Skip to main content

Advertisement

SpringerLink
Log in

Patterns and Implications of Medical Pluralism Among HIV/AIDS Patients in Rural South Africa

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

In some societies, medical pluralism has been demonstrated to delay access to care. We identified sources of health care, and explored utilization patterns and triggers of care-seeking behavior among HIV/AIDS patients in rural South Africa. A longitudinal qualitative study consisting of in-depth interviews was conducted. We purposively sampled thirty-two adult HIV clinic attendees. A high degree of medical pluralism occurred among participants before initiation of antiretroviral treatment (ART). After ART initiation, participants predominantly used the HIV/ART clinic, and utilization of private and traditional facilities decreased. Patterns included both concurrent and sequential pathways to public, private and traditional health sectors. HIV diagnosis and treatment were delayed despite early contact with health systems. Therefore, use of multiple health care modalities before ART initiation can lead to delayed HIV testing and ART initiation. Integrated-care has the potential to mitigate the impact of medical pluralism on access to HIV-related services over the longer term.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. UNAIDS. Report on the global AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2008.

  2. Shisana O, Rehle T, Simbayi L, et al. South African national HIV prevalence, incidence, behaviour and communication survey 200: a turning tide among teenagers? Cape Town: HSRC Press; 2009.

  3. UNAIDS. Epidemiological fact sheet on HIV and AIDS, South Africa, September 2008 Update. Geneva: UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance; 2009.

  4. Kahn K, Garenne ML, Collinson MA, Tollman SM. Mortality trends in a new South Africa: hard to make a fresh start. Scand J Public Health. 2007;35(Suppl 69):26–34.

    Article  Google Scholar 

  5. National Department of Health. South African national Antiretroviral treatment guidelines. Pretoria: NDOH; 2004.

  6. Montaner J, Hogg R, Wood E, et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet. 2006;368:531–6.

    Article  PubMed  Google Scholar 

  7. De Cock K, Grubb I. Towards Universal access: WHO’s role in HIV prevention, treatment and care. Bull World Health Organ. 2006;84(7):506–7.

    Article  PubMed  Google Scholar 

  8. Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. Health in South Africa 1. The health and health system of South Africa: historical roots of current public health challenges. Lancet. 2009;374(9692):817–34.

    Article  PubMed  Google Scholar 

  9. Mcintyre D, Gilson L, Wadee H, Thiede M, Okarafor O. Commercialisation and extreme inequality in health: The policy challenge in South Africa. J Int Dev. 2006;18:435–46.

    Article  Google Scholar 

  10. Goudge J, Gilson L, Russell S, Gumede T, Mills A. Affordability, availability and acceptability barriers to health care for the chronically ill: longitudinal case studies from South Africa. BMC Health Serv Res. 2009;9:75.

    Google Scholar 

  11. Habtom KG, Ruys P. The choice of a health care provider in Eritrea. Health Policy. 2007;80:202–17.

    Article  PubMed  Google Scholar 

  12. Maman S, Abler L, Parker L, et al. A comparison of HIV stigma and discrimination in five international sites: the influence of care and treatment resources in high prevalence settings. Soc Sci Med. 2009;68:2271–8.

    Article  PubMed  Google Scholar 

  13. Natrass N. The (political) economics of antiretroviral treatment in developing countries. Trends Microbiol. 2008.

  14. Tsai AC, Chopra M, Pronyk PM, Martinson NA. Socioeconomic disparities in access to HIV/AIDS treatment programs in resource-limited settings. AIDS Care. 2009;21(1):59–63.

    Article  PubMed  Google Scholar 

  15. Department of Health. Draft policy on African traditional medicine for South Africa. Government Gazette. Pretoria: Department of Health; 2008.

  16. Cant S, Sharma U. A new medical pluralism? Alternative medicine, doctors, patients and the state:London: UCL Press; 1999.

  17. Gilbert L. Medical pluralism in action? A case study of community pharmacies in Johannesburg, South Africa. J Altern Complement Med. 2004;10(3):547–55.

    Article  PubMed  Google Scholar 

  18. Gilbert L, Selikow T, Walker L. Society, health and disease. Johannesburg: Raven Press/McMillan; 2002.

  19. Janzen JM. The quest for therapy: medical pluralism in lower Zaire. California: University of California Press; 1982.

  20. Nyamongo I. Health care switching behaviour of Malaria patients in a Kenyan rural community. Soc Sci Med. 2002;54:377–86.

    Article  PubMed  CAS  Google Scholar 

  21. De Graft Aikins A. Healer Shopping in Africa: new evidence from rural-urban qualitative study of Ghanaian Diabetes experiences. Br Med J. 2005;331(7519):737–42.

    Article  Google Scholar 

  22. Hausmann-Muela S, Muela-Ribera J, Mushi AK, Tanner M. Medical Syncretism with reference to Malaria in a Tanzanian community. Soc Sci Med. 2002;55:403–13.

    Article  Google Scholar 

  23. Kroeger A. Anthropological and socio-medical health care research in developing countries. Soc Sci Med. 1983;17(3):147–61.

    Article  PubMed  CAS  Google Scholar 

  24. Mackian S, Bedri N, Lovel H. Up the garden path and over the edge: where might health-seeking behaviour take us? Health Policy Plan. 2004;19(3):137–46.

    Article  PubMed  Google Scholar 

  25. Uphold C, Mkanta W. Use of health care services among persons living with HIV infection: state of the science and future directions. AIDS Patient Care STDS. 2005;19(8):473–85.

    Article  PubMed  Google Scholar 

  26. Mkanta W, Uphold C. Theoretical and methodological issues in conducting research related to health care system utilization among individuals with HIV infection. AIDS Patient Care STDS. 2006;20(4):293–303.

    Article  PubMed  Google Scholar 

  27. Okello E, Neema S. Explanatory models and help-seeking behavior: pathways to psychiatric care among patients admitted for depression in Mulago Hospital, Kampala, Uganda. Qual Health Res. 2007;17(1):14–25.

    Article  PubMed  Google Scholar 

  28. Moodley K. Mpumalanga Province. In: Barron P, Day C, Monticelli F, editors. The district health barometer 2007/08. Durban: Health Systems Trust; 2007.

    Google Scholar 

  29. National Department of Health. The national HIV and syphilis prevalence survey of South Africa. Pretoria: Department of Health; 2008.

  30. Creswell JW, Miller DL. Determining validity in qualitative inquiry. Theory Practice. 2000;39(3):124–30.

    Google Scholar 

  31. Rosen S, Fox M, Gill C. Patient retention in antiretroviral therapy programs in Sub-Saharan Africa: a systematic review. PLoS Med. 2007;4(10):1691–700.

    Article  Google Scholar 

  32. MacPherson P, Moshabela M, Martinson N, Pronyk P. Mortality and loss to follow-up among HAART initiators in rural South Africa. Trans R Soc Med Hyg. 2009;103(6):588–93.

    Article  Google Scholar 

  33. MacLachlan M, Carr S. Managing the AIDS crisis in Africa: in support of pluralism. J Manag Med. 1994;8(4):45.

    Article  PubMed  CAS  Google Scholar 

  34. Ross E. Traditional healing in South Africa. Soc Work Health Care. 2007;46(2):15–33.

    Article  Google Scholar 

  35. Liddell C, Barrett L, Bydawell M. Indigenous representations of illness and AIDS in Sub-Saharan Africa. Soc Sci Med. 2005;60:691–700.

    Article  PubMed  Google Scholar 

  36. Plummer M, Mshana G, Wamoyi J, et al. ‘The man who believed he had AIDS was cured’: AIDS and sexually-transmitted infection treatment-seeking behaviour in rural Mwanza, Tanzania. AIDS Care. 2006;18(5):460–6.

    Article  PubMed  Google Scholar 

  37. Girardi E, Sabin C, Monforte A. Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing. J Acquir Immune Defic Syndr. 2007;46(S1):S3–S8.

    PubMed  Google Scholar 

  38. Matovu JK, Makumbi FE. Expanding access to voluntary HIV counselling and testing in sub-Saharan Africa: alternative approaches for improving uptake, 2001–2007. Trop Med Int Health. 2007;12(11):1315–22.

    Article  PubMed  Google Scholar 

  39. Bodeker G, Carter G, Burford G, Dvorak-Little M. HIV/AIDS: traditional systems of health care in the management of a global epidemic. J Altern Complement Med. 2006;12(6):563–76.

    Article  PubMed  Google Scholar 

  40. Tilburt JC, Miller FG. Responding to medical pluralism in practice: a principled ethical approach. J Am Board Fam Med. 2007;20:489–94.

    Article  PubMed  Google Scholar 

  41. Hatchett L, Kaponda C, Chihana C, et al. Health-seeking patterns for AIDS in Malawi. AIDS Care. 2004;16(7):827–33.

    Article  PubMed  CAS  Google Scholar 

  42. Cleary S, Boulle A, Castillo -Riquelme M, Mcintyre D. The burden of HIV/AIDS in the public healthcare system. S Afr J Econ. 2008;76(01):S3–14.

    Article  Google Scholar 

  43. Ryan G. What do sequential behavioral patterns suggest about the medical decision-making process? Modelling home case management of acute illnesses in a rural Cameroonian village. Soc Sci Med. 1998;46(2):209–25.

    Article  PubMed  CAS  Google Scholar 

  44. Hausmann-Muela S, Muela-Ribera J, Tanner M. Fake malaria and hidden parasites-the ambiguity of malaria. Anthropol Med. 1998;5(1):43–61.

    Article  Google Scholar 

  45. Kleinman A. Patients and healers in the context of culture. Berkeley: University of California Press; 1980.

  46. Peltzer K. Patient experiences and health system responsiveness in South Africa. BMC Health Serv Res. 2009;9:117.

    Article  PubMed  Google Scholar 

  47. Bonjour MA, Montagne M, Zambrano M, et al. Determinants of late disease-stage presentation at diagnosis of HIV infection in Venezuela: a case-case comparison. AIDS Res Ther. 2008;5:6.

    Google Scholar 

Download references

Acknowledgments

This research was funded in part by a 2005 minority supplement to the Lifespan/Tufts/Brown Center for AIDS Research (P30AI042853) from the National Institute of Allergy And Infectious Diseases. Authors would like to acknowledge the contribution of our research assistant Ms Thembi Matokane, the support offered by staff at Rixile clinic, and we thank all patients who took part in the study.

Author information

Authors and Affiliations

  1. Rural AIDS and Development Action Research (RADAR), University of Witwatersrand, Johannesburg, South Africa

    M. Moshabela & P. Pronyk

  2. School of Public Health, University of Witwatersrand, Johannesburg, South Africa

    M. Moshabela

  3. Earth Institute, Columbia University, New York, USA

    P. Pronyk

  4. University of Pittsburgh School of Medicine, Pittsburgh, USA

    N. Williams

  5. Department of Public and Family Medicine, University of Cape Town, Cape Town, South Africa

    H. Schneider

  6. Brown University Medical School, Rhode Island, USA

    M. Lurie

  7. RADAR, Po Box 02, Acornhoek, Mpumalanga, 1360, South Africa

    M. Moshabela

Authors
  1. M. Moshabela
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Pronyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Lurie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Moshabela.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moshabela, M., Pronyk, P., Williams, N. et al. Patterns and Implications of Medical Pluralism Among HIV/AIDS Patients in Rural South Africa. AIDS Behav 15, 842–852 (2011). https://doi.org/10.1007/s10461-010-9747-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-010-9747-3

Keywords

Search

Navigation