Broadening Notions of AIDS Treatment, Care in Africa

By: Trust for Indigenous Culture and Health (TICAH)

With Rockefeller Foundation support, TICAH hosted a meeting at the Rockefeller Conference Centre in Bellagio, Italy, to discuss strategies for broadening notions of AIDS treatment and care in Africa.

We invited policymakers and donors who shape treatment protocols and funding; program managers, care providers, and researchers involved in AIDS care in Africa; positive treatment activists from Africa; and Rockefeller Foundation staff responsible for the Foundation's HIV/AIDS programs.

Our goals were the following:
1) Ground recommendations for treatment and care in the realities of patients' lives, and in the context of Africa;

2) Identify opportunities for providing optimal AIDS treatment in Africa at all stages of HIV progression, including attention to herbal and traditional medicines;

3) Incorporate the treatment aspirations and choices that positive Africans are making into treatment protocols and funding;

4) Outline the fundamental tenets of comprehensive AIDS treatment in a clear and compelling public statement, and;

5) Determine next steps toward an alliance for action to bring about more inclusive and effective care in Africa.

Twenty-two of us actively participated in the Bellagio gathering. During three full days in this beautiful and protected setting, we shared stories about our own experiences as care seekers and we designed comprehensive prevention, mitigation, care and treatment packages for one African community in order to put our deliberations into their larger context. We discussed the role that traditional healers play in communities and that traditional medicines play in the health care of the majority of positive people in Africa.

We divided into two working groups, each focusing on one area of care which we felt was neglected in current treatment approaches. The first was on positive living, all of the health promotion activities which precede and can delay the need for medical care. The second was on two kinds of research: work to widen the available mix of tested and safe treatments to include traditional and herbal approaches; and research to better understand the ways in which traditional medicines are already being used by positive people and community organizations in Africa, often in tandem with biomedical therapies.

We collectively crafted and unanimously endorsed the following statement and invite others to join us in our next steps toward realizing our shared aim of improving AIDS care and treatment in Africa:

STATEMENT---ACCT-Africa

The Alliance For Comprehensive Care & Treatment of HIV/AIDS in Africa

We believe that the magnitude of the HIV/AIDS crisis in Africa requires that those who are infected with or affected by HIV/AIDS receive the most comprehensive and effective means of care and treatment, within the context of prevention, mitigation, care and treatment efforts worldwide.

All persons coping with HIV/AIDS and their supporters can be empowered to choose the optimal approach for themselves from among all the available methods of care and treatment.

We believe that it is the right of each person living with HIV/AIDS to be informed about the different modalities of care and treatment, including clear and up-to-date information about the strengths and weaknesses of various options. This is essential not only for empowering people for making the best possible choices for their health, but also for reducing the harmful impact of both traditional and allopathic practices.

The unique indigenous assets of each culture - herbal, medicinal, social and spiritual - must be recognized and mobilized in responding to the health challenges posed by HIV/AIDS. Traditional healers are an important part of African communities. Since the vast majority of Africans are already using traditional medicine, it is a public health imperative to increase research into this area to enable communities to know whether herbal therapies are safe and effective.

It is vital to accelerate the development of traditional medicines into the armament of treatment options available for HIV/AIDS in Africa. The health of Africans living with HIV and their access to care can be improved by promoting the integration of traditional and complementary medicine with Western medicine, including anti retroviral treatments, which are becoming more available. We will advance integration by:

a. Developing a compelling rationale for dramatically increasing percentages of HIV/AIDS research to quantify the clinical benefits of promising traditional medical approaches that can be widely replicated.

b. Developing and aggressively advocating adoption of holistic campaigns for healthy living that empower PLWHAs, caregivers, communities, and practitioners to seek and provide optimal care and treatment

c. Disseminating among all stakeholders, including donors, policy makers, implementers and users, current and accurate information about the benefits and limitations of available traditional and western/biomedical/allopathic treatment options.

Based on these core beliefs, ACCT-AFRICA advocates the following steps be taken to

(1) provide a continuum of HIV care and support that promotes healthy living and mitigates, delays or prevents the need for medical intervention; and provide comprehensive holistic treatment options when medical intervention is required;

(2) advance a research agenda to include a more comprehensive approach to the challenge of HIV/AIDS in Africa.

Promote a Holistic Approach to Healthy Living for Persons with HIV/AIDS and Empower PLWHA and Communities with Positive Health Skills and Knowledge.

Existing observational, field, and published evidence suggests that people living with HIV/AIDS who make optimal use of nutrition, psycho-social support systems, spiritual systems, family support, and prompt access to good services will experience a better quality of life and possibly delay the progression of the disease. Further research into existing local, traditional practices is required to improve, define, and disseminate the benefits of such an approach.

ACTIONS:
A) Health Literacy Campaigns:

Establish parameters for and promote implementation of health literacy campaigns that reach defined audiences with relevant information to increase access to food and nutrition and comprehensive AIDS care and treatment.

1. Identify all appropriate audiences (eg PLWHAs, caregivers, communities, practitioners etc) 2. Conduct literature reviews to identify available curricula and campaign strategies that can be disseminated or adopted for trial use 3. Secure resources for implementation of model campaigns by local partners and assessment of their effectiveness 4. Disseminate lessons learned and strategies for wider implementation to donors, governments, regional and local implementers etc.

B) Code of Practice: Promote development of codes of practice that improve collaboration between traditional and conventional medicine.

1. Convene specific meetings of traditional healers and biomedical practitioners separately and together that help to forge better collaborations and to build consensus for a common code of practice to benefit all patients.

2. This code of practice should be accompanied by specific training for effective implementation that includes:
- describing and defining referral systems protocols
- defining and implementing standards for quality control and appropriate use of traditional and conventional medicine

Advance a research agenda to include a more comprehensive approach to HIV/AIDS care and treatment.

A majority of Africans already use traditional medicine and therapies for many illnesses including HIV/AIDS, and there are some indications that traditional remedies contribute to improved health and/or delayed disease progression. In this context, it is important to draw from existing and expanded research funding (rather than funding from care and support) to better understand traditional health practices and products and to understand and promote collaboration between traditional health systems and biomedical approaches.

ACTIONS:
A) Research on practices and products
-- Strategically document existing practice and use of traditional medicine for AIDS care in Africa

-- Identify the most promising products to be further validated. Actions to be taken to move these products forward: criteria for choice - safety, evidence of efficacy with some understanding of type of use[1], replicability, ease of administration, ease of manufacturing, low cost.

-- Develop acceptable standard protocols to accelerate the research processes for development of traditional medicine in Africa for AIDS care. The protocols should be ethical, have statistical power, clearly identified and scientifically sound end points, match the type of product and use.
B) Research to understand and promote collaboration between two systems

-- Conduct research into optimizing and integrating care modalities (e.g. looking at role of traditional healing in supporting ARVs and other AIDS care efforts; testing effect of integrating traditional healing and bio-medical approaches)

-- Document and rapidly disseminate findings and lessons learnt on the contributions/collaborations between traditional healing and biomedical systems to improved HIV care and treatment in Africa.

For more information, visit our website: www.ticahealth.org

[1] Anti-viral, immuno-modulation effect, symptom alleviation, treatment and prophylaxis

Herbs Helping Fight HIV And Aids

ZIMBABWE- Many rural communities in most parts of Zimbabwe are realising the importance of using natural remedies such as herbs to treat some HIV-related opportunistic infections because they have been let down by the ailing health system.

Zimbabwe's health sector has deteriorated over the years and rural communities have been the worst affected as shortages of drugs and other essential medicines continue to dog rural district hospitals and clinics.

The HIV and Aids pandemic has increased the demand for health care for many people in the country but health institutions are finding it increasingly difficult to cope, especially in light of the numerous problems in the health sector itself.

People living with HIV and Aids often seek treatment for opportunistic infections such as skin rashes, sores, coughs and colds, tuberculosis and chest pains. These are problems that public health institutions have to deal with on a day to day basis.

However, as StandardHealth recently found out, in spite of the hard times, some rural communities are using their ingenuity to survive.

Having realised that the problems in Zimbabwe's health sector will not be overcome soon, some rural communities have resorted to natural remedies to treat common ailments affecting PLWAs.

Florence Guzanga, vice chairperson of the Murereka Home Based Care (HBC) programme in Makonde, says her community has benefited immensely since they established a communally-owned herbal garden.

"The herbs are working wonders for most people here and as caregivers we notice changes in people who have used them for one reason or the other when we visit them," said Guzanga.

"There are various herbs. They treat many ailments from skin sores, rashes, headaches, nausea, stomach pains and so many other things."

Herbs that are being grown and used in Murereka include lemon grass, banana powder, yarrow, Black Jack, Marjoram and warm wood.

"Lemon grass is for energy, appetite, sore legs and it also helps blood flow well in the body. One takes dried lemon grass and puts it in boiled water for a while then takes it like tea," explains Guzanga.

Recommended forpeople who have ulcers is the banana powder, which is made from dry bananas. One dose consists of one teaspoon of powder to one cup of milk.

Black Jack (tsine) is used for stomach pains, oral thrush and is also an immune booster. The roots are taken and dried in a shade and pounded to a powder after drying. The powder is then used for making tea.

Spiwe Kuzvinzwa-Chingozha from Murereka says she tested positive in 1998 but has never since been admitted to hospital.

"We rely on this herbal garden for most of our illnesses. People here hardly go to the hospital or clinic unless it's extremely necessary and serious," said Kuzvinzwa-Chingozha.

"Even when I am well I use some of these herbs because they keep me healthy and boost my immune system. I have never been to hospital ever since I tested positive and I am not on any hospital."

In Mhondoro, members of the Tsungirai Home Based Care Programme have just started a herbal nursery which they are optimistic will assist them in meeting their treatment needs.

Through the National Aids Council (NAC) and another non-governmental organisation - COSV - the Mhondoro community has established herbal nurseries under drip irrigation.

"We have learnt from other communities here the benefits of a herbal garden and we are optimistic that we will help our community once it is fully operational," said Nestai Mathlatini, a caregiver who is living positively with HIV and Aids.

"Instead of everyone rushing to hospitals and clinics where they will be disappointed because there are no drugs, we hope to give them an alternative here."

Source: Zimbabwe Standard (Harare), April 25, 2005

Lacking drugs, HIV patients turn to herbs

YANGON-- For three years Phyu Phyu Thin has volunteered to work with HIV patients in Myanmar, but like many charities, hers is unable to offer life-prolonging drugs.

That has prompted many patients to turn to traditional herbal medicines and Buddhist meditation, which offer some comfort if not a cure.

"Sometimes I feel very sorry for the patients. We can only provide counseling and education. We have no medicines like anti-retroviral drugs," Phyu Phyu Tin says.

"Our contribution is very limited and that makes me very sad," she says.

Charities like the one Phyu Phyu Thin volunteers full-time with, which is run by Aung San Suu Kyi's opposition National League for Democracy, can offer little more than aspirin and multi-vitamins to treat people with HIV.

An estimated 339,000 people were infected with HIV at the end of last year, according to statistics from the military government's National AIDS Program (NAP).

In the last three years, the ruling junta has opened up to about 30 international agencies working to fight the disease, but their activities are still limited and most volunteers would speak only on condition of anonymity.

A young vendor smiles while waiting for customers at his roadside condom shop in Yangon in this photo taken on April 6. Myanmar's National AIDS Program estimated that more than 338,000 people were infected with HIV by the end of last year.

Although Myanmar has one of the highest rates of HIV infection in Asia, estimated at 1.2 percent of the adult population, fears that aid money could be misdirected has left donors reluctant to contribute very heavily to anti-AIDS efforts.

International agencies working here are reluctant to speak about their activities, citing the military's restrictions on their work, but so far have only managed to secure financing and government approval for a few small treatment schemes.

That has sent many sufferers searching for alternative remedies, sometimes through traditional healers or Buddhist meditation, which volunteers say they know cannot cure the disease but may at least provide some comfort.

Last September, Buddhist monks and nuns in Yangon started their own outreach program, known as Yadana Myitta, that uses the teachings of Buddha to counsel patients and to educate volunteers.

In addition to trying to educate communities about how to avoid HIV, the program also trains volunteers to work at a free clinic and teaches patients how to meditate, which traditionally has been viewed as a means of pain relief by focussing on inner peace, one 21-year-old volunteer says.

"At first, I was nervous about dealing with HIV cases. But that changed after I received the training," he says.

Christian groups, who make up about 4 percent of Myanmar's population, have also started awareness programs.

"The most important thing is educating people ... because at first they might find it difficult to accept someone with HIV," an officer with the Myanmar Council of Churches says.

Some people have turned to traditional cures to try to treat the disease, especially in remote, rural areas, he adds.

Myanmar officially tries to discourage herbal remedies, banning traditional healers from advertising their services, which the military views as quackery.

But in rural areas, healers still search in the forest for plants that they grind or boil into remedies that sometimes are the only affordable medicines available.

But volunteers say the junta's attitude toward HIV prevention has improved in recent years, after the military spent most of the 1990s in denial about the disease's rapid spread.

The first AIDS case in Myanmar was reported in 1991. By the end of last year, Myanmar's National AIDS Program estimated that more than 338,000 people were infected -- a 91 percent rise from an estimated 177,279 cases at the end of March 2002.

"The main difficulties for HIV prevention here were the funding and the coordination of partner agencies," an NAP official says.

A special fund was created for HIV programs in Myanmar, meant to address donor concerns that the military would misuse the money. The Global Fund to Fight AIDS, Tuberculosis and Malaria has allocated about US$54 million.

That's nowhere near enough to provide treatment for everyone with HIV, and volunteers like Phyu Phyu Tin fear the epidemic will worsen unless anti-retroviral drugs are provided.

Clinics are also needed around the country for poor people who cannot afford to travel to cities for treatment, Phyu Phyu Tin says.

"Sometimes we also have to collect our own money to cremate the patients who died here with AIDS-related illness because their family members have no money," she says.

One volunteer says that compassion to comfort patients was all that could be offered to people in their dying days.

"Without medical supplies, this is the only way in this country," he said.

Associated Foreign Press, Taipei Times May 8, 2005