AIDS and Behavior

, Volume 19, Issue 1, pp 137–144 | Cite as

Medical Pluralism Predicts Non-ART Use among Parents in Need of ART: A Community Survey in KwaZulu-Natal, South Africa

  • Marija PantelicEmail author
  • Lucie Cluver
  • Mark Boyes
  • Elona Toska
  • Caroline Kuo
  • Mosa Moshabela
Original Paper


Despite documented common use of traditional healers and efforts to scale up antiretroviral treatment (ART) in sub-Saharan Africa, evidence on whether medical pluralism predicts ART use is inconclusive and restricted to clinic settings. This study quantitatively assesses whether medical pluralism predicts ART use among parents in need of ART in South Africa. 2,477 parents or primary caregivers of children were interviewed in HIV-endemic communities of KwaZulu-Natal. Analysis used multiple logistic regression on a subsample of 435 respondents in need of ART, who reported either medical pluralism (24.6 %) or exclusive public healthcare use (75.4 %). Of 435 parents needing ART, 60.7 % reported ART use. Medical pluralism emerged as a persistent negative predictor of ART utilization among those needing it (AOR [95 % CI] = .556 [.344 − .899], p = .017). Use of traditional healthcare services by those who need ART may act as a barrier to treatment access. Effective intersectoral collaboration at community level is urgently needed.


Antiretrovirals ART Traditional healers Medical pluralism South Africa 


A pesar de la documentada existencia del uso de la medicina tradicional y de los esfuerzos realizados por los sistemas nacionales de salud para aumentar el uso de los tratamientos antirretrovirales (TAR) en África subsahariana, la evidencia sobre el efecto predictivo de la pluralidad médica en el uso de TAR es inconcluso y limitado a centros de salud. Este estudio evalúa cuantitativamente si el pluralismo médico predice el uso de TAR en padres que necesitan TAR en Sudáfrica. 2.477 padres o cuidadores primarios de niños fueron entrevistados en comunidades endémicas de VIH en KwaZulu-Natal. Para el análisis se utilizó una regresión logística múltiple en una sub-muestra de 435 cuidadores primarios que necesitaban TAR, de los cuales el 60.7 % informó de su uso. Los encuestados reportaron ser usuarios de ambos sistemas en un 24,6 %, mientras que un 75,4 % informaron ser usuarios exclusivos del sistema nacional de salud. El pluralismo médico emergió como un factor predictivo negativo en la utilización de TAR para padres que necesitan TAR (AOR [IC 95 %] = 0,556 [0,344 a 0,899], p = 0,017). Los resultados sugieren que el uso de la medicina tradicional por parte de personas que necesitan TAR puede actuar como una barrera para el acceso al tratamiento, siendo la eficiente colaboración intersectorial a escala comunitaria de urgente necesidad.



The authors would like to thank the fieldwork teams and the families who welcomed us into their homes. This study was funded by the Economic and Social Research Council (UK), the National Research Foundation (SA), the Health Economics AIDS Research Division (HEARD) at the University of KwaZulu-Natal, the National Department of Social Development (SA), the Claude Leon Foundation and the John Fell Fund. Additional support for CK was made possible by Grant Number K01 MH096646 (PI: Kuo) from the National Institute of Mental Health and Grant Number L30 MH098313 (PI: Kuo) from the National Institutes of Health Division of Loan Repayment. We are also thankful for Rocio Herrero’s and Victor Marin Webb’s Spanish translation of the abstract. MP is grateful for the support from Nevia Pavletic during manuscript preparation.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Marija Pantelic
    • 1
    Email author
  • Lucie Cluver
    • 1
    • 2
    • 3
  • Mark Boyes
    • 1
    • 4
  • Elona Toska
    • 1
  • Caroline Kuo
    • 2
    • 5
  • Mosa Moshabela
    • 6
  1. 1.Department of Social Policy and InterventionUniversity of OxfordOxfordUK
  2. 2.Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
  3. 3.Health Economics and HIV/AIDS Research DivisionUniversity of KwaZulu-NatalDurbanSouth Africa
  4. 4.School of Psychology and Speech PathologyCurtin UniversityPerthAustralia
  5. 5.Department of Behavioral and Social Sciences and Center for Alcohol and Addiction StudiesBrown UniversityProvidenceUSA
  6. 6.Department of Rural Health, School of Nursing and Public HealthUniversity of KwaZulu-NatalDurbanSouth Africa

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