Reconciling the Irreconcilable? HIV/AIDS and the Potential for Middle Ground Between the Traditional and Biomedical Healthcare Sectors in South Africa

Abstract

This article analyses, from a policymaking perspective, the continued recourse to South Africa's thriving traditional healthcare sector, which operates in tandem with the country's relatively well-developed biomedical healthcare sector. It considers the traditional healthcare sector's potential to impact on orthodox approaches to the treatment and management of HIV/AIDS, including the uptake of antiretroviral therapy. It highlights the urgent necessity of more thorough engagement between the traditional and biomedical sectors, particularly where supernatural elements – an integral part of much traditional diagnosis and treatment – are concerned. The challenge for policymakers is how best to facilitate an effective means of meaningfully accommodating potentially conflicting traditional cosmologies within the formal healthcare infrastructure. However, although the achievement of this would represent a vital step towards a more effective overall approach to South Africa's HIV/AIDS pandemic, this article queries whether it is indeed feasible.

Keywords:

• healthcare
• HIV/AIDS
• policymaking
• South Africa
• syncretism
• traditional medicine

Notes

¹Adrian Flint acknowledges gratefully the British Academy's funding of the fieldwork undertaken for this article.

²Freidson's (1970a, 1970b) seminal medical sociology analysis focused on the propensity of the medical profession to define and control what constitutes medical practice, effectively turning the sector into a closed shop.

³‘African solutions to African problems’ is tied to Mbeki's 1997 articulation of an African Renaissance. In the interests of attracting foreign investment, Mbeki (1997) argued that ‘Africa's time has come … [t]he new century must be an African century’. Despite its initial focus on aid and investment, the sentiment came to dominate the HIV/AIDS debate (McNeill 2009). However, the prioritisation of locally developed ‘cures’ such as Virodene (Nattrass 2008) and, subsequently, traditional healthcare put the administration at odds with the global biomedical community. See a discussion of the Virodene scandal in Van der Vliet (2001).

⁴The Bill was declared invalid by the Constitutional Court in 2006 after Doctors for Life challenged it on the basis of insufficient consultation. Following minor revisions, it was assented to in January 2007.

⁵See ‘Qualities of a Competent Traditional Health Practitioner’, which lists being a good learner, sincerity, decisiveness, honesty, passion, courage, good hygiene and loyalty as key attributes (http://www.traditionalhealth.org.za/t/documents/competen_practitioner.html). See also ‘Guidelines for formulating policies on training of healers’ (http://www.traditionalhealth.org.za/t/documents.html).

⁶As a result of statements intimating their effectiveness in fighting HIV/AIDS, Tshabalala-Msimang gained media notoriety as ‘Dr Beetroot’ and ‘Dr Garlic’.