The role of traditional health practitioners as community leaders and health care providers is recognized and accepted by the majority of the population in most African countries. Their communication skills in health and social issues are a vital resource that can be tapped and utilized in a variety of crucial areas of AIDS prevention and control. A multisectoral approach has been recognized as the key to containment of the HIV/AIDS pandemic.
2.2.1 Information, education, communication, and counselling
Traditional health practitioners should be involved in activities aimed at creating and sustaining awareness about AIDS and sexually transmitted diseases by having them inform, educate, and counsel their communities in general and their clients in particular.
(a) Community leaders, including traditional health practitioners, should be mobilized and sensitized to support the AIDS control programme.
(b) Traditional health practitioners should be provided with basic information about AIDS; they can then transfer this knowledge to their clients and their community. Their understanding of the epidemiology of the disease would be useful in attempts to prevent transmission of HIV through sexual contact and other high-risk practices.
(c) Many traditional health practitioners and traditional midwives have expertise in providing marriage guidance and counselling and in discussing issues of family life and sexuality with specific target groups such as pregnant women and adolescent girls. They can, therefore, successfully reach them with appropriate information about AIDS and sexually transmitted diseases.
(d) Traditional health practitioners should encourage condom use. Condom disposal techniques (e.g., to tie and throw into a pit-latrine, burying, burning, etc.) must be clearly explained to the traditional health practitioners so that their clients can be correctly informed.
(e) Traditional health practitioners, as community opinion leaders, are in a unique position to participate in education programmes aimed at changing customs and traditions that are high-risk factors in the spread of HIV.
2.2.2 Prevention of HIV transmission through skin piercing practices, including circumcision
(a) In a collaborative dialogue with modern health practitioners, traditional health practitioners should be alerted to the potential danger of some of their practices as high-risk factors for HIV transmission to their clients and to themselves. They should be advised to identify alternative and safe methods in the management of their patients' illnesses.
(b) Traditional health practitioners should be taught basic hygiene practices as an important and key factor in the prevention of communicable diseases. Discussion groups and seminars should be organized where safety procedures are emphasized.
2.2.3 Prevention of HIV transmission through blood and blood products
The risk of transmission of HIV among traditional health practitioners, especially traditional midwives, poses a real problem. This risk can be reduced through education about safe practices.
(a) Efforts should be made to identify and build on beneficial practices that could prevent and control HIV transmission.
(b) An adequate and sustained supply of protective clothing, including gloves, should be ensured for both modern and traditional health workers when establishing a national AIDS control programme.
(c) Efforts should be made to elaborate training for all health workers in obstetric techniques, especially traditional obstetric procedures, to ensure minimum exposure to blood.
(d) Traditional health practitioners manage certain conditions by bleeding their patients. The risk of such practices should be explained in order to discourage their continuation.
(e) This situation can be used to advantage by correcting the misleading impression in African societies of the alleged superiority of injection over other forms of therapies.
2.2.4 Prevention of perinatal transmission
Traditional midwives have a crucial role to play in the education of women of childbearing age. By the nature of their role, they can discuss issues related to family life and sexuality that are important in initiating and motivating behaviour change, as well as encouraging safe sexual practices. They are also in a good position to counsel women of childbearing age who are at risk of HIV infection and inform them about preventive measures.
2.2.5 Clinical management and counselling
(a) Traditional health practitioners form a strong network of community health workers and provide support to individuals and families. National AIDS programmes should take advantage of this situation by fully involving traditional health practitioners in the information, education, and communication components of their programme and in the clinical management and counselling of AIDS patients. An appropriate mechanism to develop and facilitate this should be established by the district/village health team, including traditional health practitioners, as part of the national AIDS programme. This activity should be supported by appropriate focus-group discussions and seminars at those levels.
(b) Traditional health practitioners are experienced in providing psychosocial support to the terminally ill and in counselling bereaved families. Traditional health practitioners are an important source of alternative care for AIDS cases, and their position as community leaders should be capitalized upon in developing and soliciting community support for the care of AIDS patients.
2.2.6 An outline of ways to involve traditional health practitioners in national AIDS programmes
There is no simple or single approach to involving traditional health practitioners in national AIDS programmes; however, this should be based on mutual trust and collaboration between all health care workers.
(a) Where there is formal recognition of traditional health practitioners, with established specific organizational structures, they should be represented on national, provincial, and district AIDS committees. This could be an initial step towards recognizing their role and soliciting their support in national AIDS programmes.
(b) Where there is neither a national organization for traditional health practitioners, nor a specific policy on traditional medicine, statements on their important role in national AIDS programmes should be issued by the highest political authorities in the country until such time as a national policy is formulated and implemented. This will create an atmosphere conducive to meaningful dialogue between the traditional health practitioners and other health care workers at village and district levels.
(c) The existing primary health care administrative structure at village and district levels should be utilized to initiate contact with traditional health practitioners. When dialogue has been established, small focus-group discussions should be organized where issues relating to AIDS prevention and control are taken up and the role of traditional health practitioners is highlighted. These discussions should be followed by seminars at district, provincial, and central levels.
(d) Traditional health practitioners should be encouraged to express their perception of HIV infection/AIDS, including views on management and treatment, through their participation in focus-group discussions and seminars. Positive aspects of their understanding should be used when involving them in national AIDS prevention and control activities.
(e) Focal points should be identified that would serve as links between traditional health practitioners and other health care workers at different levels of the health system. These links should also be strengthened and extended so as to coordinate collaborative activities to prevent and control AIDS and sexually transmitted diseases with other primary health care activities.
(f) Traditional health practitioners should be involved to the extent possible in all stages of designing, implementing, and evaluating AIDS prevention and control activities. They should be involved in established community-based activities (e.g., drama and other groups) that could be used to portray the consequences of AIDS as part of health education programmes.
(g) A mutually acceptable referral system between traditional health practitioners and other health practitioners should be established. This needs to be supported by a system of continuing education to equip traditional health practitioners with the information and skills necessary to better manage and care for patients in the community.
(h) Traditional health practitioners should be involved to the extent possible in collaborative studies with modern health workers to evaluate the safety and efficacy of traditional remedies, especially medicinal plants, used in the treatment of opportunistic infections and AIDS symptoms. They could also be effective in motivating communities to participate in these studies. In order to facilitate this and to create an atmosphere of mutual trust, countries would have to consider developing patent laws to protect the rights of traditional health practitioners and to ensure equity in the distribution of income derived from drugs developed from traditional remedies.
(i) There should be a provision in the budgets of AIDS control programmes specifically for the active involvement of traditional health practitioners in AIDS prevention and control. When traditional health practitioners first begin to participate in these programmes, it would be necessary to make funds available for a number of activities, including seminars and the production of education materials, and for the remuneration of national and provincial focal points/coordinators, since they will devote most of their time to organizing their members and developing and coordinating different identified activities.