong Hill Tracts to improve the
health status of the people in the region through community health programs,
mobile medical teams and partnership building. Although the incidence of HIV/AIDS
is low in the region, the high rates of STDs, illiteracy, ignorance, availability of
commercial sex workers, injecting drug use and bordering with India and Myanmar
posses threat to a raising epidemic in the region. Considering the immense role of
the traditional healer within the community, UNDP health unit collaborated with
traditional healers for preventing HIV/AIDS in the region.

Study on perception and knowledge

Between February-May 2007, 165 traditional healers were interviewed with a semi-
structured questionnaire and face-to-face interview to gather information on their
perception and knowledge about STDs and HIV/AIDS and prevention. The findings
were analyzed using both qualitative and quantitative methods. The findings
showed that 68% of traditional healers could mention at least one mode of
transmission correctly, 31% answered about symptom of AIDS while 56% mentioned
condom as means for prevention of STD/HIV. None of the traditional healers
prescribed condoms to clients. However 41% said using herbal also could prevent
AIDS. The concern for STDs is diffused by physical and psycho sexual myths.
According to the 65% traditional healers all sexual problems are linked with the two
most commonly known STDs, i.e. gonorrhea and syphilis, which leads to
misconceptions. Interestingly, a few traditional healers could identify HIV/AIDS as a
potential threat to human being and believed that being faithful and maintaining a
monogamous relationship would prevent from getting this deadly disease.

The study concluded that while many people in the region had still faith on the
traditional healers, it is important that medical team of UNDP coordinate with the
traditional healers for better access to health service and HIV/AIDS prevention
program. One possibility is incorporating their influence and skill in the primary
health care at community level, after providing orientation on modern medical
system.
The project collaborated with the government health departments, hospitals and
NGOs to begin the training of Traditional Healers with the goal of harm reduction
and improving safety measures within their practice. A consultative meeting was
organized at the district level for stakeholders to develop strategies to include the
traditional healers within the health systems. With the help of an experienced
consultant, UNDP designed a program on HIV/AIDS Prevention.

A three-day residential workshop was organized in collaboration with UNAIDS and

Christian Hospital, Chandraghona for 131 traditional healers who participated in the
survey. Training program included orientation on STDs and HIV/AIDS, symptoms,
safe sex behaviors, prevention methods, health education messages, HIV/AIDS
counseling and responsibilities of traditional healers. The health education message
was targeted to clear the common myths regarding sexuality and HIV/AIDS and gain
better understandings of the real situation which can be conveyed to the patients.
Different adult learning methodology was adopted for the training sessions.
Participants were provided with a handbook in local language and supply of
condoms that they would distribute freely to clients. At the end of the training
session, it was noted that a new willingness on the part of traditional healers to
demonstrate and offer condoms.

Follow-up meetings were organized quarterly between health professionals and

traditional healers at the district hospital. The impact of the training on the
Traditional Healers had great impact on their practice. For most of them this was a
first time they came in contact with qualified medical practitioners and they felt
they were valued and part of the medical team. Most of them had no problem
learning from medical practitioners although a fraction of them regarded their
practice were safer and more effective. The traditional Healers considered working
with the medical doctors as a prestige for them in the society and with the
expectation that this would increase their acceptability in the community. It was
noted that those who had received training were more likely to have changed their
practices and initiated community public health activities. They reported conducting
community education, promoting condoms and referring patients to medical
treatment to district hospitals.

Conclusions and lessons learned

The role of traditional healers in the fight against HIV/AIDS is of great importance.
Traditional healers, even when illiterate, are vital to disseminating information about
the prevention of AIDS. Because of their position in the community as trusted health
care providers, they are free to speak about sensitive topics, such as sex. Although
there are differences in different tribal societies regarding the religion, the
traditional healers practiced in almost a similar fashion. For example, faith healers
used different types of prayers to cure diseases and herbal medicine was a common
practice. More than 75 % of Traditional Healers were Males compared to females.
But, as the traditional healers were mostly (83%) aged more than 40 years and
coming from the same community they were at ease to speak on sensitive issues
like sex. In a developing country like Bangladesh, many STD patients strongly
believe that they can be cured by traditional healers. Due to the limitations of
qualified doctors it is important to establish a collaborating mechanism between the
traditional practitioners and modern medicine to minimize harm and prevent spread
of the epidemic among the vulnerable people. However, there is also a strong desire
by traditional healers to access legitimacy and resources that can be achieved
through collaboration with modern medicine.

Training of traditional healers on STDs and HIV/AIDS prevention methods including

condom promotion is necessary as they are the major service provider to the large
number of population. It is important to know about the providers conception of
disease and HIV/AIDS. Training materials should be customized so that the receivers
can understand the basic message. Cultural appropriate health education message
that deals with common myths should be developed. The take home message is
important because this is what they will impose upon the people. We should
remember that HIV/AIDS prevention is not solely based on biomedical explanations
but require an integrated approach involving the socio-cultural dimension as well.
Referral for STD cases is essential in order to incorporate the traditional healers with
interventions linking STD/HIV prevention in Bangladesh. Consequently, HIV
programs and STD testing and treatment programs should develop stronger
linkages with traditional healers providing treatment of STD's, secondary infections,
pre and post counseling for the individual and family and referral.

The Way Forward

With the critical level of health workforce shortage, ineffective health systems and
increased threat of emerging and reemerging diseases in the developing countries,
bolder thinking is necessary - how can the vast majority of the informal providers be
most appropriately used? These providers are deeply rooted in their localities and
will not go away. We can not keep pretending that they do not exist but need to
think creatively about how to deal with this reality and both the positive and
negative aspects of their practice. Traditional healers need to be mainstreamed into
the formal health systems, giving them some sort of recognition, training and
certification would help to reduce the harmful practice and involve them in
providing appropriate level of care to the people who needs it the most.

* by Dr. S. M. Shariful Islam is Programme Officer with Partners in Population and

Development in Dhaka, Bangladesh. Contact: drsislam@gmail.com

Amadou Moreau is Programme Officer with Partners in Population and Development,

Dhaka, Bangladesh. Contact: amoreau@yahoo.com

References

M. S. Islam & S. S. Farah: How Complementary and Alternative Medicine (CAM) is

promoted in Bangladesh?: A Critical Evaluation of the Advertisements Published in
Local Newspapers . The Internet Journal of Alternative Medicine. 2008 Volume 5
Number 2

Health Workforce in Bangladesh: Who Constitutes the Healthcare Systems?:

Bangladesh Health Watch, 2007.

Traditional Healing, Biomedicine and the Treatment of HIV/AIDS: Contrasting South

African and Native American Experiences

Adrian Flint

Janet Seeley, Academic Editor

Author information Article notes Copyright and License information

Go to:

Abstract

Traditional healing remains an important aspect of many peoples engagement with

healthcare and, in this, responses to the treatment of HIV/AIDS are no different.
However, given the gravity of the global HIV/AIDS pandemic, there has been much
debate as to the value of traditional healing in this respect. Accordingly, this paper
explores the extent to which meaningful accommodation between the biomedical
and traditional sectors is possible (and/or even desirable). It does this through a
consideration of Native American and South African experiences, looking at how the
respective groups, in which medical pluralism is common, have addressed the issue
of HIV/AIDS. The paper points to the importance of developing culturally
appropriate forms of treatment that emphasise complementary rather than
adversarial engagement between the traditional and biomedical systems and how
policymakers can best facilitate this.

Keywords: traditional healing, biomedicine, Native American, South African,

HIV/AIDS, ART

Go to:

1. Introduction

This paper explores the extent to which lessons can be learned from the use of
Native American and South African forms of traditional healing in the fight against
HIV/AIDS, and the degree to which there is scope for meaningful collaboration in this
respect in the treatment of a disease that, currently, is invariably fatal without
recourse to antiretroviral therapy (ART). Based, to a significant degree, on original
fieldwork conducted in South Africa, the study employs the analytic framework
offered by the Native American/Indian Health Service relationship in a consideration
of the South African experience.

Native American forms of traditional healing have had, when compared with South
African equivalents, a relatively long association within formal biomedical
healthcare structures in the U.S. The U.S. Indian Health Service (IHS) acknowledged
officially the value of traditional forms of healing from the mid-1970s onwards. In
South Africa, this has only been the case since the mid-2000s. The U.S. experience
therefore offers a useful analytic framework for an exploration of both how
traditional forms of healing have been used in South Africa, andcriticallyhow
they might be employed in future. On the basis that different healing systems can
be framed and understood as being complementary to one another rather than as
being in opposition to one another, the case of the IHS suggests that traditional
forms of healing can offer a number of benefits to patientseven with respect to
diseases like HIV/AIDS that require, on certain levels at least, some measure of
biomedical engagement.
While traditional forms of healing, both Native American and South African, are
increasingly coming to be viewed as valuable by those operating within a
biomedical mindset, both of these traditional systems are still largely understood to
be secondary to biomedicine in their importance. Colonialism in both regions saw
significant efforts by authorities to eradicate what they perceived to be practices
based on superstition and irrationality and, although this binary perspective has
now in some quarters been challenged, this has only become the case relatively
recently. Native American healing practices were officially outlawed in the U.S. until
1973, and colonial-era laws against witchcraft remained in place across many
African countries until the late twentieth century. It remains the case that traditional
healing is generally categorised by both healthcare practitioners and policymakers
as alternative or supplementary, even by those sympathetic to its basic tenets.
For the most part, biomedical hegemony has resulted in traditional healing being, at
best, tolerated rather than embraced by those within the establishment. Amongst
many biomedical adherents, the ongoing New Age fascination with Native
American practices in particular has served merely to re-enforce the argument that
traditional healing should be viewed with a degree of scepticism.

Policymakers are certainly now more open to the role that traditional healing can
play as part of a broader approach to the practice of medicine, but the extent to
which it can form an integral part of formalised healthcarebased on its own merits
continues to be much debated. While there have been calls for accommodation to
be made within formal structures for traditional approaches to healing, the
prescriptions as to the forms such accommodation might take have proven
contentious, especially where the treatment of a disease like HIV/AIDS is concerned.
Furthermore, despite (and also sometimes even because of) the efforts of countries
like South Africa to offer a degree of equivalence for traditional forms of healing, it
remains the case that biomedical and traditional perspectives are often presented
as being competing (and often incompatible) systems.

Accordingly, against the backdrop of HIV/AIDS, a disease that continues to threaten

the lives of millions of people, this paper is a consideration, from a policymaking
perspective, of practical attempts to reconcile aspects of what on the surface might
appear to be irreconcilable worldviews [1].

Go to:

2. Health in Native American and South African Societies

Healthcare indicators for Native Americans and black South Africans are
significantly poorer than those of their white counterparts. For example, the
difference in life expectancy between black and white South Africans is
approximately 20 years [2]. Likewise, in the U.S., Native American life expectancy is
lower than that of the national average, and Native American communities also
demonstrate lower health status in a number of areas. The IHS notes:

American Indians and Alaska Natives die at higher rates than other Americans from
chronic liver disease and cirrhosis (368% higher), diabetes mellitus (177% higher),
unintentional injuries (138% higher), assault/homicide (82% higher), intentional self-
harm/suicide (65% higher), and chronic lower respiratory diseases (59% higher).

Given the higher health status enjoyed by most Americans, the lingering health
disparities of American Indians and Alaska Natives are troubling [3]. In both regions,
poverty, inadequate nutrition, high levels of violent crime, alcohol and substance
abuse, and poor access to healthcare are all contributing factors, many of which can
be seen to stem from colonial legacies.

Both groups have also been affected disproportionately by HIV/AIDS. In the case of
South Africa, with a prevalence rate of 12.2 percent amongst the general population
(up from 10.6 percent in 2008), prevalence amongst black South Africans is 15
percent as opposed to that of 0.3 percent for white South Africans [4] (p. xxiii). This
is despite a marked improvement in HIV/AIDS prevention efforts and treatment in
recent years. The HIV/AIDS pandemic has also had a significant impact on Native
American communities, although relatively small numbers make this impact less
visible. Official statistics suggest that Native Americans are the third worst affected
ethnic group in America, after African Americans and Hispanics. However, given the
manner in which all people entered into the U.S. health system are (mis)classified
ethnically, it is arguable that there may be significant under-reporting of the
problem [5]. Furthermore, while prevalence rates are declining amongst other U.S.
ethnic groups, they are continuing to rise amongst Native Americans. Evidence also
shows that Native Americans infected with HIV have shorter life expectancies than
those in other ethnic groups [6].

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3. Method: Establishing a Framework for South African Traditional Healers

Experiences
In the U.S., there is a rich literature, much of it published by the presses of the
universities of Nebraska and Oklahoma, that documents the lives of Native
American medicine men and medicine women, their belief systems and their
approaches to healing. These, together with observer and other anthropological
accounts offer a usefuland establishedbody of material (see for example
[7,8,9,10,11,12,13,14]) with which to contrast South African experiences. The IHS,
too, is a repository for documentation detailing debates over policymaking and
accommodation with respect to traditional forms of healing employed within formal
healthcare structures (http://www.ihs.gov/).

Using the Native American literature and related IHS policy as an analytic
framework and site of comparison, the argument put forward here draws on original
fieldwork interviews conducted with South African (and other African) traditional
healers and their clients, and addresses related policies enacted by the South
African government. The traditional healers interviewed for this research can be
categorized broadly as sangomas (diviner-healers), as opposed to inyangas
(herbalists), or faith healers linked to the traditional African churches. The
perspectives put forward by the healers consulted contribute significantly to the
discussion below; their willingness to share their time and experience is gratefully
acknowledged. The material was gathered during the course of a series of
interviews conducted in 2010 that built on previous fieldwork conducted in 2009.
The interviews were conducted in four locales across South Africa, incorporating
both rural and urban environments and male and female respondents of varying
age, social status and education level. The identities of all informants have been
anonymised. The interviews took place in Johannesburg (Gauteng Province), East
London and surrounds (Eastern Cape Province), Grahamstown (Eastern Cape
Province), and Knysna and surrounds (Western Cape Province). These locations were
selected in the interests of interrogating the pervasiveness of engagement with
traditional healing in a range of environments. Urban centres like Johannesburg and
East London are contrasted with more traditional rural areas, such as those
outside east London, which incorporate parts of the old apartheid-era homelands
of the Transkei and Ciskei. Grahamstown and Knysna represent, for the most part,
similarly rural heartlands, still influenced heavily by traditional values. In order to
achieve as broad a perspective as possible, interviews were conducted with both
healers and their patients and took the form of semi-structured informal interviews
across individual and group sessions. While all of the traditional healers were of
course working in South Africa, the nationalities of those consulted included
Malawian, Tanzanian, Ugandan and Zimbabwean as well as South African. The
traditional healer sample included both male and female practitioners of different
levels of age, experience and standing in the community (including apprentice
healers and their mentors). The patients/clients interviewed encompassed a cross-
section of individuals from local communities engaged in forms of employment that
included social work, management, education, domestic service, construction and
tourism. The paper also draws on secondary anthropological studies focusing on
traditional forms of South African healing [15,16,17,18,19,20].

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4. Locating Contemporary Traditional Healing

South African and Native American traditional forms of healing are both deeply
embedded and have a broad resonance that in many respects transcends the ethnic
and cultural boundaries of each region. Despite the best efforts of paternalists who
favoured progress as a way to eradicate Native American (see, for example, [21])
and South African [22] traditional healthcare perspectives, aspects of both systems
have proved remarkably durable. While both of the regions concerned incorporate a
number of cultural/ethnic groups that are hardly homogenous, there are sufficient
commonalities across each to make at least a degree of generalisation useful. For
example, while there are an estimated 4.1 million Native Americans living in the
U.S., comprising 566 government-recognised tribes [3], healers from the different
groups borrow extensively from each other (although some traditional healers, like
the high profile medicine man and civil rights activist John Lame Deer, have
expressed concern about the amalgamation of Native American beliefs; Lame Deer
has argued that, for himself at least, it was important to concentrate on his
specifically Sioux traditions [9]). Similarly, in South Africa, despite there being 11
official languages and a host of often-overlapping identities, traditional healers from
across the countryand as far afield as Nigeria and Ugandaare accepted as
legitimate by local communities [1].

There is a tendency for traditional healing to be embraced as static, a body of

knowledge/practices sealed in time. In fact, it is fluid, diverse and idiosyncratic
[23] (p. xx). Claims that Native American healing has been practiced for 12,000
years (or longer, depending on when the Americas were first inhabited),
intentionally or not cement this perspective [24]. It is accepted that the cataclysm
wrought by infectious diseases introduced to the Americas after 1492 impacted
dramatically upon the social and cultural fabric of Native American societies.
Depopulation estimates range between 78 and 97 percent of the pre-Columbian
population of North America [24] (pp. 324325). By the late nineteenth century only
approximately 500,000 Native Americans remained out of a pre-1492 population
that may have been as high as 18 million [24] (p. 325). By extension, this
undermines severely any argument that twenty-first century Native American
traditions represent 12,000 years of continuity. The origins of pre-colonial South
African forms of healing are similarly clouded. However, while generally
conservative and rooted in the past, the traditional healing practiced today in both
regions has not gone unchanged over the centuries. All systems evolve and
traditional healing is no different in this respect. Colonialism engendered additional
complications; knowledge and traditions have eroded in the face of centuries of
instability and conflict to the point that it is difficult to say with any certainty that
what is practised currently would have been recognisable to pre-colonial societies.

Murray Last, describing traditional healing in West Africa in his seminal 1981 article,
The importance of knowing about not knowing, argued that what can be
described as a traditional system is, in fact, so un-systematised as to scarcely
constitute a system, though it flourishes nonetheless. The lack of a system is seen
in the disunity of traditional doctors, in their lack of a single consistent theory and in
the wide variation in meaning in the medical terminology in daily use [25] (p. 387).
In a number of respects, Lasts observations can be seen to hold when applied to
other systems of traditional healing. Contemporary Native American practitioners
like Lewis Mehl-Madronaa qualified biomedical doctor as well as a traditional
healeracknowledge the fact that much of what is practiced by current healers is
drawn from different sources and often based largely on intuition [11]. For Mehl-
Madrona, modern shamanspick and choose bits of different traditions, using a
combination of things that work for them and their clients [11] (p. 135).

The twentieth-century evolution of the peyote religion into what is now the Native
American Church is an illustration of the potential for shifts and changes within
traditional systems: peyotisms move away from its central American origins
combining Catholic and Mexican ritual to form something of a pan-Native American
religionrepresents a quite revolutionary transformation within Native American
tradition [26]. In terms of basic observances for example, peyote ceremonies
usually take place in tipis even though such structures were not traditionally
employed by groups of significant size like the Navajo [14]. The sweat lodge too,
long viewed as a universal symbol of Native American healing (and one embraced
by New Age healers), and now also incorporated as a ceremony within the Native
American church, was not historically utilised by all groups. Traditional South African
forms of healing have similarly seen changes, particularly in urban areas. The list of
industrial ingredients found in many traditional remedies would, of course, have
been wholly unknown in pre-colonial societies [27,28]. Engagement with healers
from other parts of Africa also represents an evolution of traditional perspectives
[29].

Roots aside, contemporary traditional healing forms an important aspect of Native

American and South African perspectives on healthcare. There is a much-employed
World Health Organisation statistic that suggests that 80 percent of people living in
Sub-Saharan Africa make use of traditional forms of healing/medicine (see for
example [30,31]). This figure was also employed with specific respect to South
Africa in the South African Medical Journal in 2012 [32]. In 2011, President Jacob
Zuma of South Africa put the figure at 70 percent [33]. While this particular statistic
is something of a factoid, the controversy surrounding it should not be allowed to
undermine the importance placed on traditional healing in Sub-Saharan Africa. In
South Africa, the more considered evidence suggests a far lower but nonetheless
significant proportion of adherents [34]. Similarly, with respect to Native Americans,
figures for those making use of traditional healing range between 38 and 70 percent
[35] (p. 670).

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5. Science and the Supernatural: Distinguishing between Healthcare Systems

Traditional and biomedical tend to be the terms employed in the literature to

distinguish between these two systems of healthcare but this dichotomy is not
unproblematic. While much of the discourse in medical anthropology and medical
sociology prior to the 1980s saw a clear separation between what were perceived to
be very different approaches to sickness, Bradley Stoner has shown that, globally,
the division is less precisely delineated [36,37]. The reality is that practitioners and
patients on both sides dip into the alternatives available to them; meaningful
engagement can take place when the need arises. As Stoner has also
demonstrated, what people want, with respect to healthcare, are options,
irrespective of how these may be defined.

Evidence from both regions suggests that the vast majority of users engage in some
form of medical pluralism. Most South African and Native American traditional
healers are comfortable in both distinguishing between traditional and non-
traditional sicknesses, and accepting that aspects at least of the latter are best
treated through recourse to biomedicine. It is also clear that Native American
traditional healers themselves see nothing problematic with engaging personally
with biomedicine when necessaryConley [10], Mohatt [13] and Langley [14] all
record conversations with healers freshly discharged from their local hospitals.

Until recently, analysts saw the lines dividing the two systems as being fairly clear
cut (and at odds with each other), especially on matters involving the supernatural.
Bluntly, the European and North American perspective was that biomedicine was
based on science while traditional healing was nottraditional healers could not be
viewed as doctors. Anthropologists like Erwin Ackerknecht, writing in the 1940s,
viewed Native American healers as having been the antagonist(s) of the physician
for centuries [38] (p. 22). As Ackerknecht saw it, healers were ancestor[s] of the
priest rather than of the modern biomedical practitioner. In colonial Africa,
witchdoctors were dismissed as being representative of the dark continent that
colonialism sought to displace [39].

At the same time, appeals to the healing powers of supernatural forces are not as
divorced from a contemporary biomedical perspective as many operating within a
rationalist mindset would like to admit. Most biomedical hospitals have chaplains
of various faiths attached and prayer is employed regularly by users of biomedical
institutions as a complement to treatment (a survey suggests that up to 70 percent
of Americans believe that prayer can help to cure sickness) [40] (p. 577). Moreover,
although attempting to quantify the impact of prayer on those who are sick is
methodologically controversial, evidence from a small number of randomised tests
suggests that it may be possible to identify a positive effect. A study focusing on
coronary patients in the U.S. found that supplementary, remote, blinded,
intercessory prayer produced a measurable improvement in the medical outcomes
of critically ill patientsfurther studies using validated and standardized outcome
measures and variations in prayer strategy are warranted to explore the potential
role of prayer as an adjunct to standard medical care [41] (p. 2278).

A study amongst HIV/AIDS patients in the U.S. during the 1990s suggested that,
although CD4 counts remained unaffected, prayer resulted in better indicators for
disease progression, decreased medical utilization, and improved psychological
well-being [42] (p. 357). The authors argued that science does not require a known
mechanism to prove the existence of a phenomenon...for years no one knew how
colchicine, morphine, aspirin, or quinine worked, yet they were known to be
effective [42] (p. 362).

Such evidence is, however, far from conclusive. Scientists and biomedical
practitioners continue to debate hotly the extent to which the impact of prayer can
be studied objectively. Be that as it may, it can be taken that many patients and
practitioners within the biomedical system believe in the power of supernatural
intercession [43]. Critically, as an extension, the majority of patients also see no
conflict in requesting supernatural intercession whilst being treated within a
healthcare framework that offers no ontological space for the supernatural.

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6. Biomedical and Traditional Perspectives: Establishing Common Ground?

Native American and South African forms of healing should not be understood as
nascent forms of biomedicine that, given time and space, will evolve into something
akin to the western model. As Dickinson outlines, despite ongoing focus in this
regard, the prospect of a bilingual medical-traditional dictionary, capable of
translating traditional perspectives into biomedical parlance represents something
of an impossibility [23] (p. xx). Rather, these examples of traditional healing form
alternative systems of healthcare. In both instances, unlike in the pathology-
focussed biomedical model, traditional forms of healing rely heavily on aspects of
the supernatural with respect to both diagnosis and treatment [29,44]. Here, the
terms healer and medicine extend more broadly than they do within the general
biomedical paradigm. A group of male Lakota healers, when questioned as to how
they should be formally identified, after rejecting the terms medicine man, holy
man and interpreter (for the spirits), finally settled on a term that translates as
the man that fixes [13] (pp. 1314).

Alongside questions regarding training and expertise, it is the supernatural aspect

that so many in the biomedical sector find difficult to accommodate within a
rational scientific framework. For example, traditional healers from both traditions
are generally called to the profession at a young age through dreams and visions
[10,11,29,45]. Every healer interviewed for this study told of a similar calling:
from childhood, vivid and disquieting dreams in which their ancestors tried to
establish lines of communication with them [29]. Many, although not all [29], who
come to the profession are either illiterate or have had little formal schooling [9,46],
and much of their power is derived from the strength of their relationships with
the spirit world and/or their ancestors. Consequently, while forms of what might
equate to biomedicine are practiced by traditional herbalists [38] who utilise plants
to treat ailments, most medicines and treatments are revealed through
supernatural engagement [11,13,29].

Illness in both Native American and South African traditions is generally understood
to be less the result of pathogens or physiological changes and rather the result of
supernatural interventions brought about through either ones own spiritual
missteps or malevolent intent on the part of others. Ones own provoking of
supernatural displeasure can come about through the violation, intentional or
otherwise, of taboos, obligations and responsibilities. Malevolent intent on the part
of others, on the other hand, involves witchcraft: the deliberate calling forth of
negative supernatural intervention in another persons life [15,38]. In both
traditions it is witchcraft that is understood to play an often central role in the
causation of illness. As a result, illness is rarely viewed as transmittable; witchcraft
is nearly always person- (or, occasionally, family-) specific [10,14,29]. The invoking
of witchcraft, as perceived across both cultures, generally originates out of jealousy
and a desire to see a successful person brought low. Witchcraft is understood to
bring about general misfortune, financial problems, alcohol and/or substance abuse,
relationship and personal issues, and, critically, ill health. As a number of informants
contributing to this study detailed, bad luck is, essentially, no matter of chance;
both good and bad fortune are shaped by the supernatural [29]. Resolution of bad
fortune, therefore, is also understood to require supernatural intervention, usually
invoked through ceremonies and rituals. Medication, if required, is determined on
the basis of supernatural direction rather than pharmaceutical benefitfor example,
the smoking of blessed cigarettes is a common prescription within Native American
healing [11,47].

The emphasis on the supernatural has, from the initial stages of European
intervention, resulted in accusations of quack medicine and of charlatans
preying on the weak and gullible. More recently, that clinical trials have found few
traditional medicines to impact positively on pathogens has served to corroborate
this earlier perspective. South Africa is just one of the African countries where this
has led, in part, to governmental attempts to regulate and control the traditional
sector, through the provision of certification for genuine healers (Ghana, Nigeria,
Burkina Faso, Democratic Republic of Congo, Guinea, Madagascar and Mali have
legislation governing the registration of traditional medicines [48]). However,
attempts by both policymakers and the biomedical community to codify what is and
what is not traditional healing reveals a fundamental misunderstanding of what it is
and how it is practiced. For example, the idea of charlatan healers sits
uncomfortably within both culturesin general, failure to find a cure is often viewed
as an indication not of fraudulence or misdiagnosis on the part of the traditional
healer, but rather of the strength of the supernatural forces aligned against the
patient. In such cases, it thus becomes a matter of seeking out a more powerful
healer. In South Africa, it tends to be understood that genuine healers will only
request payment once the patient is healed. A healer demanding payment upfront
may sometimes be deemed suspect [29].

The gulf between biomedical and traditional cosmologies is undeniably wide, as are
the respective approaches to diagnosis, patient care, and treatment; double-blind
testing and laboratory-based demonstrations of efficacy are inadequate tools for
validating diagnoses acquired through communication with the spirit world. Medical
anthropologists have, in the past, sought to address these differences by
distinguishing between the conceptualisation of disease and illness, and
curing and healing. Curing is, in essence, a largely biological process that
results in the removal of disease from the body. Illness is viewed generally as a
more psychosocial condition involving spiritual or mental health aspects in need of
healing (for a more detailed discussion see [49]). While the utility of this dichotomy
is much debated, it tends to be the case that biomedicine is focused on the curing
of disease while traditional healing is inclined to be more concerned with illness. In
basic terms, the two systems are not necessarily attempting to achieve the same
goals or outcomes, which can be confusing to outsiders, particularly given that the
language used to describe both processes is often seemingly interchangeable. In
part this is due to the fact that the lexicons of traditional cosmologies often
translate poorly into English (and other European languages), resulting in the
obscuring of major epistemological divides. When traditional approaches are
described in English terms, with the biomedical associations of the latter, it can
create illusionsif not aspirationsof equivalence: in English, many traditional
healers themselves reach for what is largely biomedical terminology in order to
describe their work to outsiders. Traditional healers marketing themselves in urban
South Africa often adopt the titles doctor or professor. They routinely receive
their patients in offices, with waiting rooms staffed by receptionists, in much the
same way as biomedical general practitioners would. However, as Waldram points
out, traditional healers interpretations of biomedical terminology are rarely
considered [49].

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7. The Advantages of Traditional Healing for Patients

Mehl-Madrona describes how, during his biomedical training, management

demanded that he see at least three patients per hour [11]. This is by no means
unusual within biomedicine; doctor-patient interaction is generally kept to a
minimum. The UK National Health Service (NHS) suggests that a GP will see, on
average, between thirty and forty patients per day [50]. In Native American and
South African communities, where biomedical healthcare personnel and
infrastructure can both be limited, practitioner-patient face time can be somewhat
perfunctory. The resultant feelings of alienation and frustration experienced by
patients under these circumstances can be exacerbated when practitioners are
unable to engage patients in their own languages. Traditional healers, on the other
hand, tend to spend a great deal of time with their patients, with some Native
American ceremonies extending across a number of days [10,12,14]. Some
intensive therapies have been known to involve daily contact between healer and
patient for over a month [13]. Amongst the Navajo, complex ceremonies can involve
up to a hundred hours of ritual chanting on the part of the healer, and can also
require the participation of the patients entire extended family [51]. In fact, what
stands out when comparing the two systems, is that traditional healing, unlike that
of biomedicine, is often communal rather than private. In all cases, patients are
asked to be part of the process in the interests of contributing to their own healing.
Furthermore, due to the ways in which the supernatural is perceived to impact on
peoples health, treatments and ceremonies are tailored to the requirements of
individuals, as is any prescribed medication [11]. Likewise, traditional forms of
healing in South Africa are unhurried and deeply personalised, with treatment being
specifically tailored to each individual [29]. South African traditional healers see far
fewer patients than their biomedical counterparts, offering in-depth treatment that
includes counselling for both individual patients and their families [46]. South
African traditional healers, like their Native American counterparts, also frequently
travel significant distances to treat patients in their own homes [52]. Traditional
healing is therefore a highly individualised and interactive experience for patients,
in which healers are facilitators. This differs substantially from the expert-driven
approach central to biomedicine.

Engagement with the supernatural can also enable people to find a measure of
meaning in their suffering, even if these same individuals are prepared to accept
the germ theory of disease as the immediate cause of their illness [53]. As with
biomedical practitioners, traditional healers identify what is wrong with their
patientsthe naming of the illness presented is viewed as a significant aspect of
the treatment process. In this respect, the divergence between the systems occurs
on the basis of the significance surrounding a patients experience of ill health that
is offered by traditional healing. In contrast, biomedicine has little to offer patients
in terms of explanations for their misfortunediseases are contracted randomly (at
least in part) against the background of a largely disinterested universe. In this
respect, a witchcraft paradigm [16,17] offers a degree of solace to patients; their
suffering can be seen to have been caused by malevolent forces deployed against
them, usually out of jealousy, rather than having come about through random
infections and mutations. Jealousy-as-causation was a recurring theme within the
majority of the discussions on witchcraft that arose during this study, with both
patients and healers in broad agreement on this aspect [29]. At the same time,
within such a worldview, it must be emphasised that for every victim of witchcraft
there must be a perpetrator [10,14,29]. Instances of retaliationoften violent
against witches by communities in South Africa are well documented [54]. In
1995, as a result of nearly 150 deaths the preceding year in Northern Province,
South Africa, a commission of inquiry was established to investigate witchcraft-
related murders [55]. In 2007, in response to similar levels of violence, Mpumalanga
Province, South Africa, passed the Witchcraft Suppression Bill that made the
identifying or sniffing out of witches a criminal offence. While there is less
documented detail regarding the negative social effects of a witchcraft paradigm on
Native American communities, retributionusually supernaturalis often implied
[10,14].
Go to:

8. Bringing the Traditional and Biomedical Sectors Closer Together

Studies in the U.S. have shown that traditional healing techniques have proved
most effective in treating alcohol and drug addiction, often associated as these
addictions are with physical, sexual and domestic violence, and HIV/AIDS-risk
behaviours. The traditional healing approach has also been proved to be effective in
the treatment of mental health disorders such as depression. In the 1950s, the IHS
was already beginning to employ culturally appropriate forms of engagement with
patients, bringing traditional healers into the formal system in the interests of
promoting better therapeutic outcomes [56]. In this regard, the first director of
the IHS, appointed in 1953, James Ray Shaw, saw improving ties with traditional
healers as an important aspect of the agencys mission [57]. Once established, the
relationship between the IHS and traditional healers became (to a degree) reflexive.
For example, the head of mental health services for the IHS in the 1970s, Robert
Bergman, describes the establishment, by Navajo healers, of a school for medicine
men in which he taught classes on biomedical practice and psychiatry and was, in
turn, moved to refer his own patients to local traditional healers [51]. Fostering
cooperation has remained an important part of the IHS mission, especially in the
wake of the 1976 Indian Health Care Improvement Act, which offered a far greater
degree of self-determination to Native American communities with respect to the
running of the IHS, and the 1978 American Indian Religious Freedom Act, which
afforded protection for Native American religious beliefs. Reflecting on the impact of
the Act in 1994, an IHS policy paper stated that:

The Indian Health Service (IHS) recognizes the value of traditional beliefs,
ceremonies, and practices in the healing of body, mind, and spirit. The IHS
encourages a climate of respect and acceptance in which traditional beliefs are
honored as a healing and harmonizing force within individual lives, a vital support
for purposeful living, and an integral component of the healing process. It is the
policy of the IHS to facilitate access to traditional medicine practices, thereby
protecting the right of American Indian and Alaska Native people to their beliefs and
health practices as defined by the tribes or villages traditional culture.

[58]

At the same time, it would appear that dissatisfaction with biomedical treatment is
not the driving force behind engagement in medical pluralism and neither is the
cost [29,59]. Studies, from as far back as the 1952 Many Farms project targeting
tuberculosis amongst Navajo communities, suggest that patients could be
persuaded to undergo simultaneous biomedical and traditional treatments, on the
basis of what was accepted as the complementary potential of a combined
approach [56,60]. Contemporary Native American healers themselves relate how
they use their powers to assist biomedical practitioners in their work, of which an
example might be invoking their spirit guides to work with surgeons in operating
theatres [13]. Furthermore, evidence suggests that, with respect to biomedical
regimes, self-compliance remains unaffected by consultation with traditional healers
[59].

Notable too are the costs involved in both Native American and South African
traditional healing, especially when compared with those of biomedical alternatives.
A 1998 study amongst Navajo communities found the average cost of a traditional
treatment to be approximately $400, a significant figure given the high rates of
poverty and unemployment within these communities; IHS services are provided
free of charge. Some traditional treatments were reported to cost as much as $3000
[59]. The South African situation is similar. South African biomedical care, although
often limited in rural areas, is free; intensive traditional treatments, often requiring
animal sacrifices, can currently cost as much as R5000 ($470) [29], when the
average unskilled wage is just R10 ($1) per hour.

Despite a history of chronic underfundingthe IHS has traditionally been funded to

a much lower degree than other Federal programmes like Medicare and Medicaid
[61]the IHS remit means that it can offer a more tailored response to its patients
than that which is available in South Africa. Like the IHS, the South African
healthcare system is underfunded and understaffed. Critically, the South African
system is also less flexible in its approach. As a national healthcare provider serving
a population of 54 million [62], it is in many respects unsurprising that IHS-style
engagement between the biomedical and traditional healthcare sectors has had
little space in which to evolve. In South Africas case, while gradual change is now
beginning to take place, the relationship between biomedical and traditional
practitioners remains one governed largely by misunderstanding. That this climate
exists is due at least in part to the fact that no institution along the lines of the IHS
is present in South Africa. In the IHS, as an institution geared specifically to the
treatment of a far smaller group of people drawn from a relatively common cultural
background, the potential for accommodation between the sectors has been far
greater.

Funding and diversity issues notwithstanding, differences in the

biomedical/traditional climates of the U.S. and South Africa are also the result of
policymakers framing official narratives on traditional healing in different ways. With
respect to the Native American experience, policymakers efforts to codify the
different spheres owned by the two healthcare systems have resulted in these
being accepted as different but complementary (although this is not to suggest that
some mutual suspicion does not exist). In South Africa, the two systems are usually
presented as being in competition with one another. That this (often false)
dichotomy has remained entrenched is due largely to the focus placed on traditional
healers and traditional medicine by the Mbeki government (19992008), in reaction
to its failure to deal with the spiralling HIV/AIDS pandemic of the period. At this
time, a shortage of biomedical practitioners also meant that the government was
under pressure on healthcare issues more generally (For a middle-income country
such as South Africa, the World Health Organisation suggests a doctor-to patient-
ratio of 180:100,000. The South African reality is closer to 50:100,000, with rural
areas being particularly poorly served [46]. Traditional healers outnumber
biomedical practitioners by almost 10:1 [1]). Affording equivalence to the traditional
sector was seized on by policymakers as a way of killing two birds with one stone.

As is well documented, President Thabo Mbeki was sceptical about the links
between HIV and AIDS, being persuaded by much of the denialist science on the
subject. The result, driven by his determination to present his position as being one
based on resistance to imperialist values, was an increased focus on traditional
medicine as a potential African solution to an African problem. This message had
traction because, as Dickinson points out, while South Africa is not a traditional
society, it still retains much traditional belief [23] (p. 26). Furthermore, during the
early days of the pandemic, when mass South African access to the new biomedical
response that was ART was a remote possibility, those who were HIV-positive sought
out alternative treatment regimes, many of which included forms of traditional
healing. Corinne Squires narrative approach to understanding the pandemic in
South Africa highlights how, during the Mbeki period, people living with HIV/AIDS
(PLWHA) set about supporting themselves through the construction of their own
AIDS narratives [63].

The government, for its part, sought to legitimise its preferred counter-narrative
through the formalisation and regulation of the traditional healthcare sector,
framing it as part of Mbekis African Renaissance [64]. The subsequent 2008
Traditional Health Practitioners Act ignited significant discussion on, amongst other
issues, the rights of traditional healers to write legally-valid sick notes for workers,
and whether patients could claim for traditional healing expanses on their medical
insurance [32]. Albeit for different reasons, Mbekis successor, Jacob Zuma, whose
popularity rests at least in part on his staunch support of traditional values, has
maintained emphasis on the continued mainstreaming of traditional healing: (o)ur
commitment as government is to bring traditional medicine into the mainstream of
health care, appropriately, effectively and above all safely [33].
While there has been some considerable movement towards accommodation on the
part of certain South African practitioners (on both sides of the divide), biomedical
practitioners have been accused of conducting what amounts to medical missionary
work rather than attempting to truly accommodate traditional cosmologies [1]. For
example, while traditional healers have been strongly encouraged to press patients
they suspect of being HIV-positive to be tested, and many have expressed
themselves content to do so [29,65], surveys suggest that biomedical practitioners
are, on the other hand, reluctant to recommend traditional healers to patients [46].
South African interaction is, in effect, the education of traditional healers into the
biomedical perspective, rather than a meeting of minds.

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9. Traditional Healing and the Treatment of HIV/AIDS

Debates regarding value systems, cultural sensitivity and ideological

accommodation become highly charged when, as is the case with South Africa,
literally millions of lives continue to be threatened by HIV/AIDS. In addressing
HIV/AIDS within Native American communities, the use of traditional healing has
been most successfully employed in treating illnesses involving substance and
alcohol abuse (which have in turn have been shown to exacerbate HIV/AIDS-
associated risk behaviours). Native American traditional healing has not been
presented as an alternative form of HIV/AIDS treatment, and neither has it been
viewed as such in the wider community. In South Africa this has not always been the
case, meaning that lines are often blurred [29]; for this reason, levels of HIV/AIDS
education remain unacceptably low [23,66].

In contrast to illnesses that have shown themselves to be responsive to traditional

healing, HIV/AIDS and its treatment offers little doubt with respect to efficacy,
regardless of how the latter may be defined [49]. The indisputable success of ART
has made the case for biomedical treatment irrefutable. With PLWHA increasingly
able to live into old age so long as they have adequate treatment, the importance of
engaging with ART cannot be overemphasised. This, however, reduces dramatically
the scope for patients to engage in medical pluralism. Traditional approaches cannot
treat HIV/AIDS. This not to say that that traditional healing cannot have a positive
effect on the conditions and symptoms affecting PLWHAespecially with respect to
efforts to assign meaning to sufferingbut attempts to suggest that comparable
efficacy is a matter of interpretation is problematic. The human cost in not engaging
with biomedical HIV/AIDS treatment is both high and undeniable; researchers from
the Harvard School of Public Health suggest that, as a result of the South African
governments failure to roll out ART between 2000 and 2005, more than 330,000
lives or approximately 2.2 million person years were lost [67]. The same study
estimated that during this period 35,000 babies acquired HIV via mother-to-child
transmission, something that might have been averted through the administration
of the ARV nevirapine [67]. Of equal concern is evidence published in the journal
AIDS in 2006 that pointed to low levels of awareness of appropriate HIV/AIDS
treatments amongst South Africans [66]. It was clear from this study that many
South Africans viewed ART as simply one of a number of HIV/AIDS treatment
options. The authors of the study argued strongly that if antiretroviral agents are to
compete more successfully in the therapeutic continuum, there needs to be explicit
recognition of, and further strategies to counter, the attraction of alternative
therapies for patients and the systematic promotion these treatments receive [66]
(p. 1977). While the Zuma government has been far more forthcoming with respect
to addressing the pandemic than its predecessor, it is clear that serious confusion
remains with respect to HIV/AIDS. The fact that a 2014 report shows that, two
decades after the democratic transition, South African prevalence rates continue to
rise as a result of, in part, an estimated 469,000 new infections in 2012 (the year of
the study) alone, suggests that the pandemic shows little sign of easing [4] (p.
xxix).

The obvious superiority of biomedicine in this particular instance, combined with

statistics such as the above, have led to a sometimes fractious debate over the
value and place of traditional forms of healing in South Africa. As stated, Native
American prevalence rates have tended to be driven by risk behaviours associated
with alcohol and substance abuse, and prevention programmes have been
developed with the intention of addressing these behaviours [68]. Groups like the
Navajo AIDS Network (NAN), a non-profit organisation that works with the IHS, have
established structures that allow for culturally-appropriate systems of treatment for
PLWHA, including traditional healing. One of the services offered by the NAN helps
PLWHA identify and fund treatment with traditional healers. At the same time, a
notable outcome of the programme has been increased adherence to biomedical
regimes [69]. What is clear, in this instance, is that traditional healing is not being
proffered as an alternative to ART. Rather, it is seen as a vehicle for both the
provision of culturally-sensitive forms of HIV/AIDS education and the encouragement
of prevention behaviours. Where South Africa is concerned, traditional remedies are
frequently prescribed by healers as ART alternatives. One of the more publicised of
such cases was that of Zeblon Gwala and his uBhejane (rhino) herbal cure, which
developed a devoted following in KwaZulu-Natal in 2006, the South African province
with the highest levels of HIV/AIDS in the country. Gwala, a truck driver turned
traditional healer, claimed that the treatment was revealed to him in a dream by his
late grandfather who had, in turn, also been a traditional healer [70]. In promoting
his remedy, he claimed that it increases your CD4 count and reduces the viral load
until it disappears [71]. Critically, Gwala also advised all patients taking his
treatment to discontinue ART. An additional concern to AIDS campaign groups was
that Gwala received active support from, amongst others, Mbekis Minister of
Health, Mantombazana Tshabalala-Msimang and other political elites. When
subjected to clinical trials in 2005, the Medical University of South Africa found
uBhejane to have no positive effect on the treatment of HIV/AIDS [72]. AIDS
activists argued strongly that official support for uBhejane (along with other
traditional treatments), created confusion in the minds of South Africans as to the
value of ART [46,73].

While there have been attempts by the national and provincial governments in
South Africa to train traditional healers in HIV/AIDS awareness, the funding allocated
to such efforts has been limited and, as a result, the rollout of appropriately trained
healers has been inadequate [74]. Much of the training that has occurred has been
left to NGOs. This is problematic; evidence suggests that many traditional healers
remain poorly informed about HIV/AIDS. A study published in the South African
Medical Journal in 2004 estimated that only 6.25 percent of traditional healers had
undergone government-funded HIV/AIDS awareness training [74]. Furthermore,
where government training has been provided, the results have, at times, been
disappointing, with significant numbers of healers still professing a belief that
HIV/AIDS can be cured [46]. Additional studies have also pointed to the continuation
of HIV/AIDS risk-associated practices, such as the use of unsterilized equipment for
the administering of enemas and the use of single blades for the scarification of
multiple patients [75]. That said, the South African Medical Journal study showed
that traditional healers were increasingly demonstrating a willingness to promote
condom usage and to stress the dangers of unprotected sex with multiple partners
[74].

Go to:

10. Conclusions

This paper is not intended as a study of either the efficacy of traditional healing or
alternative belief systems. Rather, it is an attempt to move beyond the usual calls
for better understanding between traditional healers and biomedical practitioners in
South Africa. These generic calls do little to shift the debate past the above very
basic point. Using the Native American experience as an analytical framework, the
paper has sought to understand how meaningful accommodation might be
accomplished in an instance where a degree of this has already been achieved. The
evidence suggests that the IHS, in acknowledging the importance of culturally-
sensitive approaches to HIV/AIDS treatment, has found room for traditional healers
within the formal structures of the system. In stressing the complementary potential
of traditional and biomedical systems, IHS policymakers have eased the historical
tension between the two sectors. In the South African case, the discourse reflects
many of the unresolved tensions that continue to emanate from the colonial and
apartheid legacies; an adversarial tone is immediately obvious in many aspects of
the debate. The HIV/AIDS pandemic in particular, and the politicised narrative that
emerged from it, has served to entrench yet further the distance between the two
systems. Consequently, in South Africa, the two systems are often presented as an
either-or scenario. If the South African government is serious about its
engagement with the merits of traditional healing, as opposed to using the sector to
offset deficiencies in public health spending or to redress aspects of the injustices of
apartheid, then the current dichotomy of medical choice is an issue that must be
addressed. In this regard, the IHS model offers a useful starting point. Importantly,
for all concerned in the policymaking sphere, there needs to be a shift away from
any attempts to create equivalence, towards an acceptance of each system on its
own merits. Dickinsons bilingual medical-traditional dictionary analogy is useful
in this respect [23]; it is only the abandoning of the contemporary emphasis on
syncretism that will enable further progression towards a viable form of
accommodation. The identification of biomedical equivalence, double-blind clinical
trials, and attempts at the codification of traditional healing (and traditional
medicine) and its best practice, misses the point. For its proponents, the value of
traditional healing lies elsewhere. In essence, the evaluation of traditional healing
within an assessment framework that is itself a product of the evolution of the
biomedical sector condemns the traditional sector from the outset; its practice will
always be viewed by stakeholders within the formal healthcare sector as, at best,
misinformed. Open acknowledgement of the integral aspects of much traditional
healing that are, at present, downplayed in the interests of shoring up its position
within a biomedical frameworkthat it is not rational, that it is not based on
scientific principles, and that it is not falsifiablerepresent, somewhat counter-
intuitively, the best means of bringing the sectors closer together.

Go to:

Acknowledgements

The author would like to gratefully acknowledge the British Academys funding of
the fieldwork undertaken during 2010. The author is also grateful to Dr. Jill Payne
(University of Cambridge) for her advice and input in developing the paper, and
Professor Sarah Childs (University of Bristol) for her valuable insights early on in the
process.

Go to:
Conflicts of Interest

The author declares no conflicts of interest.

Go to:

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From Goffman's classic sociological work on stigma to Sontag's popular works on

metaphors, stigma has captured academic and general public interest. The severity
of the AIDS pandemic has transformed our lives profoundly, and the stigma
experienced by persons with AIDS has grave consequences for public health efforts.
Fears of the consequences of open discourse and self-identification have created a
silence that threatens all of us. Using analyses of Western imagery and African
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posed to stimulate discussion of future ethnographic work on illness and stigma in
Africa. The paper concludes with a discussion of the impact on public health of four
types of AIDS stigmatization: theologically-based blame, liberal concern for the
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point of view of enlightened management of public health, the civil rights issue
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rest of society, interferes with the development of large-scale, effective public
health programs

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Introduction to recent developments in HIV epidemic modeling

Wilson, David P; Garnett, Geoffrey P

Current Opinion in HIV & AIDS:

March 2011 - Volume 6 - Issue 2 - p 9193

doi: 10.1097/COH.0b013e328343c02e

Epidemic modelling: Edited by Geoffrey Garnett and David P. Wilson

Author Information

This issue of Current Opinion in HIV/AIDS addresses recent developments in the

increasingly common and influential field of epidemic modeling. Modeling has
become a powerful tool to assist public health authorities interpret local surveillance
data to understand past and current epidemiological trends (Hallett et al., pp. 102
107) and evaluate the potential impact of future strategies to reduce levels of
transmission and burden of infection in populations (Abbas, pp. 114118).
Therefore, HIV epidemic models have provided substantial input into decision-
making processes to inform the development of policies and practices at local and
international levels (Stover, pp. 108113). In order to develop models that are
realistic and useful, utilizing and interpreting the best data available, it has become
important for modelers to establish collaborative partnerships across numerous
disciplines including the social sciences (Cassels and Goodreau, pp. 119123). This
fact has been demonstrated with models that have been applied to key population
groups, such as MSM in industrialized settings for whom quality input data and
access to the best clinical care has enabled the development of models that
incorporate new levels of detail about the future of prevention, treatment and care
that may not yet be feasible and realistic for other populations (Wilson and Zhang,
pp. 94101). The widespread availability of antiretroviral (ARV) therapies defined a
new era of health experienced by people living with HIV but also the need to
understand and plan for the management of drug resistance. Models of the
emergence and transmission of drug-resistant strains of HIV have been an area of
focus in recent years, but future modeling will need to continue to better
understand the public health implications of predicted levels of resistance and
emphasize the simultaneous effects of multiple ARV interventions on resistance
emergence and spread (Baggaley, pp. 131140). In order to understand the
complex nature of the impact of treatment on individuals and populations, recent
developments have started to involve the design and analysis of sophisticated
models that describe the impact of use of specific ARV drug regimens including their
associated toxicities and side-effects (Phillips and Cambiano, pp. 124130). The
current issue was formulated through the invitation of leading HIV modeling groups
to contribute papers that summarize significant recent modeling literature over
these relevant topics and provide indications of future directions in HIV epidemic
modeling.

The prevalence of infection in a population is one of the best indicators for the
burden of infection/disease at a population level. However, trends in prevalence are
not good measures for the effectiveness of public health programs and the extent of
current transmission. Ideally, access to ARV therapies that keep HIV-infected people
alive should lead to prevalence levels that are stable or even increasing. Incidence,
as the rate of new transmissions, is the most important epidemiological measure for
understanding the extent of transmission in a population. However, it is very
difficult and costly to calculate incidence from cohort studies and incidence assays
are not necessarily appropriate in all settings. In many (particularly developing)
countries routine public health surveillance of HIV involves the collection of
prevalence estimates from serial cross-sectional surveys. Therefore, modeling has
been used in an important practical manner to interpret prevalence trends and infer
incidence rates. Hallett et al. (pp. 102107) have reviewed the recent developments
in this area of modeling and their valuable contributions to public health
surveillance and evaluation for informing policy and practice. Their review also
summarizes new statistical methods that have been developed to improve the
accuracy and interpretation of incidence assays in an unbiased way. Recent
developments in these algorithms along with epidemiological and incidence assay
methods for measuring incidence could largely transform the way in which public
health surveillance of HIV is carried out in many parts of the world.
Public health responses in particular settings require understanding of current
epidemic patterns and information about the effectiveness of potential new
interventions. Randomized controlled trials are the best standard for providing
evidence of efficacy of a particular intervention. However, clinical trials are not
designed to measure the long-term impact of the intervention or the population-
level impact when scaled up in a broader population. Consequently, in preparation
for the release, or upon release, of trial results, mathematical models are often used
to extrapolate localized study findings to broader implications if the intervention of
interest is scaled up to entire or targeted populations. When models are developed
and used appropriately, they are powerful advocacy tools to insightfully inform
policies and programs. Abbas (pp. 114118) provided a summary of various
biomedical interventions for preventing sexually transmitted HIV; these
interventions include male circumcision, ARV preexposure prophylaxis, vaccines,
treatment of other sexually transmissible infections and condoms. After reviewing
the empirical evidence, Abbas (pp. 114118) reviewed recent modeling studies that
provide qualitative and quantitative insights regarding the epidemiological impact
of the uptake of biomedical interventions, singly and/or in combination.

It can be difficult to draw overarching conclusions from the large number of

modeling studies that are often produced to examine most intervention strategies.
This is due to inconsistencies in model assumptions, applications to different
settings, and differences in the ways in which results are reported. Stover (pp. 108
113) reviewed recent modeling activities with the objective of informing decision
making in HIV policy and programs, particularly applied to global strategies. He
outlined examples of consensus-forming activities across numerous modeling
groups in order to draw appropriate and consistent conclusions and provide a better
knowledge base for international and national decision makers. Such
communicative channels or formation of modeling consortiums will likely become
increasingly important for modelers. This situation will enable the modeling field to
be most effective in translating empirical trial outcomes into clear messages that
genuinely assist public health decision making to maximize prevention efforts.

Models are only as good as the behavioral, biological, clinical, and epidemiological
assumptions on which they are based. The data collected from sociobehavioral
researchers are of particular importance when a model is being applied to a specific
population. The integration between sociobehavioral researchers and modelers is a
fundamental relationship for the production of effective modeling studies. However,
this partnership is generally underdeveloped. The review by Cassels and Goodreau
(pp. 119123) addressed the integration of these complementary disciplines and
how modeling has added value and been informed by sociobehavioral research. In
addition to providing examples of how models have elucidated the importance of
relational concurrency and evaluated the effectiveness of serosorting, Cassels and
Goodreau reflected on how mathematical modeling in social and behavioral
research is useful for effectively targeting interventions to prevent new infections
and how modeling can theoretically test the expected epidemiological impact of
behavior change incorporating coverage, impact, and duration of intervention in
ways that are not possible or feasible to explore empirically.

Wilson and Zhang (pp. 94101) provided an overview of the latest developments in
mathematical transmission modeling of HIV epidemics among MSM and people who
inject drugs (PWIDs). Models have recently been used to evaluate the effectiveness
and costeffectiveness of harm reduction programs among PWIDs. Future models
applied to populations of PWIDs may not be particularly scientifically novel but are
likely to be of large practical significance for establishing evidence to change
difficult legislature and advocate for effective programs in many countries. Due to
the quality of clinical care, health, and research data associated with MSM living
with HIV residing in resource-rich settings, mathematical models have been utilized
to explore innovative areas in clinical, biomedical, and public health research that
cannot be conducted in other population groups. Future directions are likely to
include evaluation of sociobehavioral characteristics and public health programs,
specific treatment regimens, and forecast the incidence and interaction of comorbid
conditions that will affect aging populations of people living with HIV.

Baggaley (pp. 131140) reviewed recent transmission modeling studies that have
investigated ARV resistance in the context of therapeutic combination ART (cART),
ARV-based vaginal microbicides (ARV-VMBs), and oral preexposure prophylaxis
(PrEP). Early studies focused on MSM and PWIDs but more recently models have
been applied to a wide variety of settings and clinical environments around the
world. Modeling of cART resistance appears to have been more useful in providing
qualitative insights than accurate quantitative predictions on expected levels of
resistance in the long term. It has also been useful in providing guidelines around
establishment of surveillance systems for regular management and monitoring of
people who use ARVs for treatment or prevention. The literature on resistance in
industrialized countries may not be readily generalizable to resource-poor settings
and interpretation of clinical data to form assumptions of these models may require
more scrutiny and exploration in future developments. This should occur as the field
moves more toward the investigation of specific drug combinations and the
simultaneous effects of multiple ARV-based interventions on resistance emergence
and spread.
Phillips and Cambiano (pp. 124130) provided a summary of modeling studies that
have explored the impact of treatment with individual ARVs. Many mathematical
models developed to date are deterministic compartmental models and do not have
the level of detail of specific effects of individual drugs. Dynamic individual-based
stochastic models have recently been employed to assess the use of different drug
regimens in a population in terms of their costeffectiveness, benefits, and harms
(toxicities, side-effects, resistance profiles), and to estimate long-term outcomes
that are generally not able to be measured within a trial. As Phillips and Cambiano
expound, HIV epidemic models have tended to focus on issues specific to outcomes
in the treated person or have considered HIV transmission dynamics but not both
aspects. Some future models will likely include individual-level outcomes (including
specific mutations, immunological and virological status related to adherence levels,
etc.) as well as transmission between people and subsequent population-level
outcomes (including outcomes that are directly and indirectly related to HIV
infection). More detail should mean more realism but also greater technical
complexity in model development and calibration against the many outcomes that
may be represented by these models. However, possibly a significant trade-off is
that these complex models can become much less transparent and reproducible. At
the same time, some research questions require a high level of detail and therefore
complexity. Complex models will be used to provide quantitative precision, whereas
simple models are useful for providing qualitative insight.

HIV epidemic modeling has become a valuable and mainstream discipline within the
HIV research community. Modelers will continue to be called upon to investigate
implications of empirical findings. But the modeling community will also continue to
create innovative ideas based on interpretations and extrapolations of current
evidence, evaluate complex systems of a wide variety of interacting factors, and
explore hypothetical scenarios in preparation for future biomedical developments

Treating HIV

There is no cure for HIV, but there are treatments to enable most people with the
virus to live a long and healthy life.

Emergency HIV drugs

If you think you have been exposed to the virus within the last 72 hours (three
days), anti-HIV medication may stop you becoming infected.

For it to be effective, the medication, called post-exposure prophylaxis or PEP, must

be started within 72 hours of coming into contact with the virus. It is only
recommended following higher risk exposure, particularly where the sexual partner
is known to be positive.

The quicker PEP is started the better, ideally within hours of coming into contact
with HIV. The longer the wait, the less chance of it being effective.

PEP has been misleadingly popularised as a morning-after pill for HIV a

reference to the emergency pill women can take to prevent getting pregnant after
having unprotected sex.

But the description is not accurate. PEP is a month-long treatment, which may
have serious side effects and is not guaranteed to work. The treatment involves
taking the same drugs prescribed to people who have tested positive for HIV.

You should be able to get PEP from:

sexual health clinics, or genitourinary medicine (GUM) clinics

hospitals usually accident and emergency (A&E) departments

If you already have HIV, try your HIV clinic if the PEP is for someone youve had sex
with.

Want to know more?

Terrence Higgins Trust: post-exposure prophylaxis (PEP)

If you test positive

If you are diagnosed with HIV, you will have regular blood tests to monitor the
progress of the HIV infection before starting treatment.

This involves monitoring the amount of virus in your blood (viral blood test) and the
effect HIV is having on your immune system. This is determined by measuring your
levels of CD4+ve lymphocyte cells in your blood. These cells are important for
fighting infection.

Treatment is usually recommended to begin when your CD4 cell count falls towards
350 or below, whether or not you have any symptoms. In some people with other
medical conditions, treatment may be started at higher CD4 cell counts. When to
start treatment should be discussed with your doctor.

The aim of the treatment is to reduce the level of HIV in the blood, allow the
immune system to repair itself and prevent any HIV-related illnesses.

If you are on HIV treatment, the level of the virus in your blood is generally very low
and it is unlikely that you will pass HIV on to someone else.

Want to know more?

namlife (aidsmap.com): Why monitor CD4 and viral load?

namlife (aidsmap.com): When to start treatment?

If you have another condition

If you have also been diagnosed with hepatitis B or hepatitis C, it is recommended

that you start treatment when your CD4 count falls below 500.

Treatment is recommended to begin at any CD4 count if you are on radiotherapy or

chemotherapy that will suppress your immune system, or if you have been
diagnosed with certain other illnesses, including:

tuberculosis

HIV-related nephropathy (kidney disease)

HIV-related neurocognitive (brain) illnesses

Want to know more?

nam (aidsmap.com): Starting treatment if you have another condition

Antiretroviral drugs

HIV is treated with antiretrovirals (ARVs), these work by stopping the virus
replicating in the body, allowing the immune system to repair itself and preventing
further damage.

A combination of ARVs is used because HIV can quickly adapt and become resistant
to one single ARV.

Patients tend to take three or more types of ARV medication. This is known as
combination therapy or antiretroviral therapy (ART).

Some antiretroviral drugs have been combined into one pill, known as a "fixed dose
combination". This means that the most common treatments for people just
diagnosed with HIV involve taking just one or two pills a day.

Different combinations of ARVs work for different people so the medicine you take
will be individual to you.

Once HIV treatment is started, you will probably need to take the medication for the
rest of your life. For the treatment to be continuously effective, it will need to be
taken regularly every day. Not taking ARVs regularly may cause the treatment to
fail.
Many of the medicines used to treat HIV can interact with other medications
prescribed by your GP or bought over-the-counter. These include herbal remedies
such as St John's Wort, as well as recreational drugs.

Always check with your HIV clinic staff or your GP before taking any other
medicines.

Want to know more?

nam: Anti-HIV drugs (PDF, 1.37Mb)

Terrence Higgins Trust: Treatment for HIV

HIV i-Base: Introduction to combination therapy

Pregnancy

ARV treatment is available to prevent a pregnant woman from passing HIV to her
child.

Without treatment, there is a one in four chance your baby will become infected
with HIV. With treatment, the risk is less than one in 100.

Advances in treatment mean there is no increased risk of passing the virus to your
baby with a normal delivery. However, for some women, a caesarean section may
still be recommended.

If you have HIV, do not breastfeed your baby because the virus can be transmitted
through breast milk.

If you or your partner has HIV, speak to an HIV doctor as there are options for safely
conceiving a child without putting either of you at risk of infection.

Missing a dose

HIV treatment only works if you take your pills regularly every day. Missing even a
few doses will increase the risk of your treatment not working.

You will need to develop a daily routine to fit your treatment plan around your
lifestyle.

Want to know more?

nam: Adherence & resistance (PDF, 1Mb)

Side effects

HIV treatment can have side effects. If you get serious side effects (which is
uncommon) you may need to try a different combination of ARVs.
Common side effects include:

nausea

diarrhoea

skin rashes

sleep difficulties