CV ancient remedies CAG 19.6.

2002 9:14 Page 1

In many African countries, traditional healers far outnumber modern health

practitioners, and the majority of the population use traditional medicine. There
has been much scepticism about traditional healers but, as this report shows, they
can play a prominent role in caring for people living with HIV/AIDS as well as in
prevention activities. Many traditional healers are willing to collaborate with ANCIENT REMEDIES,
conventional health practitioners, sharing their patients’ histories and their
knowledge about local treatment options. NEW DISEASE :
This report describes three initiatives—in Kenya, the United Republic of Tanzania
and Uganda—that have narrowed the gap between the traditional and Involving traditional
biomedical health systems. In the Kenyan and Tanzanian projects, a traditional
medicine component is integrated into more comprehensive HIV/AIDS prevention
and care programmes, while the Ugandan project has dedicated itself entirely to
healers in increasing
building collaboration between traditional and biomedical healing systems for
AIDS.
access to AIDS care
The report also includes anecdotal accounts by traditional healers themselves, as and prevention
well as details of training provided to the healers, and lessons learned from each
of the three initiatives. in East Africa

UNAIDS
Case Study

Joint United Nations Programme on HIV/AIDS (UNAIDS) June 2002

20 avenue Appia, 1211 Geneva 27, Switzerland
Tel. (+41) 22 791 36 66 – Fax (+41) 22 791 41 87
$10.00 E-mail: unaids@unaids.org – Internet: http://www.unaids.org UNAIDS Best Practice Collection
CV ancient remedies CAG 19.6.2002 9:15 Page 3

This document was prepared under the direction of the UNAIDS Intercountry Team for Eastern and
Southern Africa, Pretoria, Republic of South Africa, and the Regional Task Force for Traditional
Medicine, THETA, Uganda. It was written by Rachel King.

UNAIDS Responsible Officers: Sandra Anderson and Noerine Kaleeba

Photos: Vanessa Vick, Joseph Tenywa, and Rachel King.

Drawings: Jennifer Balaba

UNAIDS/02.16E (Original version, June 2002)

ISBN 92-9173-171-4

© Joint United Nations Programme on HIV/AIDS The designations employed and the presentation of the
(UNAIDS) 2002. material in this work do not imply the expression of any The Joint United Nations Programme on HIV/AIDS (UNAIDS) is the leading advocate for global action on
opinion whatsoever on the part of UNAIDS concerning HIV/AIDS. It brings together eight United Nations agencies in a common effort to fight the epidemic: the
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ancient remedies A4 CAG 19.6.2002 9:07 Page 1

U N A I D S B E S T P R A C T I C E C O L L E C T I O N

ANCIENT REMEDIES,
NEW DISEASE:

Involving traditional healers

in increasing access to AIDS care
and prevention in East Africa

UNAIDS
Geneva, Switzerland
2002
ancient remedies A4 CAG 19.6.2002 9:07 Page 2
ancient remedies A4 CAG 19.6.2002 9:07 Page 3

UNAIDS

CONTENTS
Abbreviations 4

Acknowledgements 4

Foreword 5

I. Introduction 6

II. Traditional medicine and AIDS in sub-Saharan Africa—

history and terminology 7

III. Women, AIDS and traditional medicine in Kenya 9

• AIDS in Kenya 9
• Women Fighting AIDS in Kenya (WOFAK): objectives and activities 10
• Lessons learned from WOFAK 15
• Summary analysis of WOFAK 16
• Best Practice criteria analysis of WOFAK 17
• WOFAK’s specific criteria/approach for traditional
medicine/biomedicine collaboration 17

IV. AIDS care and prevention: an integrated model

in the United Republic of Tanzania 18

• AIDS in the United Republic of Tanzania 18

• Tanga AIDS Working Group (TAWG): objectives and activities 18
• Lessons learned from TAWG 27
• Summary analysis of TAWG 28
• Best Practice criteria analysis of TAWG 29
• TAWG’s specific criteria/approach for traditional medicine/
biomedicine collaboration 29

V. Training, research and information-sharing on traditional medicine and AIDS:

a comprehensive approach in Uganda 30

• AIDS in Uganda 30
• Traditional and Modern Health Practitioners
together against AIDS (THETA): objectives and activities 31
• Lessons learned from THETA 46
• Summary analysis of THETA 47
• Best Practice criteria analysis of THETA 48
• THETA’s specific criteria/approach for traditional medicine/
biomedicine collaboration 48

VI . Conclusions and a call for action 49

VII. References and further reading 50

ancient remedies A4 CAG 19.6.2002 9:07 Page 4

Ancient remedies, new disease

Abbreviations

AIDS Acquired immunodeficiency syndrome

BHP Biomedical health practitioner
CBO Community-based organization
CHICC Community Health Information and Care Centre (Tanzania)
FGD Focus group discussion
HIV Human immunodeficiency virus
IEC Information, education and communication
KANCO Kenya AIDS NGO Consortium
KEFRI Kenya Forestry Research Institute
KEMRI Kenya Medical Research Institute
KITHETA Kiboga THETA (Uganda)
NACP National AIDS Control Programme (Tanzania and Uganda)
NACC National AIDS Control Council (Kenya)
NGO Nongovernmental organization
MoH Ministry of Health
PLWHA People living with HIV/AIDS
SHDEPHA+ Service Health and Development for People with HIV/AIDS (Tanzania)
STDs Sexually transmitted diseases
STIs Sexually transmitted infections
TAWG Tanga AIDS Working Group (Tanzania)
TASO The AIDS Support Organisation (Uganda)
TB Tuberculosis
TBAs Traditional birth attendants
THETA Traditional and Modern Health Practitioners together against AIDS and other
diseases (Uganda)
THECA Traditional Healers, Educators and Counsellors on AIDS Awareness (Uganda)
TH Traditional healer
UNICEF United Nations Children’s Fund
UNAIDS Joint United Nations Programme on HIV/AIDS
WOFAK Women Fighting AIDS in Kenya

Acknowledgements:
The valuable contributions of time, care and devotion of the staff of WOFAK, TAWG and THETA allowed
this document to come alive. Insightful and thorough editing was also done by David Scheinman, Heather
Mcmillen and Jaco Homsy. This review would not have been possible without the dedication, skill and
hard work of Joseph Tenywa of THETA, who collected data, took photos and travelled to all the project
sites.

Sincere thanks are also due to all the traditional healers for their tireless work in the community and their
enthusiasm for collaborating with the biomedical sector. Lastly, our deepest gratitude to the clients of
healers, a large majority of whom are people living with HIV/AIDS; they were the first to build the bridge
between the two health sectors.

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ancient remedies A4 CAG 19.6.2002 9:07 Page 5

UNAIDS

Foreword

Scaling up AIDS efforts in Africa is crucial, and requires the participation of all social and eco-
nomic sectors. As frequently noted at the 2001 International Conference on AIDS in Africa, scaling
down disease can only take place by scaling up resources. One abundant and relatively untapped
resource for an expanded response to the AIDS epidemic is the traditional sector. In Africa,
pioneer programmes and empowered communities have demonstrated to the world the impor-
tance of local responses to HIV/AIDS.

In countries where resources are limited, the principles of primary health care demand that all
available, accessible, acceptable and affordable resources be applied towards the health of the
people. The AIDS epidemic forces us to renew our interest in these principles, partly because of
desperate and overwhelming needs, but also because of the imperative to seek diverse solutions
that are embedded within the cultural and environmental milieux.

Traditional healers make a unique contribution that is complementary to other approaches. They
also tend to be the entry point for care in many African communities, and even more so for the
complex HIV-related diseases that frequently jolt family dynamics and shake community stability.
Traditional healers often have high credibility and deep respect among the population they serve.
They are knowledgeable about local treatment options, as well as the physical, emotional and
spiritual lives of the people, and are able to influence behaviours. Thus, it is imperative and prac-
tical to consider traditional healers as partners in the expanded response to HIV/AIDS, and to
maximize the potential contribution that can be made towards meeting the magnitude of needs for
care, support and prevention.

To this end, best practices from the traditional sector were identified in three countries of East
Africa: Kenya, the United Republic of Tanzania and Uganda. Three specific programmes exhibited
an enormous capacity for care and influence on the part of traditional healers, and for creating a
wider and more comprehensive response, as well as for embracing traditional healers as part of
the solution to HIV/AIDS in the African context.

There is an urgency to act now. We know that the HIV/AIDS challenge cannot be met without new
resources. Furthermore, it cannot be met without consideration for the contribution from the old
and trusted traditional sector. Ancient Remedies, New Disease provides motivation and inspira-
tion through the sharing of experiences and innovative approaches to tackling the new chal-
lenges of HIV/AIDS with both new and old resources to increase access to HIV/AIDS care and
prevention.

Sandra Anderson Noerine Kaleeba

UNAIDS Intercountry Team E. and S. Africa UNAIDS
Pretoria, South Africa Geneva, Switzerland

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Ancient remedies, new disease

I. INTRODUCTION
“The disease is all around us—within our community, our families, our
houses—and it will defeat our best efforts at peace and development unless
we defeat it first.”
Kofi Annan, UN Secretary General

In the 20 years that it has been with us, AIDS has continued its relentless spread across conti-
nents. By the end of 2000, the United Nations Joint Programme on HIV/AIDS (UNAIDS) reported
that 36.1 million men, women and children were living with HIV around the world and 21.8 million
had died. Though AIDS is now found in every country, it has most seriously affected sub-Saharan
Africa—home to 70% of all adults and 80% of all children living with HIV, and the continent with
the fewest medical resources in the world.

AIDS is now the primary cause of death in Africa and it has had a devastating impact on villages,
communities and families on the continent. In many African countries, the numbers of new infections
are increasing at a rate that threatens to destroy the social fabric. Life expectancies are decreasing
rapidly in many of these countries as a result of AIDS-related illnesses and socioeconomic hard-
ships. And of the 13.2 million children orphaned by HIV/AIDS worldwide, 12.1 million are in Africa.

In the past, AIDS-control activities relied on giving information about HIV transmission, and
imparting practical skills to enable individuals to reduce their risk of HIV infection and care for
themselves if infected. There is a growing awareness, however, that sociocultural factors sur-
rounding the individual need to be considered in designing both prevention and care interven-
tions. As the epidemic continues to ravage the low- and middle-income world, it becomes
increasingly evident that diverse strategies to confront the wide-ranging and complex social, cul-
tural, environmental and economic contexts in which HIV continues to spread must be
researched, tested, evaluated, adapted and adopted.

Today, in 2002, interventions to stem the spread of HIV worldwide are as varied as the contexts in
which we find them. Not only is the HIV epidemic dynamic in terms of approaches to treatment,
prevention strategies and disease progression, but sexual behaviour, which remains the primary
target of AIDS-prevention efforts worldwide, is widely diverse and deeply embedded in social and
cultural relationships, as well as environmental and economic processes. This makes the pre-
vention of HIV very complex. In addition, care for people infected with HIV depends not only on
the local health infrastructure of the country or village, but on social and family structures, beliefs,
values and economic conditions.

Monitoring and evaluation of prevention programmes have shown that prevention does work. In
countries that have quickly implemented well-planned programmes with support from political
and religious leaders, HIV prevalence has been kept consistently low, and has even decreased in
some countries in the last five years (UNAIDS, 1998). Yet, cases of decreased HIV prevalence are
still the exception and many developing countries are struggling to find innovative, cost-effective
strategies that are relevant to the status of the epidemic in their nation. Especially in countries
where prevalence and incidence of HIV are still climbing rapidly, as well as in those countries
where morbidity and mortality associated with HIV are alarmingly high, AIDS programme leaders
are searching for creative solutions to increase access to both prevention and care services.

Pioneering programmes in Africa have demonstrated to the world the importance of local
responses to HIV/AIDS, which aim to empower communities through local partnerships consist-
ing of social groups, service providers and facilitators. Effective community-centred efforts have
generally been both empowering, i.e. strengthening a community’s capacity to make decisions,
and enabling, assisting communities in mobilizing the resources required for them to act on those
decisions.

In countries such as Kenya, the United Republic of Tanzania or Uganda, where resources are
limited, there is a desperate need for care, support and prevention alternatives that are readily
available, accessible and affordable, given the vast number of people who do not have access to
government health units or hospitals. And, given the stigma associated with HIV/AIDS in many

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UNAIDS

African communities, to be viable, these alternatives must take into consideration the feelings of
patients, their ability/inability to pay for the health services and their sociocultural and economic
realities. Traditional medicine is one such alternative.

II. TRADITIONAL MEDICINE AND AIDS IN SUB-SAHARAN

AFRICA—HISTORY AND TERMINOLOGY
Traditional healing practices existed in Africa long before conventional medicine, and attempts by
colonial governments and early religious missionaries to suppress it did not succeed. As an
untapped reservoir of knowledge, philosophy and history, traditional medicine not only offers the
possibility of cures, but it also provides a national heritage and a means of linking the land and its
people.

In sub-Saharan Africa today, traditional healers far outnumber modern health practitioners, and
the majority of the population uses traditional medicine. WHO estimates that 80% of people in low-
and middle-income countries rely primarily on traditional medicine for their primary health-care
needs. Although the actual number of traditional healers is unknown in most countries, such heal-
ers constitute a significantly large group of practitioners who are recognized, trusted and
respected by their respective communities.

Traditional healers provide client-centred, personalized health care that is tailored to meet the
needs and expectations of their patients. This makes them strong communication agents for
health and social issues. They have greater credibility than do village health workers, especially
with respect to social and spiritual matters. They, thus, make valuable supporters and imple-
menters of development initiatives. In resource-constrained settings, traditional medicine
provides access to treatment where expensive imported pharmaceuticals cannot. Moreover, in
some contexts, traditional medicine has been found to be as effective as biomedical treatment, if
not more so, in treating HIV-associated opportunistic infections such as herpes zoster and
chronic diarrhoea (Homsy, 1999).

There has been much scepticism surrounding traditional medicine and traditional healing prac-
tices in the last four decades. This document is an attempt to shed light on the complex nature of
traditional medicine and its prominent role in disease prevention and care that began centuries
before the advent of modern medicine.

Traditional medicine in East Africa

The majority of populations in East Africa have access to only traditional health care. Traditional
healers are well known in their communities for their expertise in treating many sexually trans-
mitted infections (STIs) (Green, 1994). The World Health Organization (WHO) has advocated the
inclusion of traditional healers in National AIDS programmes since the early 1990s (WHO, 1990).
Unfortunately, this has rarely happened.

African traditional medicine encompasses a diverse range of practices, including herbalism and
spiritualism, and traditional healers represent a range of individuals who call themselves diviners,
priests, faith healers or bone-setters, among others. The term ‘traditional healer’ used here,
though an oversimplification of a complex range of practices, refers to either herbalists, spiritu-
alists or to those (the great majority of healers) involved in both realms.

African traditional healers reflect the great variety of cultures and belief systems on the continent,
and possess equally varied experience, training and educational backgrounds. This diversity is
further enhanced by their adaptation to the dramatic social changes that have affected much of
the region since colonization, such as urbanization, globalization, population migration and dis-
placement, and civil conflicts (Good, 1987). Whenever African healers’ knowledge, attitudes,
beliefs and practices about STIs and AIDS have been explored, findings have reflected the stage
of the epidemic, the amount of information these healers have been exposed to, and their pre-
existing belief systems about health and disease in general, and STIs and AIDS in particular.

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Ancient remedies, new disease

Many reports have noted the genuine interest and enthusiasm of traditional healers to collabo-
rate with their biomedical counterparts. Social research has shown that, in many countries,
healers could name and describe numerous types of STIs (which do not always correspond to the
biomedical definition). However, few of them consider AIDS an ‘African’ disease (Green, 1992;
Green, 1993). Many traditional beliefs about the prevention of STIs or AIDS include limiting the
number of sexual partners, wearing protective charms or tattoos, having ‘strong blood’, using
condoms to reduce the risk of ‘pollution’ or undergoing a ‘traditional vaccination’ consisting of
introducing herbs into skin incisions (Green, 1992; Green, 1993; Nzima, 1996; Schoepf, 1992). In
numerous cases, condoms have become acceptable to traditional healers. Although many
African healers consider semen an important element for nourishing a growing foetus and main-
taining the mother’s health and beauty, their concern for family and cultural survival can override
this belief and allow them to promote condom use (Green, 1993; Schoepf, 1992).

Lastly, it has been found that when there is a mutual

willingness on the part of traditional healers and
conventional health practitioners to collaborate, and
when there is a genuine interest in the beliefs and
values of traditional healers, as well as a respect for
their practices, a bridge can be built between the
two complementary health systems. This document
is an attempt to describe and record the lessons
learned in three such collaborative projects in East
Africa, with the aim of sharing information for the
benefit of communities who trust and believe in the
Traditional healer providing community practices of traditional healers.
education in Uganda

The aim of this document is to describe three initiatives that have narrowed the gap between the
traditional and biomedical health systems in different ways, and to highlight their far-reaching
benefits with regard to HIV prevention, treatment access and care for people living with HIV/AIDS
(PLWHA), their families, caregivers and communities. The projects described here were chosen
as a result of an earlier study that looked broadly at initiatives in sub-Saharan Africa involving col-
laboration with traditional healers for AIDS prevention. The three collaborative initiatives
described here are certainly not the only ones in East Africa, but they were selected because of
their long-term existence (all of them started in the early 1990s) and experience in working with
traditional healers. Each of these initiatives is a reaction to a different context or situation, thus it
was created with different objectives in mind. The first two—in Kenya and the United Republic of
Tanzania—have integrated a traditional medicine component into more comprehensive AIDS
prevention and care programmes, while the Ugandan project dedicated itself entirely to building
collaboration between traditional and biomedical healing systems for AIDS. This document
focuses on how each of the projects built a collaborative relationship with traditional healers and
how this relationship has helped surrounding communities. At the end of each chapter, each proj-
ect has been summarized in a table and analysed with respect to UNAIDS Best Practice
criteria. New criteria have also been proposed for the specific type of collaboration pioneered by
each initiative.

This documentation will undoubtedly highlight the need for more research in the uses, effects,
benefits and challenges of traditional medicine. A multiplicity of variables need to be assessed
and it is only with systematic documentation of the already existing best practices that we hope
to answer crucial questions regarding the effectiveness, advantages and limitations of traditional
medicine, and determine how we can further incorporate traditional medicine into the HIV/AIDS
response.

We hope that documenting some of the best practices of the few organizations in East Africa that
have initiated collaboration with traditional healers in fighting HIV/AIDS will stimulate positive
thinking, promote practical action and provide an opportunity for sharing experiences in respond-
ing to the challenges of AIDS care and prevention in Africa.

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UNAIDS

III. WOMEN, AIDS AND TRADITIONAL MEDICINE IN KENYA

Background statistics*: Kenya

Total population in millions (1999) 29.5

Urban population (1997) 30%
Annual population growth rate (1990–1998) 2.6%
Infant mortality rate (1999) 65 per 1000 live births
Life expectancy (1998) 52
Total fertility rate (1998) 4.4
Literacy rate (1995) Male: 86%
Female: 70%
Per capita GNP (1997) US$340

HIV prevalence—general population (1999) 13.1%

* Source: AIDS in Africa, Country by Country Report, UNAIDS 2000
Kenya National HIV/AIDS Strategic Plan, 2000–2005

AIDS in Kenya
In Kenya, AIDS is a tragedy of devastating proportions. Seven hundred people die every day from
the disease and, since the epidemic started, more than 1.5 million Kenyans have died of AIDS. Most
AIDS deaths occur between the ages of 25 and 35 in men and 20 and 30 in women. Thus, most
infections occur in the teenage years and early 20s. The country is faced with more than 2 million
HIV-positive individuals and half of the beds in government hospitals are occupied by PLWHA.
National HIV prevalence rose from 5.3% in 1990 to 13.1% in 1999 and shows signs of stabilizing at
around 14%. Seroprevalence among pregnant women ranges from 6–17% in low-prevalence areas
to 25–30% in higher-prevalence areas (Kenya National HIV/AIDS Strategic Plan, 2000).

Following the November 1999 Presidential address declaring AIDS a national disaster, a National
AIDS Control Council (NACC) was created by presidential decree with the objective of coordinat-
ing the efforts of the government, NGOs, CBOs, development partners, religious groups and
PLWHA. A national network of 450 NGOs, CBOs and religious groups, formed in 1990, called Kenya
AIDS NGO Consortium (KANCO), has as its mission providing and promoting leadership, solidarity
and collaboration among members for collective action towards an effective response to
HIV/AIDS. In addition, the Kenya HIV/AIDS Consultative Group, a forum including heads of UN
agencies, bilateral donors, the Government of Kenya, PLWHA, representatives of private sectors,
NGOs and religious organizations, was formed to set priorities, and advocate and promote multi-
sectoral approaches, as well as actions recommended by a technical working group.

Recent studies have demonstrated that the health system is being overstretched by the number
of AIDS patients and that there is a large funding need to scale up care and prevention pro-
grammes (UNAIDS, 2000). AIDS has also highlighted many weaknesses in the social system and
other ethical, legal and economic issues with which society was previously little concerned. The
epidemic has placed unprecedented demands on the limited social services and it is estimated
that the 1 million children orphaned by AIDS in Kenya have already overwhelmed existing systems
of adoption.

In Kenya today, fear, ignorance and lack of open dialogue about HIV/AIDS have placed tremen-
dous pressure on family bonds. Gender biases are exacerbated as infected women bear more
rejection than their male counterparts. Women are also disproportionately responsible for the
care of those infected with HIV/AIDS, often without sufficient information, medication or support.

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Ancient remedies, new disease

Since the beginning of the epidemic, governmental and nongovernmental organizations, CBOs,
and religious groups have been actively involved in fighting the epidemic. However, few have ini-
tiated a relationship with traditional healers as has WOFAK—Women Fighting AIDS in Kenya.

Women Fighting AIDS in Kenya (WOFAK): objectives and activities

In 1993, with the realization that women were particularly hard hit by the discrimination, stigmatiza-
tion and rejection that goes along with HIV infection, 10 infected and affected women got together
and initiated WOFAK as an AIDS support organization. WOFAK was registered as an NGO to sup-
port and empower affected and infected women to live positively with HIV/AIDS, and to help them
access the limited services available. With a board of directors and a constitution, WOFAK began
operations from an office in Nairobi in January 1994. Since then, membership has grown to more
than 450 women infected and affected by HIV/AIDS. The main support WOFAK provides is bringing
women living with HIV/AIDS together to share experiences and provide mutual support. The activ-
ities undertaken by WOFAK include:
• counselling and psychosocial support for infected and affected children and adults;
• traditional medicine for the relief of opportunistic infections;
• HIV/AIDS education and awareness to different groups, including youth throughout Kenya;
• reproductive health services;
• home-based care;
• advocacy for the rights of women with HIV/AIDS;
• training in counselling, education and home-based care for WOFAK members and traditional
healers;
• training in income-generating projects.

WOFAK is comprised of 20 permanent staff and five volunteers, including counsellors, educators,
home-based carers and a traditional healer. Below is an organogram showing WOFAK’s structure
and the collaboration between WOFAK and Kenya Forestry Research Institute (KEFRI).

Most of WOFAK’s
services are offered in
the WOFAK drop-in
centre, Kayole, located
in the Eastlands of
Nairobi, about 30km
from the city centre.

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ancient remedies A4 CAG 19.6.2002 9:07 Page 11

UNAIDS

KEFRI WOFAK Head Office,

Nairobi city centre
• Herbarium
• Herbal processing • Reception
• Herbal research • Administration
• HIV counselling and testing

WOFAK drop-in centre,

Kayole WOFAK Outreach Office,
• Medical and herbal clinic Homa Bay, Nyanza Province
• Home-based care • AIDS counselling
• AIDS counselling and testing • AIDS education

Counsellors, educators, home-based

carers, traditional healers & volunteers

The 'worried People infected Public and Organized Street

well' & affected by HIV private groups children
institutions

Dorothy Onyango—WOF AK Founder and Programme Director

Dorothy, a single mother with three children, was diagnosed as

HIV-positive in 1990. She describes this period as a very trying
time, as she was taking care of her mother who also had the
deadly virus. When she felt the courage to share her HIV status
with a friend of hers whose husband died of HIV, this friend helped
her attend a women’s meeting in the Netherlands. There, she met
HIV-positive women from all over the world and was inspired to
start a support group for women living with AIDS in Kenya. This
was the humble beginning of WOFAK. Initially, these women were
just assisting each other but, with time, more and more women
became interested. Dorothy is very proud of what WOFAK has
achieved since then in care, counselling, advocacy, orphan sup-
port and especially in empowering HIV-positive women. Dorothy looks forward to the bimonthly
WOFAK group therapy sessions, where women mix and learn from each other. She is, however,
overwhelmed with the many responsibilities involved with running an organization.

Dorothy feels that traditional medicine is a very valuable option for WOFAK clients, as Western
medicine is much too expensive for WOFAK’s target population. She explains that the government
is generally opposed to the use of traditional medicine, so WOFAK only uses it with its own mem-
bers until it is officially tested at the Kenya Medical Research Institute (KEMRI). “Most people pre-
fer herbal medicine as there are no side effects. It is our first aid and we have seen only positive
impact on our clients.”

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ancient remedies A4 CAG 19.6.2002 9:07 Page 12

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Nicanor: a WOF AK client

Though he is alone most of the time, Nicanor has a wife who works and three children aged 8, 5
and 3. He had been sick for over six months when he developed a very bad cough. Twice this year
he was admitted to hospital with a wound on his arm and a rash all over his body. Nicanor was
formerly employed, but is now jobless as he is too sick to
work. Luckily, one of the community leaders asked WOFAK to
make a home visit to see Nicanor. As a result, two months ago,
he started using traditional medicine when he was unable to
walk.

He is relieved that, with treatment, he can now walk. Although

he went to conventional biomedical clinics and the doctor
prescribed treatment, Niconar was unable to afford it on the
Nicanor receiving herbal medicine meagre income his wife earns selling rice. So he is grateful for
from Fredrick Olum, WOFAK healer the treatment and care from WOFAK.

WOFAK and traditional medicine—a new initiative

In May 1999, with the inspiration of the first International Meeting on Traditional Medicine and
AIDS, held in Dakar, Senegal, and with funds from the Ford Foundation, WOFAK embarked on an
exciting new adventure to support the discussion and use of traditional therapies for HIV-
associated opportunistic infections. WOFAK’s mission with regard to herbal medicine is: to sus-
tain and promote various forms of traditional medicine and to develop ties with beneficial cultural
practices throughout the country.

To further its objectives, WOFAK has established a working agreement and collaboration with
KEFRI to grow, process and conduct safety assessment and analyses of some medicinal herbs.
So far, useful herbal therapies have been identified for herpes zoster, diarrhoea, malaria, skin
rash, cough, fever and joint pains. The strong relationship between KEFRI and WOFAK is rein-
forced by one KEFRI herbalist, Fredrick Olum, who works at the WOFAK drop-in centre two days
a week treating clients with herbal medicine.

WOFAK traditional medicine activities:

• Identification of traditional medicines: This includes the collection of raw materials by the
KEFRI herbalist and processing through KEFRI. Traditional medicines are also identified in
training seminars and workshops, as well as through group therapy sessions. WOFAK group
therapy takes place twice a month and over 50 women come together to share experiences
with experts in both herbal and biomedicine. Members bring samples of the plants they are
using and are taught how to properly collect and store them. This is one empowering way for
women to take control of their health in an accessible and affordable manner. WOFAK docu-
ments the names and uses of medicinal plants identified by members in these therapy and
training sessions.

• Collaboration between biomedical doctors and traditional healers: In general, the collaboration
between the two health systems is low in Kenya, as in many other countries of East Africa, but
WOFAK considers it an important element of good-quality health services. The main activity
undertaken in this area is that of encouraging cross-referral. Within the WOFAK drop-in centre,
there are two clinic rooms side by side—one for traditional medicine and one for biomedicine.

The nurse or doctor refers to the herbalist and vice versa, depending on the condition, the
medicine available, or the patient’s preference. Screening through conventional testing is
done to determine the problem before treatment begins. The clinic has one community nurse,
one traditional healer, one part-time doctor and two herbal nurses.

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ancient remedies A4 CAG 19.6.2002 9:07 Page 13

UNAIDS

Side by side, traditional and biomedical clinics at the WOFAK drop-in centre in Kayole, Nairobi.

Fredrick Olum: Traditional Healer, WOF AK and KEFRI

Fredrick, a herbalist working at KEFRI, inherited knowledge about medicinal plants from his
maternal grandmother, who used to send him to collect herbs in the garden. Though she died long
ago, he says her spirit is still teaching him through his dreams. He explains, “At night, I will dream
of a plant and be forced to use it the next day or she will come back in a dream and ask why I
haven’t used it.”

In 1990, the director of KEFRI, who was very interested in herbal medicine, set up the herbarium
and other traditional medicine projects. Through KEFRI, more than 3800 species of medicinal
plants from all over Kenya have been identified and processed. After this director left in 1995, the
activities of the herbarium declined.

Fredrick has been treating people with herbal medi-

cine since 1985 and began working with WOFAK in
1999. His collaboration with WOFAK began when
Eunice Odongo, a lab technician at KEFRI, asked him if
he could provide herbs for the WOFAK drop-in centre
in Kayole two afternoons a week and collaborating
with the biomedical clinic in the next room. He says, “It
is here that I know my herbs were working”. He says
he is gratified because people respond well to his
herbal treatment, and many people are availing of both
KEFRI herbarium the herbal and biomedical approaches. His most suc-
cessful treatments are for oral thrush, herpes zoster
and cough. He has also learned about counselling and
home-based care through WOFAK. The collaboration between Fredrick and WOFAK is protected
by an agreement that states that his herbal secrets will not be divulged without his approval. Thus,
the trust is maintained between the two parties.

Fredrick feels he has benefited from WOFAK in that he has learned a great deal about HIV/AIDS
prevention and care, which helps his work with patients at the WOFAK clinic and in their homes.
He has three daughters and three sons, but only the youngest one, who is nine years old, is inter-
ested in learning about traditional medicine to carry on the family tradition.

• Training of healers in HIV/AIDS counselling and education skills: Two training sessions have
taken place—one in 1999 and one in 2000. The first three-day training was held in Nyanza
province for 34 participants, 20 of whom were traditional healers. The objective was to establish
collaboration between people living with HIV/AIDS, conventional researchers and traditional
healers. Issues highlighted included the AIDS situation in Kenya and in Nyanza Province, tra-
ditional healers’ views on health and disease, the role of traditional healers in AIDS control,

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Ancient remedies, new disease

ethnomedicine in Kenya, traditional medicine in the management of opportunistic infections,

access to treatment for HIV/AIDS, home-based care and protection of intellectual property
rights. The second training session covered similar topics but included counselling skills and
the identification of herbs for some opportunistic infections.

• AIDS education and education against harmful traditional prac-

tices in schools, for religious groups, matatu1 drivers, youth
groups and other NGOs. Harmful traditional practices can include:
widow inheritance, early marriage, female genital mutilation and
circumcision.

• Provision of technical assistance to projects related to the value of

traditional medicine.

• Income-generation and cost-sharing on use of traditional medicine.

Income-generating activities include hair dressing, shopkeeping, and
fruit-, vegetable- and paraffin-vending. WOFAK has drawn up a con-
tract with two herbalists who supply herbal medicine for WOFAK patients. WOFAK members are
treated free of charge, but non-members pay a small fee.

• Development of a data bank on Kenyan healers and their areas of expertise, which includes
name and full contact address of the healer, a short biography (age, level of education, length
of training, etc), area of operation, area of specialization and list of herbal remedies used
(roots, leaves, herbs, how they are prepared, their dosage and what they treat).

• Ensuring confidentiality and quality control of the herbs being used through code names and
agreements with healers.

Joseph Parmuat: a traditional healer, WOF AK

As a traditional healer operating in three clinics (one in

Dagoretti, which is in the outskirts of Nairobi; one in
Malaba, along the border with Uganda; and one in
Loitokitok, Masai), Joseph is extremely busy. He is in his
mid-thirties and has arranged his Dagoretti clinic so that
it resembles a modern clinic with a waiting room adorned
with public health posters, and a consulting room with his
herbal medicines neatly organized on shelves. In his very
matter-of-fact manner, he explains that, unfortunately, he
is unable to expand his services further as his patients
trust only him and would be wary of newcomers. He, therefore, cannot let anyone else operate
his other clinics; only his wife helps in the clinic in Masai.

Having learned AIDS education and counselling skills from WOFAK, he has tried to gather
patients together to educate them on these issues. He also advises on condom use, but is unable
to distribute condoms for he has no reliable supply himself.

Though Joseph has worked closely with the University of Nairobi’s Department of Pharmacy in test-
ing his herbs in the lab, he feels that his greatest challenge is the collaboration with biomedical
health workers as they are generally not willing to work with healers. He believes that about 98%
of his patients come to him after Western medicine has failed them. He says that, in contrast to
his biomedical counterparts, he is open to collaboration and does not hesitate to refer patients
back to the hospital for conditions he cannot manage.

1 Minibuses used for public transportation in many sub-Saharan African countries

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UNAIDS

Lessons learned from WOFAK

WOFAK works with very limited resources, in extremely marginalized communities and with high
rates of HIV infection. Some factors in the success of WOFAK include:
• The dedicated staff members who walk for miles in the glaring sun to visit the homes of clients, who
often have little or no family support and limited resources for food and medicine. WOFAK’s home-
care service may be the client’s only source of food and/or care in a highly stigmatized environment.
• The collaboration with institutions such as KEFRI that enables WOFAK to provide its tradi-
tional medicine. KEFRI processes herbs and allows the herbalist to work for WOFAK two days
a week. The traditional medicine component is a valuable addition to the care and support
services of WOFAK as it leads to clients’ empowerment and their ability to care for themselves.
• The care and openness of WOFAK towards all clients who are HIV-infected and affected,
which is an important step in fighting stigma and working towards a more open Kenyan society.
• The combination of traditional and biomedical care services provided at WOFAK’s drop-in centre,
which is a unique and pioneering step and a highly positive development for WOFAK clients. This
open relationship allows for true collaboration, under one roof, in a genuine area of need. Based on
input from the herbalist and the nurse, clients are able to decide which medicines are best for them.

Eunice Odongo: Programme Officer, Care and Support, WOF AK

Though she was trained as a lab technician, Eunice calls herself a herbalist by experience with
‘interest added’. In 1996, she tested positive for HIV after delivering a baby boy. She had painful her-
pes zoster on her face, which was successfully treated with herbal medicine. She was soon
relieved of the pain and had no scarring.

She worked at KEFRI for 10 years before she went public with her HIV status in 1999. She then took
a year off from KEFRI to dedicate her time fully to WOFAK. As one of the few WOFAK members open
about her HIV status, Eunice is also the head of the herbal medicine project. Her enthusiasm and
zeal make for passionate testimonies on the value of traditional medicine for people living with HIV.

Eunice works as a home-based care coordinator, trainer, counsellor, consultant and

herbal nurse at WOFAK. She organizes the training of traditional healers and works
with them in providing care and support for clients. In addition, as a true AIDS
activist, Eunice networks with other AIDS NGOs in Nairobi and globally for the rights
of women with HIV.

She believes in the need for meaningful representation of traditional healers in the
planning, development and implementation of programmes and policies. Eunice
stresses that, “the accessibility and availability of traditional healers in rural popula-
tions and their unique continued popularity give them an important potential as collaborating part-
ners in HIV/AIDS activities, especially regarding health, illness, and personal and social problems.”

Eunice is passionate about her work with traditional medicine and this has allowed her to partici-
pate in numerous conferences on the subject. At the last World AIDS Conference, held in Durban
in 2000, participants and traditional healers came up with the following recommendations that
Eunice felt were important to share:

– all countries should develop a legal framework for traditional medicine.

– all traditional healers should be empowered to take an active role as IEC agents.
– this process should be integrated in such a way that:
a) healers collaborate with modern medical infrastructures
b) local structures are created to facilitate people’s access to health-care services
c) healers participate in biomedical research
– an international office should be created for the protection of traditional medical knowledge
– an international council of professional, traditional medical organizations should be created to
coordinate and provide advice regarding healer activities
– the sources of traditional medical knowledge should be identified and promoted.

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SUMMARY ANALYSIS OF WOFAK

MAIN
LESSONS LEARNED CHALLENGES FUTURE PLANS
COLLABORATORS
• Traditional healers are very • AMREF • AIDS-related information • Increase production of
valuable, not only as • Kenya AIDS Society materials are all in English, medicinal plants through the
collaborators, but also as (KAS) thus they are not relevant development of traditional
instigators of more innovative to much of WOFAK’s medicinal plant nurseries
and effective campaigns for • Kenya AIDS NGO target audience
Consortium • Develop a resource centre
HIV/AIDS prevention, care and • The best herbal medicine on traditional medicine
support (KANCO)
comes from Mombasa, and AIDS to organize
• Traditional healers form long- • Kenya Forestry which is very far away and information exchange
term innovative and Research Institute WOFAK does not have the through seminars,
participatory support groups, (KEFRI) resources to collect it workshops, publications,
which have proven successful in • Kenya Medical • Many traditional healers networking and
prevention, care and support to Research Institute still lack counselling and appropriate information,
HIV-infected and -affected (KEMRI) home-based-care skills to educational and
people cope with the immensity communication materials
• MoH
• Many traditional healers have of the AIDS problem
• National AIDS
migrated from rural areas to • WOFAK would like to
Control Council
make herbal medicines more cover the whole country,
(NACC)
available and accessible to but lacks the resources
urban dwellers • Society for Women,
AIDS in Kenya • Many traditional healers
• Communication with traditional lack skills in the packaging
(SWAK)
healers calls for face-to-face and processing of herbs
contact, especially in the case of
ceremonies and during the use of • Traditional healers are not
herbal medicines recognized in society,
hence there is a loss of
• Traditional healers are capable indigenous knowledge
of providing culture-specific
information on attitudes, beliefs • WOFAK's budgetary
and practices in relation to control is not clearly defined
sexuality • WOFAK is dependent on a
• Traditional healers are catalysts very few traditional healers
for the traditional medicine
• Traditional healers can provide component
home-based care in relation to
sexual behaviour and
HIV/AIDS
• Traditional healers can provide
basic counselling for patients
and families

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UNAIDS

BEST PRACTICE CRITERIA ANALYSIS OF WOFAK

Relevance Effectiveness Ethical soundness Efficiency Sustainability

• Objectives clearly • No reported failures with • Patient • According to • Relies on donor
stated traditional medicine so far confidentiality WOFAK external support
• Eight years of • Traditional healers act as emphasized assessment2 • Clinic run on cost-
experience gatekeepers within target • Agreement • the few available sharing basis
• Only service of its communities, identifying people signed between resources are well • Members pay monthly
kind in poor, peri- needing support and WOFAK and utilized; registration fee
urban area, which recommending WOFAK healers supplying • herbal medicine is
services, such as home visits, herbs • Receives donations
has high HIV cheap; from ‘WOFAK friends’
prevalence in which include treatment and food • One WOFAK
• WOFAK pays (individual donors)
marginalized • Traditional healers distribute traditional healer traditional healers
communities condoms and refer clients for works within • Committed staff,
for herbal board and volunteers
• PLWHA (especially HIV testing KEFRI medicine, thus
women) highly • Traditional healers keep records • Herbal medicines creating an • Extensive network
stigmatized and on client treatments and have been tested income-generating both nationally and
rejected in Kenya follow-up at KEFRI activity for them; internationally
• Healers distribute educational • Strong • WOFAK's • Strong support from
materials through chief’s collaboration reporting system is collaborating agencies
barazas (village meetings) or as with KEFRI and good, and (NACC, KEFRI and
community leaders NACC accounts are KANCO) and
audited annually. community
• Healers transmit counselling
and home-based care skills to • Staff members get on-
other traditional healers the-job herbal training
• Traditional healers initiated an • Since the beginning,
organization after a WOFAK WOFAK has been able
seminar, which includes a to implement a lot
collaborative clinic with herbal with extremely limited
and modern medicine resources

WOFAK's SPECIFIC CRITERIA/APPROACH FOR TRADITIONAL MEDICINE/

BIOMEDICINE COLLABORATION
Criteria for selecting traditional Approach used to build trust Approach used to involve BHPs
healers with healers
• Through KEFRI's data base on • Healers gained trust when they knew • Health workers work side by side
traditional healers that WOFAK was not an organization of with herbalist in WOFAK’s drop-in
• Through healers who already know researchers centre
WOFAK • WOFAK brought healers together and, • Joint seminars and workshops for
• Through the Traditional Healers through sharing their ideas, the healers traditional healers and biomedical
Association under the Ministry of agreed to work together. Their initial health practitioners.
Culture and Social Services fear was that researchers would take • Discussions and information sharing
their samples and not give them for the herbalists and conventional
• Through sharing experiences of
proper credit. WOFAK explained that medics
successful treatments with women
the aim was to treat PLWHA and not to
during group therapy at WOFAK • Sensitization to reduce human
take their samples
• Through community leaders suffering by treating diseases using
different approaches

2 Assessment conducted by the organization ‘Improve Your Business, Kenya’ in 1999.

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IV. AIDS CARE AND PREVENTION: AN INTEGRATED MODEL

IN THE UNITED REPUBLIC OF TANZANIA

Background statistics: United Republic of Tanzania*

Total population in millions (1999) 32.8

Urban population (2000) 35%
Annual population growth rate (1990–1998) 2.9%
Infant mortality (1998) 80 per 1000 live births
Life expectancy (1998) 48
Total fertility rate (1998) 5.4
Literacy rate (1995) Male: 79%
Female: 57%

Per capita GNP (1997) US$210

Adult HIV prevalence (1999) 8%

*Source: AIDS in Africa, Country by Country, UNAIDS 2000

AIDS in the United Republic of Tanzania

In the early 1990s, annual deaths from AIDS were estimated at 20–30 000 or 5–7% of all deaths in
Tanzania. However, a study by the Ministry of Health in 1997 re-estimated the burden of AIDS mor-
tality and found that AIDS accounts for more deaths than the next four leading causes combined.
AIDS is also responsible for four-to-seven times more deaths in women than men, especially in
urban areas. In rural areas, the virus accounts for one-third to one-half of deaths among men in
their early thirties. A World Bank Country Study in 1997 estimated that, by the year 2010, the num-
ber of HIV-infected people in Tanzania will reach 6–17% of the population (DANIDA, 1999).

About 90% of reported AIDS cases occur in the 15–49-year-old age group. Women in Tanzania, as
in most sub-Saharan countries, are more at risk of contracting HIV than are men and have a
seropositive peak between the ages of 20 and 24, compared to 25–35 for men.

In addition to the National AIDS Control Programme (NACP) of the Ministry of Health, Tanzania has
both a National Advisory Board on AIDS (NABA) and a Tanzania AIDS Commission. NABA was
established by the Prime Minister and is headed by His Excellency former President Ali Hassan
Mwinyi. The Commission, currently being established, is headed by Major General Lupoga and is to
be the leading body responsible for coordinating the multisectoral response to HIV and AIDS.

Tanga AIDS Working Group (TAWG): objectives and activities

From 1992 to 1998, there were 4792 cases of AIDS reported in the Tanga Region, yet the NACP
estimates that only one-in-five cases were reported. These figures invariably suggest high infec-
tion rates in the region, hence the Tanga AIDS Working Group’s (TAWG’s) activities are critical in
areas where little, if anything, is offered for HIV prevention and care services.

Background and history of TAWG

In the words of one of TAWG’s founders, TAWG sprouted from a traditional healer’s initiative in
1990, in collaboration with health workers from the government hospital in Pangani—a coastal

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UNAIDS

town just 60km from Tanga. During a workshop, Waziri Mrisho, an 84-year-old healer, offered to
treat a hospitalized AIDS patient with his plant medicines. Although Mrisho explained that his
medicines had successfully been used for centuries to treat the symptoms this patient displayed,
the hospital staff didn’t expect to see the patient gain weight and improve after taking Waziri’s
medicines. The patient surprisingly improved, was discharged from the hospital, and is reportedly
still alive today. From that exciting beginning sprung TAWG (Scheinman, 2000).

In Tanzania, as in many other countries in sub-Saharan Africa, it is well known that the burden of
primary health care is on traditional medicine, especially since the establishment of cost-sharing
in the hospitals. There is a Department of Traditional Medicine in the Ministry of Health and tradi-
tional healers are organized at all levels of the district health team. The Institute of Traditional
Medicine in Dar es Salaam has established guidelines for collaboration between traditional heal-
ers and biomedical practitioners and is now working on a legal framework. In addition, a research
network is being established between the National Institute of Medical Research and traditional
healer organizations.

The activities of TAWG cover three district towns in the Tanga Region, with a head office situated
in Bombo Hospital in Tanga town, which is the government referral hospital for 1.5 million people
in the region. In late 2000, TAWG was treating approximately 400 patients with the overall goals of
bridging the gap between traditional and hospital medicine for the benefit of people living with
AIDS and reducing HIV transmission in the region.

TAWG was built on a foundation of early collaboration between healers who had treatment for
some AIDS-associated conditions and doctors who were truly interested in partnering for the
benefit of their patients. In association with local healers, three efficacious herbal remedies were
developed for the treatment of a variety of ailments commonly associated with HIV/AIDS.
Thereafter, a home-care service was initiated for HIV/AIDS patients and their families. Today,
home visits involving the monitoring of general health, the administering of traditional remedies
and the provision of counselling services are the backbone of the group’s daily work.

Through collaborating physicians, TAWG acquired space within the compound of the Regional
Hospital, and now occupies a floor in an old German building, called Cliff Block, overlooking sce-
nic Tanga Bay. In 1994, the organization became an officially registered NGO and is now a major
player in the fight against HIV/AIDS in the Tanga Region. The Regional AIDS Control Coordinator
(RACC) has always been on TAWG’s Board of Directors, and TAWG works closely with the
regional and district health teams.

In order to get critical AIDS and STI information out to

the people, TAWG initiated a Community Health
Information and Care Centre (CHICC) located in the
central business area of Tanga town. The CHICC is
staffed by nurses who are trained as counsellors and
community educators.

In Tanzania, the work of TAWG is an outstanding exam-

ple of how positive results can be achieved in the fight
against AIDS by using local, culturally relevant expertise
and resources to provide low-cost care and prevention
for people living with AIDS.

Objectives of TAWG
The United Republic of Tanzania with 1. To provide treatment for people living with
TAWG's operational area HIV/AIDS
(Muheza, Pangani and Tanga) 2. To minimize the spread of HIV infection in Tanga
3. To collaborate with traditional healers

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Summary chart of TAWG organization and activities

Collaboration with Providing care and Minimize the spread of HIV
traditional healers treatment for people infection in Tanga at the
• Training of healers in STIs and living with HIV/AIDS CHICC
HIV/AIDS, community • Home-care visits • HIV testing and counselling
education and counselling
• Social support to • Information on HIV/AIDS
• Treatment of PLWHA with PLWHA and other IEC activities,
herbs
• Counselling including youth-centred
• Studying efficacy of herbal drama and daily video
medicines sessions
• Joint traditional healer-
biomedical health practitioner • Treatment of STIs
home care

TAWG HEAD OFFICE,

Bombo Hospital, Tanga

PANGANI DISTRICT MUHEZA DISTRICT

OFFICE OFFICE

Dr Mberesero, TAWG co-founder

A medical doctor by training, Dr Mberesero is married with three chil-

dren and works at Bombo, the Tanga Regional Hospital. Dr
Mberesero is a founding member of TAWG and is currently the Vice-
Chairperson of the Board of Trustees. She explains that TAWG was
started by a German doctor, Dr Elmar Ulrich, who was working in
nearby Pangani Hospital at the time. He observed that patients
delayed reporting to the hospital for treatment and was curious about
the reasons behind the delays. He discovered that patients first vis-
ited traditional healers, which prompted him to approach the healers.

Dr Mberesero’s personal interest in joining forces with traditional healers also stemmed from the
fact that her grandfather was a healer. Currently, she volunteers with TAWG, and is involved in
designing and facilitating healer training. She is also part of TAWG’s home-care team.

Dr Mberesero stresses that, through TAWG activities, healers have been trained as HIV/AIDS
counsellors, peer educators, condom distributors and better health-care providers. They have a
better understanding of HIV/AIDS, can sensitize communities and refer patients with complica-
tions that they cannot manage.

One of the challenges TAWG faces is the reluctance of some healers to collaborate because they
fear that their treatment secrets will be stolen. Dr Mberesero explains the situation to traditional
healers in the following way: “We are not interested in becoming famous; we give them the recog-
nition they deserve and feedback on the research we conduct. But we also clarify that many
people use the same herbs, so who really owns them? Aren’t they community property?” She also
noted the resistance of her medical colleagues who ask her, “Why do you collaborate with some-
one who has never gone to school?” Dr Mberesero views traditional medicine as valuable because
it differs from biomedicine, unlike some people who would like to convert healers into community
health workers. She says, “We should keep traditional medicine as traditional medicine and not try
to make it more like Western medicine”. Some hospital workers are now referring patients to TAWG
for traditional medicine and the Regional Medical Officer is open to collaboration.

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UNAIDS

What does TAWG do?

TAWG’s response to the HIV/AIDS crisis in Tanga acknowledges the need for increased awareness
and prevention activities in a context where stigma and denial are still high. It also recognizes the
need for treatment and care for the increasing numbers of people infected with HIV.

HIV testing and counselling services in a

supportive environment
A comprehensive response to AIDS includes HIV testing and
counselling. Testing services are provided at the TAWG head
office and at the CHICC, while counselling is also offered at
home. Today, many hospital personnel know that TAWG staff
members have been trained as counsellors, so patients are
referred to either of the TAWG offices for testing and coun-
selling. The story of one TAWG client illustrates the experience
of many TAWG patients: “Matilda went alone to be tested. She
had mentally prepared for the results of her test, which she
assumed would be positive. She was warmly welcomed by
Mama Ussi, a TAWG nurse, and was counselled by both her
and Dr Chaze, and then tested. A couple of days later, she got
a confirmation of her positive test results and was enrolled as a client” (McMillen, 2000). If a client
tests positive, he/she can enrol as a TAWG member and benefit from free treatment, home visits and
counselling. Through testing and counselling, HIV/AIDS patients have been encouraged to accept
their condition and take the necessary steps to cope with it. With counselling, clients are better able
to benefit from the traditional and modern treatment that TAWG provides. Numerous TAWG clients
have testified as to their improved health status after testing, counselling and traditional treatment.

Home-care visits provided for people living with HIV/AIDS—a continuum of care

“TAWG’s signature activity is treating patients in the hospital or at home with medicinal plants.
Our plants work,” says David Scheinman, one of TAWG’s founding members, adding, “they are
low-cost, effective, readily available, provided to patients at no charge, and have been used by
Tanzanian healers for centuries” (Scheinman, 2000).

When clients are enrolled in the TAWG programme, they can use traditional medicines collected
by a healer and distributed by the hospital. TAWG prescribes medicines at the doses given by
healers, while physicians and nurses monitor the patients. If a patient responds well and has no
adverse side effects, treatment continues. An often cited ‘side effect’ of traditional medicine
treatment is increased appetite, which can be difficult if patients do not have enough food to eat.

TAWG has care providers in Tanga at the TAWG office and at the CHICC, situated in the Tanga city
centre near the market. TAWG also has trained nurses and counsellors in Muheza and Pangani
Districts. Patient home visits are carried out two days a week and are appreciated by clients
because of the greater privacy and confidentiality available to them at home, compared to being
in a hospital environment. Clients feel cared for during home visits and the nurse has a chance to
discuss important issues with family members and other caregivers. One of the TAWG clients says
of her nurse, “The nurse gives me moyo and matumaini (heart and hope)” (McMillen, 2000).

Currently, TAWG has approximately 800 confirmed HIV/AIDS registered patients. In 1999, in the
three districts (Muheza, Pangani and Tanga), TAWG recorded the following activities:

Home-care contacts 1290

Inpatient contacts 249
Outpatient contacts 1432
Traditional medicine doses given 1079*

*Total number of monthly doses given by TAWG staff, excluding medicine given by traditional healers in their own offices.

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According to the Regional AIDS Control Coordinator (RACC), the Tanga AIDS Working Group is treat-
ing almost 10% of all confirmed AIDS cases in the entire region of Tanga using traditional medicine.

Modern medicine is given to patients who visit the CHICC for STI services. TAWG tries to run the
service on a cost-sharing basis. However, clients under the age of 20 are treated without charge
to encourage them to seek care for STIs.

Mary: TAWG client

Mary first began to think that she might have HIV in 1995 when she was 27 years old and pregnant
with her first child. She knew her husband was having an affair and she had heard rumours that his
girlfriend’s husband had died of AIDS. She warned him that he was risking their marriage and their
lives, but he denied everything. At this time, he was drinking a lot and spending a lot of time out of the
house. They weren’t able to reconcile, so she decided to leave him and went to live with her sister.
After moving in with her sister, her health was stable and she carried her pregnancy to term with-
out problems, but she was worried about her future in light of her husband’s affair. To her relief,
she gave birth to a healthy baby boy. But, at six months of age, his condition deteriorated. He died
at one year of age (in 1996). Soon after the baby died, Mary received a message that her husband
was also becoming very sick and weak. About the same time, Mary also started to get sick. She
was coughing and was eventually admitted to the hospital in Moshi where she was diagnosed
with TB. She completed the year-long TB treatment in August of 1998. Mary says that even though
she spent a lot of money on hospital medicines she never regained her former level of health. She
even turned to traditional healers but their medicines did not help her either; they just wasted a
lot of her money, she says. Her condition continued to deteriorate.
Mary left Moshi and moved to Dar es Salaam to stay with her aunt. Mary was not able to take
care of herself, and relied on her aunt for everything—food, bathing, clean clothes, etc. However,
this aunt was older and not really able to give Mary the care she required. Mary’s condition con-
tinued to worsen. About this time, Mary’s other sister, Susana, encouraged her to come and stay
with her and her family in Tanga. Susana was working as a housekeeper at Bombo Hospital and
had heard of TAWG. She thought TAWG might be able to help Mary.
It was January of 1999 when Susana picked Mary up at the bus station in Tanga. She hardly rec-
ognized her because Mary looked so thin and sick. She could not even walk. Mary remembers
that she had skin rashes, oral thrush, diarrhoea, high fever, cough and body aches. Mary told
Susana that she had given up all hope (“nimeshakata tamaa”). Not only was her physical condi-
tion bad, she was also very depressed, confused and worried. The next day, Susana arranged for
TAWG to come and visit Mary at home.
A nurse and doctor came and talked to Mary and, together, they decided that she should be
tested for HIV. The nurse asked Mary if she knew what she had been tested for. Mary explained
to her that she had been sick for a long time. The nurse then explained that she was HIV-positive,
but that there was hope. She told her about TAWG and the traditional medicines people use that
help them live longer.
The nurse made arrangements for Susana to come to the TAWG office to collect the herbal
medicines. For the following few months, Mary still had no strength and was attended to by the
home-care team. They monitored her condition, brought her medicines and, sometimes, milk and
soap. They also helped Susana understand more about AIDS and how to care for Mary. After
three months of using the medicines, Mary was able to go to TAWG’s office for check-ups on her
own. Her appetite returned, she regained strength and was able to return to daily activities such
as cooking, cleaning and even fetching water. She felt free to go out and talk to her friends.
Mary believes it is the herbal medicines from TAWG that returned her to health because none of the
medicines she previously used (from the hospital or other traditional healers) helped her. She con-
tinues to use the TAWG herbal medicines to maintain her condition, but because their preparation
requires a lot of work, she does not use them daily unless she is bothered by a specific problem.
–––>

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UNAIDS

Once, she stopped for two months and her condition worsened. Mary says that the herbal medicines
are best at treating fungus, stomach problems and cough, especially when hospital medicines do not
work. In addition, her periods, which had stopped, resumed on a regular basis. Now she says she is
able to walk long distances, carry water, cook ugali for four people, clean the house and wash
clothes. She feels more like herself and like a normal person. Although some of her skin problems still
come and go, her other problems (lack of appetite and weight loss, thrush and body aches) are gone.
Mary says she is much more optimistic about her future now than when she first arrived in Tanga.
Mary has also joined the support group for HIV-positive people at the CHICC. She says her fellow
members help keep her spirits up. It makes her feel better to be with people who understand and
can relate to her problems.

HIV/AIDS education through seminars, drama and the Community Health

Information and Care Centre (CHICC)
TAWG works in association with 20 theatre groups to
conduct performances aimed at increasing HIV aware-
ness and behavioural change in the three target
districts. Theatre group members have been trained in
one-week seminars on HIV/AIDS issues and evaluation
results indicate that performances stimulate conversa-
tion about AIDS and reach large numbers of people
(McMillen, 2000). Besides offering STI services, the
CHICC has books and pamphlets on AIDS, shows educa-
tional videos to the public six days a week, and regularly
conducts educational seminars for specific groups such
as health-care workers, teachers, students, workers in high-risk areas and traditional healers.

Mrs (Mama) Zimbwe: a nurse with TAWG

“Traditional healers are good cooperators,” says Mrs Zimbwe, who is married with four
children, and is a trained nurse and the coordinator of the CHICC of the Tanga AIDS
Working Group. She joined TAWG in 1989 to work with people living with HIV/AIDS and
to help them cope with life. “I did not find any difficulty in working with traditional heal-
ers, since my previous work involved working with traditional birth attendants (TBAs),”
she says of her current job. She explained that health workers were motivated to col-
laborate with traditional healers as they realized that they were losing children to
malaria, pneumonia and bilharzia. They felt that they could reach many more people
through the network of traditional healers. “In our first seminars with traditional heal-
ers, we simply listened to them describe to us which diseases they treated, what med-
icines they used and some came out and said that they treated HIV.”

Mama Zimbwe is currently one of the counsellors with TAWG, based at the CHICC. She has done a
great job, and her clients like her because of her motherly approach and the love she shows them.
“Counselling is a great thing for patients and I enjoy it. You get to understand the difficulties of
people living with HIV/AIDS and those affected.” She has been involved in training more than 300
traditional healers in STIs and HIV/AIDS counselling, prevention and care—a role she believes in.

She describes her experience of working with traditional healers as a good one. “Working with
traditional birth attendants made us realize that traditional healers had much to offer to their
patients, something that we hadn’t paid much attention to. We later found out that healers were
giving herbs to their patients for illnesses like convulsions, anaemia, pneumonia, bilharzia, and
STIs, and patients were improving.” With more than 10 years of experience in the field, she is a
strong asset to TAWG, especially given her love for new ideas and innovative ways of imple-
menting them.

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Ancient remedies, new disease

Social support for PLWHA

In an environment such as Tanga, where AIDS is still a highly stigmatized disease, the creation of
a support group for clients was a critical link to improved AIDS care services.

One of TAWG’s clients, Veronica, who joined the support group for HIV-positive people, says of
her fellow members, “Before joining the group, I was seriously sick and was only thinking of
dying. I was encouraged by group members, who gave me additional ideas for treatment. Now, I
feel stronger and can even give community AIDS education.”

TAWG was very instrumental in forming the Tanga Branch of SHDEPHA+3, an association of peo-
ple living with HIV/AIDS, founded in 1997. Association members meet at the CHICC every Tuesday
and Friday morning, to share experiences, comfort each other and discuss how to live positively.
Recently, they have started producing crafts to generate income.

Through its home-care programme, TAWG also provides material support (consisting of milk,
eggs and soap) to the most needy patients.

Collaboration with traditional healers

TAWG believes that if healers are equipped with knowledge on how to identify HIV/AIDS, how it
is contracted, spread, and can be prevented, they can advise their patients and other community
members. This strategy has enabled TAWG to extend its services to people who do not come to
the TAWG offices.

To ensure continuous dialogue and information exchange with as many traditional healers as
possible, TAWG holds monthly meetings with healers and three-to-five-day seminars every quar-
ter. TAWG educates traditional healers on HIV/AIDS, condom use, community education and
aspects of primary health care, while healers share their perspectives and experiences with
regard to their relationship with clients and their traditional medicines. One of the TAWG nurses
describes the outcome of training, saying that traditional healers:
• have increased knowledge of HIV/AIDS (evaluation results indicate that healers involved in
seminars know the modes of HIV transmission and prevention)
• make increased referral to health centres, counsellors and other traditional healers
• collaborate increasingly with biomedical health practitioners
• distribute condoms (which they get free from TAWG)
• take increased precautions against HIV infection during their work
• provide health education and HIV/AIDS counselling (at least half of the healers report that
they educate family and community members on AIDS)
• keep records and reports of their patients
• actively participate in monthly meetings with TAWG
• help identify other healers who have medicine for treating HIV/AIDS.

TAWG works very closely with one healer, Mohamed Kasomo, in treating
HIV/AIDS patients. Kasomo supplies herbal medicines to TAWG for a variety
of AIDS-related conditions, including weight loss, diarrhoea, fungal infec-
tions (including oral thrush), and skin conditions (including herpes zoster).
TAWG health-care workers distribute these medicines to patients from the
head office in the Bombo Hospital and then monitor their progress. A study,
conducted for TAWG in 2000, and anecdotal evidence from patients and
health-care workers, indicates that many patients have experienced signif-
icant improvement in their quality of life, as well as a longer life than could
have been expected in the absence of these herbal medicines. Whereas
more research is needed to confirm or disprove these claims, herbs are one
of the very few options for alleviating symptoms of HIV-associated oppor-
tunistic infections that could prove serious if left untreated.
Traditional medicine being prepared at Kasomo’s home

3 *SHDEPHA+ stands for Service Health and Development for People with HIV/AIDS

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UNAIDS

Ethnobotanical research
TAWG’s ethnobotanical research is simple and can be conducted with limited resources.
The process is explained by one of TAWG’s board members:

1. After consulting with biomedical doctors, we identify a disease or condition we want to treat.
2. We discuss the disease with healers and get their opinions. Do they recognize or treat the
disease?
3. We show healers pictures of the disease. Skin diseases are the easiest to treat.
4. We identify efficacious plant remedies already used by healers to treat targeted diseases.
5. If necessary, we carry out ethnobotanical research to find new plants from new sources.
6. We fill in botanical collection forms.
7. We collect the appropriate plants with healers.
8. We pay healers for their time.
9. We press leaf samples in a press and deliver them to a botanist.
10. The botanist identifies the family, genus and species.
11. We make sure the plant is not endangered.
12. We conduct a literature review, we check how other cultures use the plant and look for toxicity.
13. We get dosages from healers.
14. We recruit patients for observational study with healers.
15. We have a student with research skills carry out the study with the healer. This builds research
capacity.
16. We monitor results and draw conclusions.

The key to success is identifying knowledgeable healers and cultivating relationships with them. We
accomplish this by giving healers professional respect, trust, access to the hospital, and a fair price
for their time and plants (Scheinman, 2000).

Mohammed Kasomo: Traditional Healer, TAWG

Mohammed Kasomo (commonly known as Bongo Mzizi, a Swahili phrase for ‘root genius’) cur-
rently is TAWG’s sole supplier of herbal medicines. He started as a herbalist in 1971, after being
trained by his uncle who gave him the name Bongo Mzizi, seeing that he readily understood the
complexity of herbal medicine. After his uncle died in 1973, his eldest son, Bongo’s cousin, took
over the responsibility of training him.

Bongo lives and works in the outskirts of Tanga, only a 15-minute bicycle ride from
the TAWG office, in a two-room building, where, he explains, one room is for coun-
selling and the other serves as a pharmacy. He started collaborating with TAWG in
1993, after he was trained as a HIV/AIDS counsellor and community educator. He
claims he did not hesitate joining forces with TAWG, as he was aware that he was
going to work with doctors and nurses—people with a common cause. At his
office/clinic, he has two young men to help crush and pound the herbs while he fol-
lows up with his patients.

Through clinical observation by TAWG, Bongo’s medicines have proven quite effective in treating
common HIV/AIDS opportunistic infections, such as chronic diarrhoea, herpes zoster, oral thrush
and wasting. His herbs are identified by numbers, and are given to patients in finely or coarsely
ground form to be prepared at home as a tea to drink or as a topical application.

When clients come for consultation, Bongo says, “I welcome them and ask questions about their
health and life in general. After understanding the problem, I advise them to go to the hospital for
further investigations like a blood test for malaria or HIV. If I see signs of HIV, I tell them that it
might be ‘this disease of nowadays’. Counselling helps and, if it is a new patient, I escort them to
Cliff block (where the TAWG offices are located). If there are signs of witchcraft, I collaborate with
other traditional healers and refer to them. I also talk to other family members.”
–––>

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Through training, Bongo has gained skills in HIV counselling. “Before training, I was counselling
my patients on how to use herbs only. Now I tell them about the dangers of HIV/AIDS and how to
avoid it,” he says. Training and working with TAWG have changed local communities’ perceptions
of him. He has become quite popular as a herbalist and people come all the way from Dar es
Salaam and Moshi, each about 350km from Tanga, to consult him. Local people also come to his
office for advice on other health issues besides HIV/AIDS. “People think I can heal any disease,”
he says. Community members generally come in the afternoons in groups of 8–10, and he uses the
opportunity to educate them about HIV/AIDS. In addition, he advertises the AIDS video shows at
the CHICC.

Bongo also gives education to his fellow healers on research as he is the Research Coordinator
of CHAWATIATA, a local healers’ association. Bongo highly values referral, especially for patients
suffering from malaria, convulsions and anaemia. He uses forms designed by TAWG to monitor
the effectiveness of his herbs.

Being the sole supplier of herbs to TAWG has also created problems as other healers are jealous
of him—a situation TAWG is trying to address by involving more healers. He also explains that
some patients are reluctant to take condoms, saying that they do not enjoy sex with a condom.
Bongo replies, “What is better: to enjoy sex or get a disease with no cure?”

Client responses
In a recent evaluation of TAWG activities, patients reported that TAWG’s most valuable service
was that of providing traditional medicines, giving this as the main reason for registering with
TAWG. Patients use traditional medicine to both treat and prevent medical problems. Interestingly,
seven per cent of the respondents said they used the medicine only when they had problems. Most
use the medicines to keep problems from arising or recurring (Sheinman, McMillen, 2000).

TAWG patients enthusiastically claim that the medicines work. After nearly 10 years of admin-
istering them, TAWG staff members believe they are right. Though TAWG has not used the bio-
medical gold standard of placebo-controlled clinical trials or biochemical studies, there is a
compelling body of anecdotal and observational data from clients and staff indicating that
these herbs do help.

Both clients and staff have noted that herbal medicines help to increase appetite and weight gain,
stop diarrhoea, reduce fever, eliminate oral thrush, resolve skin rashes and fungus, cure herpes
zoster and clear ulcers. Most patients reported seeing results within 7–30 days of beginning treat-
ment and said they felt better, their appetite and strength increased, and they gained weight.
Other frequently cited improvements include: cough decreased, headache stopped, urination and
bowel movement increased, sleep improved and worries eased.

In TAWG’s recent evaluation, clients reported the following:

Satisfaction with Home care Satisfaction with Treatment

Unsatisfied Unsatisfied
0% 0%

Very Satisfied Very Satisfied

33% 40%
Satisfied Satisfied
61% 54%
Somewhat Somewhat
Satisfied Satisfied
6% 6%

TAWG Chairperson, Dr Mberesero, claims that traditional medicines work best at treating skin
conditions, diarrhoea, appetite problems, fungal infections and oral thrush. Almost everyone
agrees that herbal medicines are not very helpful for someone with advanced HIV/AIDS.

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UNAIDS

Thirty-two per cent of the clients reported that their symptoms returned after stopping the medi-
cines. In addition, many clients noted that traditional treatment was the only medicine that gave
them results. Most patients had already been treated with conventional biomedicines, with lim-
ited results. Many patients expected to improve with Western medicines, but did not, and have
thus continued taking herbal medicines because they brought relief and few side effects
(McMillen, 2000; Scheinman, 2000).

Maama Maharage: Traditional Healer, TAWG

Maama Maharage owns a small ‘clinic’ on the outskirts of Tanga. It is

filled with gourds, some hanging from the roof and others all along the
walls, while in the centre of the room sits a tall cylindrical-shaped
drum. Her compound is busy with children, clients, friends and other
family members. In her mid-sixties, Maama Maharage says she has
been treating patients since she was 24. She became very sick, her
breasts were discharging pus and she was brought to the hospital
where they believed she had cancer. When it was discovered that she
did not have cancer, her explanation was “The spirits of my old father
wanted me to be a healer”. She continues, “So they (relatives) brought
the drums and I have been treating patients ever since”. From the
respect accorded to her, it is no doubt she is a powerful healer.

Through her collaboration with TAWG, she has received much information about HIV and AIDS. Since
training, she is able to give health education and counselling to her clients when they come to her for
treatment. Not only does she inform patients about AIDS, but she talks to the family as well. And
though she is not a specialist on AIDS, she believes she has a remedy that is quite effective. She
would like the hospital to refer patients to her so she can monitor them on this medicine. In the
early days, she had difficulties talking to patients about AIDS, but now, with patients who know
her well, there is no problem and she emphasizes prevention.

When patients come to her, the first thing she does is to consult the spirits and then give treat-
ment. If the treatment is not working, she looks again at the ‘X-ray’ (spiritual consultation) that
tells her this patient might need to go to the hospital. If so, she refers them.

Lessons learned from TAWG

TAWG is an important building block in bridging the gap between traditional and hospital medicine
in order to assist people living with AIDS by providing available, culturally relevant and low-cost
treatment. Key elements in the success of TAWG include the following:
• Its knowledge of, and integration into, the communities with whom it works has allowed a
trusting relationship to grow between clients, staff, traditional healers and community mem-
bers. TAWG has been active in Tanga for 11 years, has a caring and dedicated staff, and is well
respected for its work.
• The traditional medicine component is the foundation of the organization and is what gives it
its character. TAWG has combined ethnobotanical research, and prevention and care activi-
ties, enabling it to provide a comprehensive response to AIDS through a culturally and
economically relevant approach. The strengths of both systems are combined in hospitals
where traditional remedies collected by traditional healers are used by biomedical workers.
• The respect given to traditional healers as health-care professionals has allowed for a trust-
ing relationship to develop between them and TAWG. TAWG has an agreement with the
traditional healers with whom it works and both parties are very happy with the working rela-
tionship and see it growing and continuing.
• TAWG’s home-care programme allows it to use its strength of combining traditional and bio-
medicine in a safe, confidential environment where counselling can also take place.

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Ancient remedies, new disease

SUMMARY ANALYSIS OF TAWG

MAIN
LESSONS LEARNED CHALLENGES FUTURE PLANS
COLLABORATORS
• Traditional healers • MoH • Social stigma associated with • Conduct clinical studies on the
should be respected as HIV/AIDS efficacy of the herbs found useful
health professionals • Bombo Hospital by TAWG
• Only one traditional healer is
• Give traditional healers • African Orphans Aid supplying medicine to TAWG • Identify more herbal treatments
access to hospitals, Appeal (AOAA) for different diseases and
clinics and patients • Lack of sufficient funds with conditions.
• Afriwag (NGO that helps which to expand the
• Involve traditional orphans) programme to involve more • Involve more traditional healers to
healers in home care • CHAWATIATA (local traditional healers supply herbs to TAWG clients
and training traditional healer • Lack of sufficient research and • Recruit more biomedical health
• Healers care about their association) documentation on traditional practitioners to be part of the
patients and want to medicine home-care team
learn more about
research • Lack of sufficient collaboration • Train more healers as HIV/AIDS
and some negative attitudes counsellors and community
• Traditional healers enjoy from biomedical health educators
mutual referral between practitioners
them and health-care • Sensitize more biomedical health
facilities • Traditional healers in general practitioners on the value of
have difficulty understanding traditional medicine
research
• Expand activities geographically
• Traditional healers often do not
trust each other

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UNAIDS

BEST PRACTICE CRITERIA ANALYSIS OF TAWG

Relevance Effectiveness Ethical soundness Efficiency Sustainability

• Objectives clearly • Clients and staff claim • Mutual respect is TAWG’s • In three years: 27 000 • As permanent
stated and based on herbal treatment is main principle community members of the
11 years of effective for HIV- members reached community,
experience working associated conditions • Counselled patients are in education traditional healers
with traditional given code numbers and sessions will continue to
healers • 160 traditional healers confidentiality is assured practice their new
trained since 1994 • 4300 home-care research and
• Linking prevention • International counselling visits carried out to
• Drama group reached standards are upheld; counselling skills
and care in high- 237 PLWHA even if TAWG is no
stigma context 55 000 people in 4 TAWG educates other
months counselling institutions in • Herbal medicine is longer present
• Providing STI and Tanga free for patients • Healers do not
AIDS services in city • CHICC has about 8000
visitors/month • Patients have access to both • CHICC biomedical receive salaries
market, a critical
area for reaching traditional healers and clinic run on cost- • TAWG office is in
• Surveys show that biomedical health sharing basis
women and youth healers have increased the hospital; links
practitioners, and are referred between hospital
• Low-cost therapy in awareness of as needed • Costs per patient
HIV/AIDS treated are very and TAWG are
context where other strong
options are limited • Traditional medicines have low
• Counselling helps been used for generations,
clients benefit from • Administration of • Supervisors from
• Only service of its hence their safety and nearby health
kind in Tanga, a treatment effectiveness are empirically TAWG is strictly
controlled and facilities were
remote region of • Clients who were documented trained to monitor
Tanzania measures are in
counselled reduced • MoH authorized research place to cut costs and support
risky behaviour and provided offices within traditional healers
hospital in their areas

• Research results are fed back • Capacity has been

to healers and NGO built in relation to
HIV counselling

TAWG’S SPECIFIC CRITERIA/APPROACH FOR TRADITIONAL

MEDICINE/BIOMEDICINE COLLABORATION
Criteria for selecting traditional Approach used to build trust with Approach used to involve biomedical
healers traditional healers health practitioners
• Being registered with the local • Give traditional healers time to observe • Biomedical health practitioners facilitate
traditional healer association programme and methods training of healers on STIs and
(CHAWATIATA), which is under HIV/AIDS, condom use and primary
the Regional Culture Office • Promote mutual respect health care
• Being recognized by the • Plan programmes and reach conclusions • THs are encouraged to refer patients with
community as a traditional healer together with traditional healers complications to hospitals. There is also
• Healers appreciated being taken some cross–referral from biomedical
• Programme Coordinator has health practitioners to traditional healers
knowledge of the community seriously and being treated like fellow
professionals. Initial dialogue between for counselling and management of other
members HIV/AIDS–related illnesses
expatriate physician, Tanzanian health
• Good performance, dependability, workers and traditional healers evolved • TAWG staff are clinical officers or nurses
and consistent cooperation into a series of workshops on patient
care, treatment, education and • TAWG offered a three–day training to the
cooperation between biomedical district health management team
workers and traditional healers
• Healers are paid for the medicine
provided to TAWG (about
US$2/month/person)

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V. TRAINING, RESEARCH AND INFORMATION-SHARING ON

TRADITIONAL MEDICINE AND AIDS: A COMPREHENSIVE
APPROACH IN UGANDA

Background statistics: Uganda

Total population in millions (1999) 21.1

Urban population (1998) 13%
Annual population growth rate (1990–1998) 2.8%
Infant mortality rate (1999) 103 per 1000 live births
Life expectancy rate (1998) 40
Total fertility rate (1998) 7.1
Literacy rate (1995) Male: 74%
Female: 50%
Per capita GNP (1997) US$330
National HIV prevalence (2000) 8.3%
*Sources: AIDS in Africa: Country by Country, 2000, UNAIDS
HIV/AIDS Surveillance Report, June 2000, STD/AIDS Control Programme, MoH, Uganda

AIDS in Uganda
Uganda, which once had the highest HIV prevalence rate in the world, is now mentioned by
UNAIDS as the only country in Africa to turn a major epidemic around. In 1985, the Government
of Uganda recognized the fact that AIDS affected all strata of the population and posed a serious
threat to the socioeconomic development of the country. Since then, the national response has
been characterized by a deliberate policy of openness, backed by effective political support from
the highest levels of government. This response has borne positive results at both individual and
institutional levels. Thus, the inclusion of HIV/AIDS in the Poverty Eradication Action Plan from
ministries and districts to lower level plans and budgets; a high-level political commitment and
advocacy; supra-sectoral coordination; community participation through NGOs, CBOs and
religious bodies; as well as the greater involvement of PLWHA at all levels of planning and imple-
mentation have had a definite impact on awareness, stigma and behaviour at all levels of
Ugandan society.

Today, AIDS knowledge in Uganda is almost 100% among adults. There has been an overall
decline in HIV prevalence rates that had reached an alarming peak of 30% in some urban settings
in the early 1990s and had steadily declined to 10–12% by the end of 2000 in the same surveillance
sites. In 2001, the prevalence rate was estimated at 6.1% by the Ministry of Health. In some parts
of Uganda, infection rates among teenage girls dropped dramatically during the 1990s, as did teen
pregnancies. However, the number of teen pregnancies is still alarmingly high. The Uganda AIDS
Commission states that, on average, 60 million condoms are being used annually by Ugandans.

Although Uganda has gone a long way in the fight against HIV/AIDS, the epidemic still poses a
serious threat to society at many levels. Even at 8.3%, the overall HIV prevalence rate is still
unacceptably high. Prevalence rates around the country are not declining fast enough and
behavioural change needs to occur at a rate more in keeping with the increasing HIV/AIDS
awareness. The high morbidity and mortality rates associated with the maturing of the epidemic
places an enormous burden on already overstretched health and social services, and political will
and enthusiasm do not always filter down to lower levels of government. The Government of

30
 UNAIDS

Uganda thus continues to call for everybody to participate in the struggle, within their means,
mandate and capacity.

Traditional and Modern Health Practitioners together against AIDS

(THETA): objectives and activities
At the peak of HIV prevalence in Uganda in
1992, health workers, families and communities
were feeling overwhelmed and powerless
against an enormous tide of health-care and
prevention challenges. Yet, this emergency
sparked a flood of new ideas in response,
including the founding of THETA. With the sup-
port of the National AIDS Control Programme
and the Uganda AIDS Commission, together
with The AIDS Support Organisation (TASO)
and Médecins Sans Frontières (MSF)4, THETA’s
work started in 1992 with two pilot projects
based in Kampala. The first project aimed at
evaluating traditional herbal treatments for
some specific AIDS symptoms. The second
project tested the effect of empowering tradi-
tional healers as STI/AIDS educators and
counsellors through training. Overall, these two projects, which lasted three years, yielded very
encouraging results.

THETA’s clinical study demonstrated that herpes zoster and chronic diarrhoea—both debilitating
conditions affecting PLWHA—could be successfully alleviated by local herbal preparations. Two
consecutive studies, consisting of systematic clinical observation and laboratory follow-up of more
than 500 patients, supported this finding. As a result, many recognized AIDS clinics now advise
their patients to use local herbal preparations rather than prescribing Acyclovir, the Western drug
of choice for herpes zoster shingles eruptions. Acyclovir is imported, thus difficult to find, espe-
cially in rural areas, and unaffordable for most Ugandans. In order for these local preparations to
be used more widely, THETA has piloted a herbal processing and packaging demonstration lab and
has also initiated the growing of useful herbs at a herbal garden near its Kampala offices.

The THETA training programme has shown that traditional healers can be enthusiastic and effec-
tive community educators and counsellors for STI/AIDS through their ability to deliver preventive
messages in unique ways, such as the use of personal testimonies, stories, song, dance, drama
and proverbs. This programme was first piloted in Kampala, where its success elicited several
requests from other districts for the programme to be expanded. By April 2001, nearly 1000 heal-
ers from seven rural districts had participated in a three-day AIDS awareness workshop, and
nearly 300 traditional healers had gone through an intensive two-year training and certification
programme in STI/AIDS counselling and education. This latter group has continued to engage dis-
advantaged communities in remote areas where no other AIDS educational activities had been
initiated. Among various post-training initiatives, traditional healers conduct community AIDS
education and individual AIDS counselling and care.

In 1995, THETA started a Resource Centre for Traditional Medicine and AIDS, which includes a
library and speakers’ bureau. The Centre facilitates the exchange of information and networking,
both locally and globally. It has also published booklets, training kits, two informational/educa-
tional videos and a newsletter with a readership of over 500.

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THETA’s success story attracted the attention of UNAIDS and, in February 2000, it was asked to
host a regional meeting to discuss traditional medicine and HIV/AIDS in Eastern and Southern
Africa. At this meeting, where 17 countries were represented, THETA was chosen as the Regional
Secretariat of a Task Force aimed at developing collaboration between the traditional and mod-
ern health sectors for HIV/AIDS prevention, care and research in Eastern and Southern Africa.
The mandate of this Task Force is to share information, advice and experience, to network, and
to document best practices around traditional medicine and AIDS.

THETA’s main goal is to improve and expand access to HIV/AIDS prevention, education and care
for disadvantaged populations, such as women and children, through mobilization and the train-
ing of traditional healers in Uganda. The specific objectives are:

1. To train traditional healers in rural districts of Uganda in AIDS care, counselling and education
2. To improve knowledge, access and quality of selected herbal treatments for opportunistic dis-
eases
3. To build the capacity of other NGOs and CBOs to enable them to work with traditional healers
in AIDS prevention and care
4. To support healer HIV/AIDS initiatives in their own communities.
5. To collect, organize and disseminate information on traditional medicine and HIV/AIDS in East
and Southern Africa.

THETA,
Kampala

Programmes Monitoring and evaluation Finance and administration

• Training traditional healers in
community mobilization, • Monitoring and evaluation of • Resource mobilization
prevention education and all programmes including • Human resource management
counselling follow-up of traditional healer • Financial management
• AIDS care training for healers initiatives long after the com- • Partnerships
• Training of Trainers (TOT) for pletion of training • Representation
healers • Review of indicators and tools
• Biomedical health practitioner • Special studies on traditional
training in traditional healer medicine and AIDS
collaboration • Report writing
• Information management
• Herbal processing and packag-
ing
• Herbal gardening
• Clinical and social research on
traditional medicine and AIDS

THETA training for traditional healers in AIDS care, counselling, and

education: what it entails
THETA’s healer training began in 1993 as a pilot programme. It was confined to a small group of
25 healers in Kampala, with the aim of sharing ideas and information between the two health sys-
tems. In 1995, with requests from the Uganda AIDS Commission, and other NGOs, THETA
extended its training programme to peripheral districts. The broad objective of this exercise was
to empower traditional healers with information on AIDS and STIs to enable them to give good-
quality education and counselling to their clients and community members.

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Specific training objectives

1. To share information on sexually transmitted infections (STIs) and disease management
practices, including the recognition of serious symptoms that require rapid referral.
2. To initiate and promote collaboration between traditional healers, biomedical workers and the
community.
3. To equip traditional healers with effective communication, reporting, leadership and coun-
selling skills.

Following a training cycle of two years, THETA holds a formal certification ceremony for healers,
where community leaders are invited and healers have a chance to demonstrate what they have
learned in the form of stories, personal testimonies, song, dance and drama. Subsequently, healers
are followed up to support their post-training activities, to ensure sustainability and to document
innovative healer initiatives. This process is lengthy, but it has bred strong ties between THETA and
the healers who have been part of its programme. This aspect of THETA is key to its success. The
important steps of this training cycle are outlined below and in the following diagrammes.

MAIN STEPS OF THETA TRAINING PROGRAMME

(1) Site selection and community mobilization

Several districts are visited and one is chosen based on specific criteria, including the willingness
of health workers to collaborate with traditional healers, the lack of similar HIV/AIDS services,
and the level of interest of district officials in supporting the programme after THETA pulls out.

Mobilization workshops are then organized at the subcounty level. They usually last one day and
include about 100 traditional healers, elders, community and religious leaders and other resource
people. The aim is to introduce the objectives of THETA, and to share AIDS and STI information.

(2) Baseline traditional healer KABP survey and community assessment

A baseline assessment is carried out by community interviewers to determine communities’
knowledge, attitudes, beliefs and practices (KABP) towards HIV/AIDS and traditional medicine. A
KABP questionnaire is administered by the community interviewers, with the supervision of social
scientists, to 100 randomly selected healers in each subcounty.

(3) Training of traditional healers, biomedical health practitioners and community

representatives
Traditional healer training is conducted in two phases. Initial training is given three days a month
for six months and is aimed at giving healers basic facts about STIs, collaboration, counselling
and patient care and support. THETA trainers use this period to create rapport and to learn more
about healers’ knowledge, attitudes and practices towards HIV and AIDS. The second phase of
training is intended to enhance collaboration and further develop skills in community AIDS edu-
cation, counselling and referral, and includes field visits to local AIDS NGOs and hospitals.
Biomedical health practitioner training workshops also take place regularly and are aimed at pro-
moting collaboration between traditional healers and biomedical health practitioners. The
Community Monitoring Committee (CMC) and Community Interviewers (CIs) are trained in com-
munity mobilization and social research respectively.

(4) Monitoring, evaluation and follow-up

Process evaluation includes site visits to healer clinics, as well as focus group discussions with
community members, including untrained traditional healers. Dissemination of key findings takes
place during regular meetings with stakeholders. The THETA training team visits key players on a
regular basis to encourage their support of healer activities to ensure sustainability. A final
assessment takes place to determine which post-training activities healers have excelled in, and
covers a post-training KABP survey, oral and written tests and trainers’ input. Healers are then
certified in community education, counselling and collaboration, or a combination of the above.
After training, THETA conducts one-to-two-day follow-up visits quarterly, while CMC and CI sup-
port is offered regularly. Impact and sustainability are assessed by reviewing reports and col-
lecting additional information from programme stakeholders in a final evaluation.

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THETA District Outreach Programme Community Structures

COMMUNITY MONITORING KEY PLAYERS

COMMITTEE (CMC) Important and/or interested members
Formed during mobilization workshops to of the District Health Team, commu-
help mobilize, monitor and follow-up with nity leaders, other biomedical health
healers during and after training. practitioners, community interviewers
Composed of representatives of district, (CIs), and Community Monitoring
community and THETA stakeholders, as Committee (CMC).
well as a District Liaison Person. All work as
volunteers.

DISTRICT LIAISON PERSON (LP) COMMUNITY INTERVIEWERS (CIs)

The LP is chosen through consultation with Local people trained in basic social
THETA and key players. The LP is responsible research who are able to monitor activi-
for organizing training, contacting healers ties. They conduct surveys, Focus Group
and biomedical health practitioners, and Discussions (FGDs) and other community
coordinating with THETA, CMC, key players assessment exercises on a voluntary basis.
and CIs.

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THETA training cycle

HEALERS IN THETA TRAINING PROGRAMME

Site selection
Traditional
healer giving
counselling
while trainers
assess
UGANDA

Traditional healer
demonstrating
condom use
during a
community
education
session

Community
mobilization

Training of traditional
healers Training of biomedical
health practitioners

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The THETA training cycle lasts two years. Site selection and community mobilization last
three-to-six months, including a KABP survey and community assessment. Training is
spread over 18 months, with the first six focusing on information sharing, and the last 12
emphasizing collaboration and skill development. Training targets traditional healers as
well as biomedical health practitioners, the Community Monitoring Committee and
Community Interviewers. Monitoring and evaluation of the process takes place through-
out the cycle. Post-training follow-up is conducted through quarterly visits and through
the support provided by the CMC and CIs. Impact and sustainability are assessed through
participatory evaluations.

THETA traditional healer AIDS education and

counselling training programme and outcomes

Consult district opinion leaders

to select district

Consult
Consult Community
community leaders to
identify county and traditional
Leaders to Identify
healers County
for training
and TH for Trainin g

100 traditional … gain basic AIDS

healers… and STI knowledge

Traditional healer KABP survey and three-day AIDS

awareness workshop
• …are trained over two years to
40 healers selected conduct community AIDS
according to geography, education and counselling
gender, patient load, • become known to BHPs in their
willingness to area
collaborate and • while CMC and CI gain basic
community reference… community mobilization and
social research skills
TH, BHP, CMC and CI training

Most healers excel in AIDS

CMCs, CIs carry out community education,
regular follow-up and counselling, herbal gardening
THETA visits districts and collaboration, including
quarterly referral
Monitoring, evaluation and follow-up

…selected trained healers

10 out of the 40 trained can now train fellow healers
healers selected according to
in areas that THETA cannot
their performances
reach

TRAINING OF TRAINERS (two weeks) + three months of follow-up

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Outcomes of traditional healer training in AIDS care, education and counselling

Traditional healers trained by THETA have added to the group of fighters against AIDS.
(Community leader, Hoima, 2000).

Before THETA initiated activities in the districts, healers reported that they were doing little or
nothing regarding AIDS and that they did not see AIDS patients. Healers were often known for
their witchcraft and rarely cooperated with each other or the biomedical health services.

Over the last nine years, THETA has enrolled and certified in its four-year training programme
almost 300 healers in AIDS prevention and care in eight districts of Uganda (Apac, Hoima,
Kampala, Kamuli, Katakwi, Kiboga, Mbarara and Mukono). In addition, THETA has sensitized
almost 1000 healers in numerous districts in three-day STI/HIV/AIDS sessions. To date, traditional
healers trained as trainers by THETA have also reported training over 200 other healers in AIDS
prevention and care. THETA has involved over 100 biomedical health workers in the collaboration.

Following training, healers are offering a range of new services, such as AIDS community edu-
cation, counselling, home visits, condom distribution and improved patient management using
referrals among themselves and to health units. Some healers have also embarked on herbal gar-
dening and combined biomedical/traditional medicine clinics as a result of training.

Community AIDS education by traditional healers: a popular and interesting

community event
Community education was not part of THETA’s initial plan. But healers trained by THETA felt the
information they received was important for other healers and their clients. One healer explained
that everyone should have a similar understanding of risky behaviours so that if he counsels a
client who then goes out into a community that does not have the same information, the client may
get confused. “So,” he said, “we were forced to start educating our communities.”

According to THETA’s 1998 Evaluation Report,

community members from many districts have
commented that they only believed the informa-
tion about AIDS when they heard it from the
traditional healers. This highlights the critical
role healers play in the community:

The information about AIDS used to be rumours

in my ears; today, I got the privilege to hear from
my healers some information that is going to help
me save my life.
—Community member, Katakwi
Traditional healer giving
community AIDS education Because I am still young, I can protect my life using condoms,
and spacing my children.
—Community member, Kiboga

A typical traditional healer community education event begins late in the afternoon, at around
3pm. People converge usually under a mango tree, at a school or somebody’s home, their
numbers continuing to grow as the event unfolds. Usually conducted by a team of three or
four traditional healers trained by THETA, the session begins with introductions of the heal-
ers, community leaders and guests, and is followed by the programme of the day. Generally,
topics discussed in community education include the impact of AIDS on the community, the
difference between HIV and AIDS, HIV transmission and prevention, stages of HIV infection
and positive living. Since the healers conduct AIDS education in teams, a point missed by one
is usually caught by another. Community education is participatory and the methods used usu-
ally include brainstorming, question-and-answer sessions, music and drama, personal testi-
monies, use of posters and condom demonstrations. The local language is used, including
proverbs and stories. Community education events sometimes run late into the evening,
depending on the need for community counselling or clarification of an issue.

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Many times traditional healers have emphasized that HIV/AIDS kills, and they will always
emphasize taking your child for testing. Traditional healers advise and insist that each of
their clients brings his/her own razor blade. —Community member, Mbarara

Healers describe their role in educating their families and communities, not only about AIDS, but
about other important health issues:

We have started to educate people on the importance of hygiene in homes.

—Trained healer, Mukono

This information (AIDS) is very useful to my family, especially my adolescent sons, and I
no longer fear looking after a person with HIV. —Trained healer, Mukono

I work together with fellow healers to educate the communities. When there are many of
us, we can handle all the questions. —Trained healer, Kiboga

By June 2000, 1503 people had been reached by traditional healers in community education
events in one THETA outreach district (Hoima, 2000). By extrapolation, it can be estimated that
over 10 000 community members have been reached by THETA-trained traditional healers in eight
districts of Uganda. And in both Hoima and Kamuli Districts, of the 100 community members inter-
viewed in the end-of-programme assessment, 62% and 61%, respectively, had heard traditional
healers giving AIDS educational sessions during which they talked about HIV transmission and
prevention methods, emphasizing condom use.

Byooya Deogratius: Traditional Healer, Mbarara District

It is a Tuesday morning and ‘Dr’ Byooya is in his

clinic—a small mud room in a bustling market in
rural Kashari County, Mbarara District, Western
Uganda. The sun shines brightly outside, but
inside it is cool, calm and dimly lit by only a small
window. The room is divided in two by a tempo-
rary bamboo wall that provides a confidential
examination area on one side and a waiting,
consultation, and herbal display area on the
other side. There are five people, men and
women, young and old, waiting inside, and two
outside. A grey-haired man is kneeling in front of
the healer, finishing his consultation. The healer
explains how to use the herbs and notes in his record book what the patient is suffering from, the
name of the herb given and the dosage. A woman with a baby goes to wait in the ‘examination
room’.

The traditional doctor is old by Ugandan standards—67 years—and he has grey hair and wears a
white coat, implying that he deserves respect. Not only is he a healer and a traditional birth atten-
dant, but he grows bananas and coffee, and has a herd of cows. Dr Byooya also serves as a
community leader. Married with 17 children, he started practising in 1946, through what he termed
‘a natural inheritance’. His grandfather was also a healer and said that when the missionaries
came to ban traditional medicine, the spirits protected him. When Dr Byooya’s sister fell sick, he
dreamt of the herbs to cure her and they were the same herbs that his grandfather used. After
treating his sister, he became a practising healer. But, in 1963, his ‘spirits got away’ and he could
no longer practice, so he worked for the Ministry of Works as a road inspector for 17 years. Then,
in 1983, again during sleep, the spirits came to him and told him that his work was not the roads;
he should go back to treating people. He soon became a very famous healer as a result of his treat-
ments and by training other healers in hygiene and new herbal treatments.
–––>

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There have been challenges in his practice, including the fact that he does not have packaging
equipment and supplies for his herbs, and his cows constantly spoil his herbal garden. He would
like to fence it.

THETA training has changed his methods of diagnosing patients because he now knows the
symptoms of AIDS and he can tell through counselling what they are suffering from. The main
change in his ‘job description’ before and after THETA is his record-keeping. He notes down the
name of every patient he sees. On average, he sees about 10 clients a week for diarrhoea, worms,
enlarged liver, cough, madness, fever, trouble with child birth, impotence, nose bleeds, syphilis
and HIV/AIDS. The diseases he cannot treat, such as TB, HIV/AIDS and enlarged liver, he refers
to the hospital. In fact, one of the patients waiting has a brain disease and he has been trying to
treat him, but has also referred him to the hospital for medication. So this young man is getting
both traditional and biomedical treatments.

Dr Byooya has noticed some significant changes in the community since the arrival of THETA,
namely that his patient load has increased because community members trust the trained heal-
ers more than untrained healers. Trained healers have been uniting for different projects such as
community education events and they have come together to plant a herbal garden. They have
also proposed building a traditional medicine centre on land given to them by the Local Council.

When patients come to Dr Byooya for consultation, he takes that opportunity to give them infor-
mation on HIV and hands out a pamphlet published by the National AIDS Control Programme
called, Questions and Answers about HIV and AIDS. In addition, he used to get condoms from the
health centre and distribute them. However, he has recently been in an accident and cannot walk,
so his community has been disappointed that he no longer has condoms to give away. It is mostly
the youth who come to ask for condoms, but he also noted that, ‘The big men also come asking
me for condoms’.

Healers counsel their patients

Traditional healers who have learned about the benefits of AIDS counselling, have quickly inte-
grated their new skills into their old practices. In all the THETA districts, traditional healers have
appreciated learning about AIDS counselling and are applying it in helping to diagnose patients’
problems, as well as supporting clients in prevention of HIV and care for PLWHA and their family
members. For example, in the end-of-programme survey in Hoima, 93% of traditional healers said
that they talk to their patients about AIDS, compared to 81% before the programme began. The
most common information given to patients, both before and after the programme, is related to
taking HIV tests (THETA reports, 1999).

Counselling helps the healer to establish the

cause of disease without using the spiritual pow-
ers; it helps you explore clients’ feelings and gives
clients a chance to make decisions and plans
—Traditional Healer,
Follow-up visit, Hoima, 1999

We counsel AIDS patients so that they avoid get-

ting too worried or committing suicide. We coun-
sel those who are not sick so that they can
change their behaviour to avoid HIV infection
—Trained healer, Kiboga,
Traditional healer in family counselling session THETA Evaluation Report, 1998

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Gertrude Lukowe: Traditional Healer, THETA

Widowed, 54 years old and a mother of seven, Gertrude is one of the traditional healers who have
been trained in Mukono District. A slender woman, Gertrude is both a spiritualist and a herbalist.
She specializes in treating impotence, miscarriages and jaundice.

Since the beginning of THETA training in May 2000, Gertrude has learnt how to take better care
of her herbs, and herself. She now discourages sharing sharp instruments and razor blades in her
‘clinic’. “I have learnt a lot about HIV/AIDS and other STIs, how to prevent them and care for
patients, and also how to use condoms,” she says.

Gertrude describes a typical scenario with her clients: “As the patients come to my clinic, I first
take particulars of where they are from, their age and family background. I listen to the patients
as they explain their problems. My patients have a choice on the type of diagnosis, whether
through spiritualism (using the ancestors) or by me. Depending on how patients explain their ill-
nesses, I take the opportunity to counsel them about the dangers of STIs and HIV/AIDS. I give
my patients herbs already mixed and I determine the dosage depending on their condition.”

On how she has benefited from the training, she says THETA has brought healers closer to bio-
medical health workers. “I can now use gloves like other health workers and I am now respected
by them and the community,” she boasts. In addition, she says, now that she is quite knowledge-
able in AIDS care, she shares what she has learnt with untrained healers.

Gertrude is deeply involved in counselling and referral of clients. She refers patients with com-
plications of fever, diarrhoea and severe headaches to the subcounty health centre.

Gertrude is challenged by the lack of cooperation on the part of fellow healers. “Everyone works
on his/her own. We need to open up and share knowledge about the different herbs that we use
to treat patients,” she emphasizes.

How do traditional healers take up the job of condom use and distribution?
In the past, it was difficult for health workers to distribute condoms because they didn’t
have ways of reaching communities; now trained healers do the work (THETA Evaluation
Report, 1998).

As an example, in two of the THETA outreach districts, the increase in condom use among tradi-
tional healers themselves is reported in the figure below. In Kamuli, reported use of condoms (i.e.
not necessarily regular use) among healers increased from 20%, before the training, to 40% two
years later, after the THETA training programme. In Hoima, the increase was from 16% to 40%.

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The THETA 1998 Evaluation also

Reported ‘ever use’ of condoms by traditional found that in communities with a
healers in two outreach districts in Uganda THETA-trained traditional healer,
community members were more
before and after THETA training programme. aware of condoms and more peo-
ple understood that condoms are
40% effective in blocking HIV than in
35% communities where there was no
trained healer. Community mem-
30%
bers recognized that they could get
25% Baseline information and condoms from a
20% trained healer.
15% End of
Programme We get condoms from Kavuma, the
10%
5%
healer.
—Community member, THETA
0% Evaluation Report, 1998
Kamuli Hoima
The community is now consulting
us on condoms and AIDS-related
information. Even the clergy is beginning to consult us.
—Trained healer, Kamuli Status Report, 2000

In one THETA district, the proportion of healers who

reported discussing condoms with clients increased
from 68% to 90% after the THETA training.

One Kampala healer, Musa Mutebi, talked about his

experience in condom distribution:

A traditional healer in Mukono District Clients come to me with physical and spiritual problems.
receiving condoms from a THETA Trainer I use a relationship problem as my entry point to intro-
duce condoms. We discuss condom use, disposal and
some of the misconceptions. Clients have appreciated
my role of information-giving, and when they go back they share with others and refer their
friends to me. The biggest concern of my clients is the durability of the condoms and miscon-
ceptions such as the rumour that the virus is inside condoms. Many community members that
come to me already know that I distribute condoms, so they are sometimes shy at the first visit,
but upon subsequent visits become open. My condom clients are mostly young people, boys who
come often in the evenings and on weekends. Yet, some people come at odd hours in the night
for condoms and often pose as visitors because openly talking about sex is still a problem. I have
to invite them into a private room as I cannot demonstrate how to use a condom with a penis
model in the open. We also have to discuss condom negotiation with their partners.

Have traditional healers improved their patient management through training?

Fifteen out of 20 (75%) trained traditional healers interviewed in one THETA district keep records
of patients. All THETA-trained healers reported using the skills they learned in patient-care train-
ing, as well as referring patients to biomedical facilities. Healers were able to describe common
STIs, as well as serious clinical signs that need immediate referral to hospitals.

If I get a patient complaining of abdominal pain, I check where the pain is and you may
find that he/she has a hernia that needs an operation
—Traditional healer, Focus Group Discussion

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We are now aware of danger signs on patients who need immediate referral to the hos-
pital, e.g. difficulty in breathing.
—Traditional healer, Focus Group Discussion

One medical officer noted that training had helped traditional healers understand their profes-
sional environment, and this has allowed healers to express their views openly with biomedical
workers. Secondly, as traditional healers have been exposed to the concept of modern medicine,
they have learned that both modern and traditional systems are acceptable and important. This
has encouraged openness and referral not only around HIV and AIDS, but for many other health
issues.

As an example, one healer noted that:

THETA has taught us about TB and HIV/AIDS. We never knew that TB
is spread through inhaled air. THETA has taught us about condoms and
their use. They revealed to us every method in the spread of HIV/AIDS.
—Traditional healer, Kiboga, THETA Evaluation Report, 1998

One biomedical health worker described trained healers’ work:

Traditional healers carry out home visits to their clients, which is not
common among medical workers. When they visit, they talk at length
with clients, and they encourage and support them in many aspects.
—Biomedical health practitioner in charge of NGOs, Kiboga, THETA
Evaluation Report, 1998

Since training by THETA, both healers and biomedical workers are referring patients to each other.
Trained healers have learned to take advantage of the strengths of biomedical health facilities.

I refer for checking the blood. It becomes easier to give follow-up treatment instead of
just watching someone grow thin and saying it looks like ‘slim,’ on speculation only. That
is why referral is good.
—Trained traditional healer, Soroti, THETA Evaluation Report, 1998

In one THETA district, referral increased from 58% at baseline to 90% at the end of the programme
(Hoima progress reports, 2000).

Other NGOs, such as local testing-and-care centres, have reported that healers refer clients to
them for testing, counselling and care. Biomedical health workers have also realized the value of
traditional medicine:

There are people with symptoms that we treat and they don’t respond, so we refer them
to traditional healers. In fact, the THETA training has helped, because sometimes we can
run short of drugs, so we refer the patients to traditional healers.
—Biomedical health practitioner in charge of health unit, Mbarara,
THETA Evaluation Report, 1998

Referral helps the healer, the patient and the caretakers because all of these parties
build confidence in each other. You avoid being considered as a dishonest person. With
time, you get more patients because they trust you.
—Trained traditional healer, Mukono, THETA Evaluation Report, 1998

In collaboration with biomedical workers and traditional healers, THETA has designed and trans-
lated a referral form that is now being used by traditional healers and has eased the process of
referral to health units. The form was introduced and discussed with both traditional healers and
biomedical health practitioners in a joint meeting. After only a few months of use, the response
has been highly positive and the number of forms collected from health units has increased.

Healers now help health workers mobilize resources for health promotion activities like National
Immunization Days. Kiboga District Hospital has given healers space to treat patients and there
are periodic joint community-education events by healers and health workers.

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Mugume Yorokamu: Clinical Officer, Mbarara District

Mugume is one of the few clinical officers in Uganda who are very open
about collaborating with traditional healers. He has been working in
Kashari county, Mbarara District for three years and, upon his arrival, found
that the healers were highly organized. He was soon appointed an adviser
to the newly formed traditional healer organization.

Prior to working in Kashari, he was also working with the Mbarara

University Mental Health programme. It also collaborated with traditional
healers, and he noted that most patients with mental illness consulted
traditional healers.

He explained his motivation for collaborating with healers by simply stating that they have many
patients and those patients are also ‘our patients’. “We share them and the healers do a lot of
counselling as well.” Healers also refer patients to him because they know him. He has appreci-
ated the exchange of ideas with healers and has learned about some useful herbal medicines that
he has planted in his garden.

Recently, when he visited one healer, he found a girl at the healer’s clinic with a deformity. She
had spinal TB. The healer referred her and she is now improving on a combined traditional med-
icine/biomedicine treatment. He has found that many patients with HIV-related conditions have
been helped by both oral and topical herbal therapies. And healers have been good about follow-
ing up with these patients to see if they are improving or getting worse.

He has found the greatest challenges in this collaboration have been that health workers do not
have access to healers and that untrained healers do not refer patients.

In the future, he would like to see healers uniting in order to improve on their medicine and make
it more accessible to patients. He noted that, “We cannot facilitate healers as individuals to
improve their medicine, but when they come together, we can really do something!”

Healers training fellow healers—a challenging initiative

One Kampala healer explained that traditional healers trust their fellow healers more than their
biomedical counterparts and are therefore more likely to listen to them as trainers. Healers are
taking up the challenge of training their fellow tradi-
tional healers who did not participate in the original
THETA programme. Through the TOT programme,
THETA has provided selected traditional healers
with a training kit that includes pictures and expla-
nations of different concepts related to HIV, AIDS
and STIs, as well as a trainer’s guide, all in local lan-
guages. Some healers are more active than others in
this realm. Healers who have been particularly
dynamic claim that they are motivated by the posi-
tive response to their training. Healer-trainers have
A traditional healer in Mukono District
conducted multiple training sessions that cover a
receiving condoms from a THETA Trainer
range of topics, including patient management,
transmission and prevention of HIV/AIDS, TB and family planning. The training kit and guide help
traditional healers organize their training sessions. In Kiboga District, community leaders donated
two bicycles to traditional healers in recognition of their hard work in training.

It is an achievement for trained healers to train fellow healers.

—Community Interviewer, Kiboga, THETA Evaluation Report, 1998

A THETA senior trainer explains that it is a big step for traditional healers to go from training com-
munity members who, in general, have very little technical information, to training fellow healers,

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especially in planning and organization. In addition, sometimes healers do not like to see other
healers appear more knowledgeable or powerful than themselves.

Healer organizations and associations

THETA-trained healers in Kiboga have formed an association—KITHETA—that includes health
workers, community leaders and non-THETA healers to strengthen their activities. They have
links with the district departments and they have opened up an office for counselling and herbal
treatment. Improved services have led to increased numbers of clients and, thus, increased
household incomes.

In Mbarara, traditional healers formed two organizations. One is comprised of trained healers and
the other includes both trained and untrained traditional healers, and spearheads activities such
as bee-keeping, a savings and credit scheme, and herbal gardening on four different plots.

Healers in Kamuli have organized themselves into a group with the objective of continuing activ-
ities relating to community education, counselling, information exchange on effective herbal
remedies, and income-generating activities such as brick-making, fruit growing, pig and poultry
farming and bee-keeping.

Collaboration between traditional and biomedical health workers: what does it entail?
Collaboration, as an outcome, is difficult to measure, but some indications of increased collabo-
ration include the changes in attitudes of modern health workers and community members
towards traditional medicine, referrals, site visits, or simply an increased interest and motivation
in working together for the benefit of clients and communities.

THETA has done a good job mobilizing healers to come together. It has tapped healers’
skills and knowledge, and increased information and communication in communities,
especially those where medical workers don’t go.
—Medical Superintendent, Kiboga, THETA Evaluation Report, 1998

THETA services are required; it was nice to start this programme because previously
there was no collaboration. We didn’t even know that healers were treating people with
these conditions, but now there is a forum where we can exchange ideas.
—District TB/Leprosy Supervisor, Kiboga, THETA Evaluation Report, 1998

Trained traditional healers are even involved in health committee discussions.

—Biomedical health practitioner in charge of health unit, Mbarara, Evaluation Report, 1998

In one district, healers increased their collaboration from 67% at baseline to 91% in the end-of-
programme survey. The main type of collaboration is patient referral, receiving condoms and
seeking advice from their biomedical counterparts (Hoima reports).

Muhindo: District Liaison Person, THETA

A Clinical Officer with Nakifuma Health Centre, Muhindo also doubles as

the THETA Liaison person in Mukono District.

Muhindo has a lot of experience to share. As a health worker, he feels tra-

ditional healers have filled the gap by referring patients rather than allow-
ing them to delay before receiving proper care. Initially healers did not
value referrals of complicated illnesses, but after their training, there was
an increase in the number of patients referred to the health centre.

He confesses that before working with THETA, he had never been to a

shrine and he did not have the slightest idea how healers worked. The first
time he visited, he was frightened but, after more interaction through THETA, he feels healers
have become friends and partners in health service delivery.
–––>

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UNAIDS

Muhindo says healers have changed the way they manage patients. They now carry out elemen-
tary clinical diagnosis, especially for STIs such as syphilis, which is quite common in their com-
munities. They can easily tell the difference between febrile convulsions due to malaria and those
due to epilepsy, which they initially thought were spiritual illnesses. They are quite interested in
the training and they are greatly inspired by the collaboration they now have with biomedical
health workers. Early on in training, healers did not want to disclose their methods of diagnosis
and treatment. Now, some healers keep records of their patients, the history of the illnesses, how
they are treated and with which herbs. They often disclose which herbs they know about to other
family members for continuity. “In fact,” he says, “there are five traditional healers I know of in
Nakifuma who are documenting the herbs they use for different illnesses.” Traditional healers
also have referral forms that brief clinical officers on the clinical history of patients.

Muhindo is actively involved in training, follow-up and support supervision. Through Muhindo’s
influence, healers have been included as part of the community-based health team for the sub-
counties. They have been added to the list of community workers, which includes traditional birth
attendants and community health workers.

Muhindo says he has been greatly motivated by THETA’s strong community-based approach. The
seriousness of the programme and the way THETA is following up with the healers have inspired him.
“You feel you are working with people who are enthusiastic about what they are doing,” he says.

Additional training outcomes . . .

Traditional healers have reduced the charges for their services.
They are honest, and ask for reasonable money compared to the previous exorbitant
charges, which showed greed.
—Community Interviewer, Kiboga, THETA Evaluation Report, 1998

As a result of the training, 70% of traditional healers have improved the hygiene of their work
places. Traditional healers have started constructing pit latrines, and refurbishing their shrines
and homes.

The healer’s shrine is neat and nicely built. It has a lot of cultural heritage. The box of
condoms is beside him with a dildo made of cheap wood.
—Counsellor, Kiboga, THETA Evaluation Report, 1998

Dr Donna Kabatesi: Director, THETA

Donna is married with two children and has been the director of THETA since
the very beginning. She says that before she started with THETA she was
curious about the work of traditional healers and did not know what to
expect. She had heard lots of stories and had many misconceptions. She
thought that no good could ever come out of the work of such healers. When
she entered a healer’s shrine for the first time, she was very impressed by the
number of people waiting for treatment and thought: “If this is rubbish, all
these people would not be here…”.

From that moment on, her curiosity increased, but the first three months of THETA were discour-
aging and frustrating as many of the healers were initially indifferent to the idea of collaboration.
One of the healers asked her, ‘What are you doing here? I don’t treat people with AIDS.” Donna
explained that he did not want to have anything to do with THETA, and was afraid of dealing with
AIDS. He said, ‘I’m a very busy man.” Yet, with time, this healer has become one of THETA’s clos-
est collaborators. Subsequently, the healers’ response has been overwhelming, as this is an area
people have not paid much attention to. Many people train community health workers, but nobody
–––>

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Ancient remedies, new disease

has taken the idea of training traditional healers seriously, yet healers are willing and are present
in most communities. They come around in only a few months with great enthusiasm. What the
healers have been able to do with very basic information has been Donna’s greatest source of
motivation and inspiration. She says, “I haven’t seen that anywhere else; in general they are not
educated, THETA gives them so little, yet they have done much more than we ever expected.”

Donna says there are many things she has learned in the last nine years working with traditional
healers. They respond to values that Western-trained medical personnel ignore and are insensi-
tive to. Healers understand where their patients are coming from and treat them as human beings,
which is their strength. She has learned that it is not only what you give a patient that matters but
also how you treat the patient, and that what surrounds the patient is just as important as the dis-
ease diagnosis. She says she has been humbled, having realized that biomedicine offers a very
narrow and incomplete approach and that, “Despite its limitations, traditional medicine is more
complete in its response to the broad definition of health”.

The advice Donna would like to give to others who might be interested in initiating a similar col-
laboration is to start with no assumptions, and to approach traditional healers with an open mind.
Some aspects will work and others will not. One must start with the idea that there should be a
significant time investment if the project is going to pay off. Despite the fact that difficulties may
be similar in many countries, a THETA-like programme will follow different courses in different
contexts. She feels one of the biggest challenges is to try and organize traditional healers from
the outside, but that the impetus must come from the healers themselves.

Donna sees the future of THETA as that of a reference organization—other organizations can
come, learn and share; THETA can assist healers and find better ways of approaching difficult
issues. Healers treat common health problems (not just AIDS) and their focus is not restricted to
health and disease. Many traditional-healer clients consult healers for social problems as well.
Donna recently visited a healer who was being consulted by a client who complained that her co-
wife had put a spell on her. The traditional healer provided treatment and harmony was restored
in the household.

Lessons learned from THETA

After the completion of the THETA training programme, healers in every subcounty of THETA out-
reach districts have started a new AIDS-related activity, including: training of other healers, com-
munity AIDS education events in collaboration with other health educators, herbal gardens and
combined traditional healer/biomedical practitioner clinics. Healers are also increasingly inter-
ested in organizing themselves into associations to share ideas and to work together for these
new initiatives.

According to THETA programme leaders, it is important to remember that the following key ele-
ments act in synergy with each other. None of these elements alone would be enough to ensure
the success of the programme.
• Respect for healers as legitimate health-care providers generates trust. Healers have a long
history of not being respected by colonial governments, missionaries and the biomedical
health-care system. When THETA approached them with a genuine respect for their profes-
sion and their work, the relationship started off on a positive note. THETA also relates to
healers with openness, and tries to convince others of the value of traditional healers, which
instils increased self-confidence among healers.
• Involvement of community leaders in the implementation and follow-up of training activities.
Including community leaders from the moment THETA begins its activities in outreach districts
has allowed for a community ownership, interest in sustainability, and increased collaboration
at all levels.
• Integration of biomedical health workers in the training programme allows for a relationship
to be built between traditional healers and biomedical health practitioners for future collab-
oration, including cross-referrals. As biomedical health practitioners from THETA and local
health facilities take part in the programme and are targeted in the same way as healers, the

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UNAIDS

latter are able to build a relationship with them and trust them enough to refer patients, con-
sult on medical issues and continue an open dialogue.
• The length of the intervention allows THETA and healers not only to build a trusting relation-
ship but to strengthen each other’s capacity and sustainability, while cultivating a genuine
interest in each other. At the outset, four years can seem like a long time, but the intensive
training only takes place during the first six months. The remaining time spent on follow-up is
important to reinforce concepts and to learn from traditional healer initiatives that sometimes
only start long after training is completed.
• A strong monitoring and evaluation component throughout implementation and follow-up has
allowed THETA to keep track of what is going well and what needs improvement, and to iden-
tify determinants of success and failure. It has also allowed for reflection on its aims, goals and
vision for future planning.

All these elements have resulted in increased self-esteem of healers as they have taken on new
roles and responsibilities in their communities. Community leaders and members have shown
additional respect for them as well.

SUMMARY ANALYSIS OF THETA

MAIN RECOMMENDATIONS/
LESSONS LEARNED CHALLENGES
COLLABORATORS FUTURE PLANS
• Research with healers requires mutual • AIDS Information Centre (AIC) • Low literacy levels of healers • Healers should be provided
respect and collaboration with affected their ability to learn. with well-designed referral
biomedical health practitioners • MoH-NACP It was challenging to devise forms
• The AIDS Support Organization appropriate training methods
• Collaborative work requires time to for non-literate healers • Biomedical health
build trust and continuous follow-up (TASO) practitioners must be
to monitor and evaluate a changing • Due to translation, training sensitized to the need for
epidemic, and a dynamic relationship
• Uganda AIDS Commission often took longer than monitoring of referrals
between the two health sectors • MSF expected in districts where
trainers could not speak the • Healers should identify a local
• Mistrust between the two sectors was local language biomedical health practitioner
greatly reduced during training to whom they can refer
• Talking to clients about AIDS patients, and from whom
• Healers can come up with innovative is still challenging to some they can get feedback on the
ideas for AIDS prevention long after healers in some districts patient’s progress
training is completed
• Healers complained that long • Referral should be a two-way
• This type of collaboration can extend intervals between THETA process
nationwide if strong links are built at follow-up visits made them
the community level with local leaders, forget what they had • A clinic where healers and
key government and nongovernmental previously learned biomedical health
players and health authorities practitioners work hand-in-
• During follow-up visits for hand should be set up
• Healers make diagnoses based on AIDS patient-care training, it
beliefs, not on a scientific basis, and was difficult to assess healers • THETA's Patient Care
their interpretation of diseases is not because trainers often did not Training for healers should
uniform among them find any patients at the address the fact that healers
healers’ clinics would like to learn how to
• Healers are eager to learn from perform more clinical
biomedical health practitioners • Some local leaders took a procedures (use a blood
long time to appreciate pressure machine, give
• Traditional healers often attribute
healers’ potential and the injections, set up a drip)
nutritional disorders to witchcraft
value of their post-training
activities, and were hesitant to • More lectures should be
• Traditional healers are well known for offered to healers in the
treating mental disorders commit financial resources to
healer work plans hospital setting so that they
can observe procedures

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BEST PRACTICE CRITERIA ANALYSIS OF THETA

Relevance Effectiveness Ethical soundness Efficiency Sustainability

• Objectives are • 861 healers have undergone three-day • Agreement signed • Cost of THETA • Instead of multiplying
clearly stated and AIDS awareness training in 11 districts with MoH programme ranges THETA branches,
based on baseline • 250 healers have been trained (four-year • Mutual respect is between US$0.24 and strong links are built
healer surveys and programme) in eight districts since 1993 emphasized from US$0.71 per healer with community
community the beginning client reached leaders in each district
assessments • 60 healers have been trained as trainers to support healer
of fellow healers • Patient • Training programme
• Objectives follow costs US$21/day per activities
• 311 healers have been trained by fellow confidentiality is
the National AIDS emphasized in healer trained • Healers involved in
Control Programme healers training have formed
training • Estimated number of
strategy • Traditional healers have gained programmes beneficiaries ranges their own associations
• Implementation of knowledge in HIV and STI transmission, between 150 000 and that undertake various
prevention and care • Healers have activities including
district activities is worked within the 400 000 per year
area-specific and community AIDS
• Healers have gained counselling, hospital for herbal • Administration tightly education and drama,
based on feasibility teaching, leadership and record-keeping study controlled and reports
assessments training of fellow
skills produced quarterly healers, and PLWHA
conducted in several • Research
sites before new • Trained healers provide regular participants signed • Accounts regularly support groups. Some
districts are chosen community AIDS education (reaching informed consent audited have received their
about 650 community members every own funding
quarter, per district) • Research results
are systematically • Some THETA-trained
• Trained healers provide counselling fed back to healers healers are involved in
(reaching about 100 clients per quarter, and community national policy bodies
per district) (National Drug
• Healers educate about and distribute Authority)
condoms (about 150 boxes/year) • Healers do not receive
• Functioning referral system exists salaries, allowances or
between healers and biomedical health monetary incentives
practitioners with referral forms (about while training or
60 clients referred from healers every collaborating with
quarter, per district) THETA
• THETA produces a newsletter, initiated
speakers’ bureau, hosts a library on
traditional medicine and AIDS, and
produced two videos, as well as
publications and scientific presentations
• THETA completed clinical research on
the effectiveness of herbal therapies for
treatment of opportunistic infections
• THETA developed a herbal processing
and packaging demonstration lab for
opportunistic infection treatments found
effective
• THETA created and maintains a herbal
garden

THETA’S SPECIFIC CRITERIA/APPROACH FOR TRADITIONAL

MEDICINE/BIOMEDICINE COLLABORATION
Approach used to involve
Criteria for selecting healers Approach used to build trust with healers biomedical health practitioners
• Being recognized as healers by their • Emphasis is placed on healers' right to ownership of • Biomedical health practitioners are
community and local authorities their treatments involved in facilitating healer training
• Having regular patient attendance • Initial contact with traditional healers was made • THETA organizes training sessions
• Having a clinic or shrine at which to through the Culture Officer of the Ministry of Gender aimed at biomedical health
receive and treat patients and Community development, as well as through a practitioners
TASO doctor and personal visits to the traditional • Biomedical health practitioners are
• Knowing how to prepare herbal remedies healer’s clinic
using indigenous knowledge and skills to invited to THETA speakers’ bureau
diagnose, treat and heal patients • Mutual respect is emphasized at all times sessions with healers and PLWHA
• Questionnaire answered by each healer • Traditional healers sit on THETA Board of Trustees

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UNAIDS

VI. CONCLUSIONS AND A CALL FOR ACTION

As one traditional healer exclaimed upon learning about AIDS and its impact in Uganda, “We had
no choice but to start educating our communities”.

Traditional healers feel a tremendous responsibility for the health of their communities as they are
trusted and called upon for help in a variety of capacities. This sense of responsibility, with added
skills and knowledge, has inspired traditional healers to initiate an enormous diversity of health
promoting activities in their communities—largely relating, but not limited, to AIDS and STIs.
Different settings have lent themselves to different responses. For example, one healer in
Kampala, seeing a tremendous need, set up a school for orphans in his community after partici-
pating in a THETA training programme. The situation in Tanga lent itself to a comprehensive
response based on herbal medicine provided by one traditional healer, but expanded to include a
home-based care project and an educational component that addresses the high level of stigma
still prevalent in rural Tanzania. In Nairobi, the issue of gender imbalance, as well as the rejection
and marginalization of women infected with HIV, motivated healers to set up a programme to help
infected and affected women cope with their situation with an economically feasible treatment
option.

These three programmes have demonstrated an enormous capacity for care on the part of traditional
healers. They have opened a very important dialogue to bridge the worlds of traditional and modern
medicine. The benefits, formerly unmeasured in the realm of HIV and AIDS, are far-reaching for both
in terms of prevention of HIV and for care of PLWHA, their families and community members. As
one Ugandan healer explained, when a client comes to him with information about AIDS from a
doctor or nurse, if the patient then receives similar information from the healer, he/she will then
harbour no doubt and will be more readily able to act on that information. At the same time, stigma
is significantly reduced when healers, who are highly influential community leaders, become
champions of the cause. Thus, healers can significantly contribute to changes in attitude, behav-
iour and practices in society with respect to AIDS, people living with AIDS and traditional
medicine.

Though extremely encouraging, these three initiatives are only very small islands in a vast sea of
need. The current devastation caused by the AIDS epidemic in sub-Saharan Africa points to an
unprecedented urgency for governments, NGOs, communities, families and individuals to act.
The collaboration undertaken by these projects is one avenue that suggests a potential for
reaching large numbers of people who otherwise would have very little access to prevention and
care services. All three examples show that, with little input, programmes of this type could scale
up to the national and regional levels and have the capacity to bring culturally and socially
appropriate AIDS information and cost-effective treatment to isolated rural people in much of
sub-Saharan Africa.

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VII. REFERENCES AND FURTHER READING

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and Children in Uganda, 1994. National Council for Children, UNICEF, Uganda; Child Health and
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DANIDA (1999) Final Draft, Sector Programme Support Document. July 1999–June 2002, Tanzania,
Mainland. Unpublished report.

Good C (1987) Ethnomedical systems in Africa. The Gilford Press.

Good C (1988) Traditional healers and AIDS management. In AIDS in Africa: The Social and Policy
Impact, edited by Miller N, Rockwell R. The Edwin Mellen Press.

Green E (1992) Sexually transmitted disease, ethnomedicine and AIDS in Africa. Soc Sci Med
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Green E (1992) The anthropology of sexually transmitted diseases in Liberia. Soc Sci Med, 1992,
35: 1457-1468.

Green E, Jurg A, Dgedge A (1993) Sexually transmitted diseases, AIDS and traditional healers in
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Green E (1994) AIDS and STDs in Africa: bridging the gap between traditional healers and mod-
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Green E (1995) The participation of African traditional healers in AIDS/STD prevention pro-
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Green E (1999) Indigenous theories of contagious disease. AltaMira Press, A Division of Sage
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Homsy J, King R (1996) The role of traditional healers in HIV/AIDS counselling in Kampala,
Uganda. Sociétés d’Afrique and SIDA. 13: 2-4.

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uation of chronic diarrhea and Herpes Zoster in Kampala, Uganda. IX International Conference on
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Infected Patients in Kampala, Uganda. J Alt & Compl Medicine, 5(6):553-65.

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CV ancient remedies CAG 19.6.2002 9:15 Page 3

This document was prepared under the direction of the UNAIDS Intercountry Team for Eastern and
Southern Africa, Pretoria, Republic of South Africa, and the Regional Task Force for Traditional
Medicine, THETA, Uganda. It was written by Rachel King.

UNAIDS Responsible Officers: Sandra Anderson and Noerine Kaleeba

Photos: Vanessa Vick, Joseph Tenywa, and Rachel King.

Drawings: Jennifer Balaba

UNAIDS/02.16E (Original version, June 2002)

ISBN 92-9173-171-4

© Joint United Nations Programme on HIV/AIDS The designations employed and the presentation of the
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CV ancient remedies CAG 19.6.2002 9:14 Page 1

In many African countries, traditional healers far outnumber modern health

practitioners, and the majority of the population use traditional medicine. There
has been much scepticism about traditional healers but, as this report shows, they
can play a prominent role in caring for people living with HIV/AIDS as well as in
prevention activities. Many traditional healers are willing to collaborate with ANCIENT REMEDIES,
conventional health practitioners, sharing their patients’ histories and their
knowledge about local treatment options. NEW DISEASE :
This report describes three initiatives—in Kenya, the United Republic of Tanzania
and Uganda—that have narrowed the gap between the traditional and Involving traditional
biomedical health systems. In the Kenyan and Tanzanian projects, a traditional
medicine component is integrated into more comprehensive HIV/AIDS prevention
and care programmes, while the Ugandan project has dedicated itself entirely to
healers in increasing
building collaboration between traditional and biomedical healing systems for
AIDS.
access to AIDS care
The report also includes anecdotal accounts by traditional healers themselves, as and prevention
well as details of training provided to the healers, and lessons learned from each
of the three initiatives. in East Africa

UNAIDS
Case Study

Joint United Nations Programme on HIV/AIDS (UNAIDS) June 2002

20 avenue Appia, 1211 Geneva 27, Switzerland
Tel. (+41) 22 791 36 66 – Fax (+41) 22 791 41 87
$10.00 E-mail: unaids@unaids.org – Internet: http://www.unaids.org UNAIDS Best Practice Collection