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