Journal of Community Health

, Volume 34, Issue 1, pp 16–22 | Cite as

The Cultural and Community-Level Acceptance of Antiretroviral Therapy (ART) Among Traditional Healers in Eastern Cape, South Africa

  • Justin M. ShusterEmail author
  • Claire E. Sterk
  • Paula M. Frew
  • Carlos del Rio
Original Paper


The HIV/AIDS epidemic has profoundly impacted South Africa’s healthcare system, greatly hampering its ability to scale-up the provision of antiretroviral therapy (ART). While one way to provide comprehensive care and prevention in sub-Saharan African countries has been through collaboration with traditional healers, long-term support specifically for ART has been low within this population. An exploratory, qualitative research project was conducted among 25 self-identified traditional healers between June and August of 2006 in the Lukhanji District of South Africa. By obtaining the opinions of traditional healers currently interested in biomedical approaches to HIV/AIDS care and prevention, this formative investigation identified a range of motivational factors that were believed to promote a deeper acceptance of and support for ART. These factors included cultural consistencies between traditional and biomedical medicine, education, as well as legal and financial incentives to collaborate. Through an incorporation of these factors into future HIV/AIDS treatment programs, South Africa and other sub-Saharan countries may dramatically strengthen their ability to provide ART in resource-poor settings.


HIV/AIDS Highly active antiretroviral therapy African traditional medicine ART scale-up 



This study was supported by a fellowship grant from the Rollins School of Public Health to the first author. The authors would like to thank and acknowledge the staff at Africare, South Africa. We are especially grateful to Joan Littlefield and Joyce Mandindi for their support and contribution to this study. Additional support was provided by the Emory Center for AIDS Research (P30 AI050409) and the Emory HIV/AIDS Clinical Trials Unit (U01 AI069418).


  1. 1.
    UNAIDS (2006). Sub-Saharan Africa: 2006 AIDS Epidemic Update. Accessed November 15, 2006.Google Scholar
  2. 2.
    Padarath, A., Chamberlain, C., McCoy, D., Ntuli, A., Rowson, M., & Loewenson, R. (2003). Health Personnel in Southern Africa: Confronting misdistribution and brain drain. Health Systems Trust. Equinet Discussion Paper No. 3.Google Scholar
  3. 3.
    McCoy, D. (2003). Health sector response to HIV/AIDS and treatment access in Southern Africa. Health Systems Trust. Equinet Discussion Paper No. 10.Google Scholar
  4. 4.
    Berthiasume, L. (2003). A system in crisis. Mail and guardian. Johannesburg: M&G Media Ltd. 27 June to 3 July.Google Scholar
  5. 5.
    Shisana, Olive. (2003). The impact of HIV/AIDS on the health sector: National survey of healthcare personnel, ambulatory and hospitalised patients and health facilities, South Africa. Human Sciences Research Council,131–134.Google Scholar
  6. 6.
    World Health Organization. (2006). Progress on global access to HIV antiretroviral therapy: A report on 3 by 5 and beyond. Geneva, March 28.
  7. 7.
    Homsy, J., King, R., Balaba, D., & Kabatesi, D. (2004). Traditional health practitioners are key to scaling up comprehensive care for HIV/AIDS in sub-Saharan Africa. AIDS, 18(12), 1723–1725.PubMedCrossRefGoogle Scholar
  8. 8.
    UNAIDS. (2002). Ancient remedies new disease: Increasing access to AIDS prevention and care in collaboration with traditional healers. Geneva: UNAIDS Best Practices Collection.Google Scholar
  9. 9.
    Wreford, J. (2005). We can help! A literature review of current practice involving traditional African Healers in biomedical HIV/AIDS interventions in South Africa. CSSR Working Paper 108. Cape Town: University of Cape Town: Centre for Social Science Research.Google Scholar
  10. 10.
    Wreford, J. (2005). Missing each other: Problems and potential for collaborative efforts between biomedicine and traditional healers in South Africa in the time of AIDS. Social Dynamics, 31(2), 55–89.CrossRefGoogle Scholar
  11. 11.
    Giarelli, E., & Jacobs, L. A. (2003). Traditional healing and HIV-AIDS in KwaZulu-Natal, South Africa: To curb the epidemic, South African nurses, physicians, and traditional healers are learning to collaborate. American Journal of Nursing, 103(10), 33–46.Google Scholar
  12. 12.
    Bodeker, G., Kabatesi, D., King, R., & Homsy, J. (2000). A regional task force on traditional medicine and AIDS. Lancet, 355(9211), 1284.PubMedCrossRefGoogle Scholar
  13. 13.
    Peltzer, K. (2003). HIV/AIDS/STI knowledge, attitudes, beliefs and behaviours in a rural South African adult population. South African Journal of Psychology, 33(4), 250–260.Google Scholar
  14. 14.
    Peltzer, K., Mngqundaniso, N., & Petros, G. (2005). HIV/AIDS/STI/TB knowledge, beliefs and practices of traditional healers in KwaZulu-Natal, South Africa. AIDS Care, 18(6), 608–613.CrossRefGoogle Scholar
  15. 15.
    Munk, K. (1998). Traditional healers and HIV/AIDS in KwaZulu-Natal: An interim report. Traditional Medicine. AIDS Analysis Africa, 8(5), 7–9.Google Scholar
  16. 16.
    Ssaili, A., Butler, L., Kabatesi, D., King, R., Namugenyi, A., Kamya, M., et al. (2005). Traditional healers for HIV/AIDS prevention and family planning, Kiboga District, Uganda: Evaluation of a program to improve practices. AIDS and Behavior, 9(4), 485–493.CrossRefGoogle Scholar
  17. 17.
    Burnett, A., Baggaley, R., Ndovi-MacMillan, M., Sulwe, J., Hang’omba, B., & Bennett, J. (1999). Caring for people with HIV in Zambia: Are traditional healers and formal health workers willing to work together? AIDS Care, 11(4), 481–491.PubMedCrossRefGoogle Scholar
  18. 18.
    Chirwa, B., & Sivile, E. (1989). Enlisting the support of traditional healers in AIDS education campaign in Zambia. International Quarterly of Community Health Education, 9(3), 223–231.Google Scholar
  19. 19.
    King, R., & Homsy, J. (1997). Involving traditional healers in AIDS education and counselling in sub-Saharan Africa: A review. AIDS, 11(Supl. A), S217–S225.PubMedGoogle Scholar
  20. 20.
    Green, E. (1992). Sexually transmitted disease ethnomedicine and health policy in Africa. Social Science and Medicine, 2(35), 121–130.Google Scholar
  21. 21.
    Liddell, C., Barrett, L., & Bydawell, M. (2005). Indgenous representations of illness and AIDS in sub-Saharan Africa. Social Science and Medicine, 60(4), 692–695.Google Scholar
  22. 22.
    Ngubane, H. (1977). Body and mind in Zulu medicine an ethnography of health and disease in Nyuswa-Zulu thought and practice. London: Academic Press.Google Scholar
  23. 23.
    Green, E., & Makhubu, L. (1984). Traditional healers in Swaziland: Toward improved cooperation between the traditional and modern health sectors. Social Science and Medicine, 18(12), 1071–1079.PubMedCrossRefGoogle Scholar
  24. 24.
    Ashforth, A. (2002). An epidemic of witchcraft? Implications of AIDS for the post-apartheid state. African Studies, 61(1), 121–143.CrossRefGoogle Scholar
  25. 25.
    Minister of Health. (2003). Traditional health practitioners bill. Republic of South Africa.Google Scholar
  26. 26.
    Mills, E., Singh, S., Wilson, K., Peters, E., Onia, R., & Kanfer, I. (2006). The Challenges of involving traditional healers in HIV/AIDS care. International Journal of STD & AIDS, 17(6), 360–363.CrossRefGoogle Scholar
  27. 27.
    Comaroff, J. (1978). Medicine and culture some anthropological perspectives. Social Science and Medicine, 12(4B), 247–254.Google Scholar
  28. 28.
    Green, E. (1997). Is there a basis for modern-traditional cooperation in African health promotion? Journal of Alternative and Complimentary Medicine, 3(4), 311–314.CrossRefGoogle Scholar
  29. 29.
    Bateman, C. (2004). Healers ‘get real’ about tackling AIDS. South African Medical Journal, 94(2), 74–75.PubMedGoogle Scholar
  30. 30.
    Richter, M. (2003). Traditional medicines and traditional healers in South Africa. AIDS Law Project. [].

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Justin M. Shuster
    • 1
    Email author
  • Claire E. Sterk
    • 2
  • Paula M. Frew
    • 1
  • Carlos del Rio
    • 1
  1. 1.The Hope Clinic of the Emory Vaccine CenterDecaturUSA
  2. 2.Rollins School of Public HealthAtlantaUSA

Personalised recommendations