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?

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.

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.

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.

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.