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.