Experiences of people living with HIV/AIDS in a plural health care system: probing tensions and complexities.

Abstract

HIV/AIDS is treated biomedically. People living with HIV (PLHIV) are expected to strictly adhere to active antiretroviral treatment (ART) prescribed by biomedical health practitioners in order to “progress” on the cascade of care. Poor progression on the cascade of care, however, has been shown to exist amongst PLHIV. The use of multiple health systems – biomedicine, traditional healing and religious healing, known as medical pluralism, has been said to be a contributing factor in the poor adherence to HIV testing and treatment. Some PLHIV, however, have been shown to be in care while practicing medical pluralism. Thus, this study explores the experiences of such PLHIV in their practice of medical pluralism, especially how navigate the systems and treatments utilised. This study was conducted at the Hlabisa sub-District, a rural area in uMkhanyakude District of KwaZulu-Natal, South Africa, though qualitative ethnography. Eighteen participants were recruited using theoretical and purposive sampling. Nine PLHIV were the primary participants in the study. Of the nine PLHIV, four were also traditional healers. The other nine participants, made up of five biomedical healthcare practitioners, three traditional healers and one faith/religious healer, were the secondary participants. The study found that the PLHIV in the study consciously made concurrent, parallel or sequential use of plural healthcare for various health conditions when they believed such conditions can best or only be treated using specific health systems. None of the participants sought to “treat” or “cure” HIV using health systems outside biomedicine. The study found that some of the participants refused initiation into ART due to the attitude of the biomedical health practitioners towards the participants’ use of plural health. Primary participants who maintained their ART all reported to have had suppressed viral loads and high CD4 counts. Their health-seeking behaviours can be seen as an expression of their agency. Hence, rather than excluding them from using basic primary health services due to their plural health use, a better understanding and appreciation of their reasons, motivations, and manners of practising medical pluralism is needed. This will aid in the development of health programmes that better cater for their health needs.