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E-Module

An HIV and Rehab Resource

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  • About
    • 1 – What is this resource about and who is it for?
    • 2 – Why was this resource created?
    • 3 – How can this resource be used?
    • 4 – Can this resource be used for teaching?
    • 5 – How was this resource developed?
    • 6 – Who contributed to developing this adapted resource?
    • 7 – Who funded the development of this resource?
    • 8 – Disclaimer
  • Section 1
    • 1.1 How is “rehabilitation” defined in this resource?
    • 1.2 How can rehabilitation help people living with HIV?
    • 1.3 How can the World Health Organization’s “ICF” help us think about rehabilitation for people living with HIV?
    • 1.4 How can the Episodic Disability Model help us think about rehabilitation for people living with HIV?
    • 1.5 Who provides rehabilitation for people living with HIV?
    • 1.6 Do rehabilitation providers need special skills or training to care for people living with HIV? If so, what?
    • 1.7 What roles do rehabilitation providers have related to HIV?
    • 1.8 When is rehabilitation clinical intervention useful along the HIV care continuum?
  • Section 2
    • 2.1 What do rehabilitation professionals need to know about the stages of HIV infection?
    • 2.2 What do rehabilitation providers need to know about CD4 count and viral load?
    • 2.3 What is the impact of HIV on body systems and why does this matter for rehabilitation providers?
    • 2.4 Who might rehabilitation providers treat?
    • 2.5 What do rehabilitation providers need to know about antiretroviral therapies?
  • Section 3
    • 3.1 What are the rehabilitation interventions that address impairments common among people living with HIV?
    • 3.2 What are the rehabilitation interventions that can address the activity limitations and participation restrictions common among people living with HIV?
    • 3.3 More information on the rehabilitation interventions available for people living with HIV
    • 3.4 – What do rehabilitation providers need to know about their patients’ beliefs and use of traditional healers, spiritual leaders and alternative therapies outside the formal medical system?
  • Section 4
    • 4.1: Intersectionality Theory in the Context of Rehabilitation
    • 4.2: Children and Youth
    • 4.3: HIV and Aging
    • 4.4: Substance Use
    • 4.5: Trauma
    • 4.6: Racialized Populations
    • 4.7: Indigenous Populations
    • 4.8: HIV, Sex and Gender
    • 4.9: HIV and COVID-19
    • 4.10: Is HIV itself a disability?
  • Section 5
    • 5.1 What are outcome measures?
    • 5.2 Why is it important to use outcome measures during rehabilitation with people living with HIV?
    • 5.3 How do rehabilitation providers know if an outcome measure will be useful in practice?
    • 5.4 What are floor and ceiling effects in outcome measurement?
    • 5.5 What is the difference between generic and HIV-specific outcome measures?
    • 5.6 How should you decide which outcome measures to use?
    • 5.7 How do you access a copy of an outcome measure?
    • 5.8 What are rehabilitation-related outcome measures that can be useful for people living with HIV?
  • Case Studies
    • Case #1 – Acute Care, Cardiorespiratory and Neurological
    • Case #2 – Musculoskeletal – Knee Pain
    • Case #3 – Aging, Cognition, Community, Stroke
    • Case #4 – Complex Case – Musculoskeletal, Episodic, Cardiorespiratory
    • Case #5 – Diabetes, Neuropathy, Substance Use
    • Case #6 – Transition from Paediatric to Adult Care
    • Supplemental Case Studies without Leading Questions
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3.4 – What do rehabilitation providers need to know about their patients’ beliefs and use of traditional healers, spiritual leaders and alternative therapies outside the formal medical system?

With the advent of international air travel over the last century, there is great diversity of ethnic, cultural, language and religious groups globally. Health beliefs are closely interwoven with communities’ cultural and religious practices. It is vital that rehabilitation providers are aware of the influence of these beliefs on understandings of health and illness, which can affect uptake of (and adherence to) rehabilitation and medical advice.

3.4.1 Traditional healers

It is important that rehabilitation providers work with traditional healers, where possible, both to understand what they do and to educate them regarding the importance of adherence to both medication and rehabilitation for people living with HIV. Collaboration between traditional healers and rehabilitation providers has the potential to improve safety (e.g., by encouraging better hygiene, and adherence to prescribed treatment). Training can also assist traditional healers in identifying illnesses beyond their capacity to treat, hastening referral to a clinic when necessary. A number of organizations internationally have demonstrated the benefits of collaborating with traditional healers in HIV prevention and care.

3.4.2 Spiritual leaders and religious beliefs

Spiritual leaders are revered by large sections of the population and their advice and teachings are often strictly followed. There is an extremely wide array of both indigenous and orthodox religious belief systems globally, many of which work in harmony with the health care system. Some spiritual leaders may advocate that patients avoid or cease medical treatment and rehabilitation and instead, adhere only to the beliefs of their religious sect in order to be “healed” of the virus. This may result in issues of non-adherence to ARTs and associated exacerbation of patients’ impairments. Rehabilitation providers must collaborate with spiritual leaders, providing advice and education where appropriate, in order to maximize the outcomes of treatment and rehabilitation.

3.4.3 Alternative therapies

Alternative therapies can be divided into five main categories:

  • Whole medical systems (such as Ayurvedic medicine and homeopathy)
  • Mind-body medicine (such as yoga and tai-chi)
  • Biologically based practices (such as herbal remedies, vitamins and minerals)
  • Manipulative and body-based practices (such as chiropractic and reflexology)
  • Energy medicine (such as Reiki and acupuncture)

Rehabilitation providers may employ several of these techniques (including tai-chi, yoga and acupuncture) and similarly, alternative therapists may employ techniques used by rehabilitation professionals.1 It is vital that rehabilitation providers and alternative therapists collaborate wherever possible, to ensure the best possible treatment for people living with HIV.

1 Littlewood RA, Vanable PA. Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care. AIDS Care. 2008 Sep;20(8):1002-18. doi: 10.1080/09540120701767216. PMID: 18608078

3.4.4 Who pays for these therapies?

The spiritual, traditional and alternative healers described above, in most cases, fall outside of public healthcare systems. Additionally, private healthcare institutions and insurers often provide little or no coverage for these practices. This can place additional financial strain on people living with HIV who seek advice and treatment from these healers.

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