Western health practitioners ’ view about African traditional health practitioners ’ treatment and care of people living with HIV / AIDS 1

African traditional health practitioners are an important source of health care for many South Africans. Thus, they are a health resource in this society. However, the integration of traditional health practitioners into the mainstream of health care is a complex process. Various factors contribute to this complexity, including the skepticism and reservation with which some western health practitioners view traditional health practitioners. This paper highlights the perceived strengths and weaknesses of the traditional healing system for people living with HIV/AIDS, as perceived by western health practitioners. The use of traditional practitioners as a choice of health care is attributed to both the strengths and weaknesses of this system of health care. The strength of the traditional healing system is in its sharing of the worldview and belief system of its users, it being an alternative to an inefficient western health care system (official system), privacy and absence of time limitations per consultation, treating patients psychologically, and scientifically unexplained physiological relief of the symptoms of specific illnesses. The perceived weaknesses of the traditional healing system include harmful treatment regimens, especially for people living with HIV/AIDS; prolonging the seeking of appropriate health care when traditional remedies fail to produce the desired effect; destroying interpersonal relationships of people living with HIV/AIDS through witchcraft accusations; psychological torment caused by the belief that HIV/AIDS can be cured by traditional remedies/intervention; and increasing the workload of western practitioners who are requested by patients to conduct multiple HIV tests after undergoing various traditional treatment regimens to cure HIV/AIDS. It is recommended that traditional practitioners be encouraged to adapt harmful traditional healing practices to the benefit of their patients in a non-judgemental and non-critical manner. In addition, joint workshops should be conducted with traditional and western practitioners to demystify traditional healing practices.


Background and introduction
In so cieties w hich co n tain both traditional and w estern health care systems, the western health care system is, more often than not, the official and perceived superior of the two systems.It receives g reater recognition in the professional sector than the traditional healing system, despite the acceptance of the latter system by a significantly large p ro p o rtio n o f p o p u latio n s in developing countries.In South Africa, an estimated 70-85% of the population uses African traditional medicines to help meet their health care needs and approximately 60% o f S outh A frican b ab ies are delivered by traditional birth attendants (Abdool Karim, Ziqubu-Page & Arendse 1994: 3;International Council of Nurses 2002: 1;Munk 1996: 7;Njanji 1999: 1;WHO 2002:1).The high utilisation rate of traditional medicine in developing countries may be attributed to (i) its historic accessibility and affordability in comparison to western medicine, and (ii) it being firmly embedded within wider belief systems (WHO 2002:2).
A large proportion of South Africans, both ru ral and u rban, hold strong traditional cultural beliefs and practices, which influence their reactions to illness.According to Rukobo (1992: 5), it is the belief system that determines views of health, illness and disease.In African traditional societies the view of the world is one in which all elements of society are linked and functionally integrated.Consequently, medicine, illness, disease and death are understood within the context of religion and sometimes myth and m ysticism.In the conception of illn ess th ere is a b asic d istin c tio n b etw een th eo rie s o f n atu ra l and supernatural causation, which forms the cornerstone of traditional cosmological, religion, social and moral worldviews of health and illness (Abdool Karim et al. 1994: 6).In the context of biomedicine, when an individual becom es ill, the question of causation pertains to 'what' caused the illness and 'how ' it was caused.T he tra d itio n a l A frican worldview of causation believes that, in addition, the question of 'who' caused it and 'why', must also be addressed.This is an essential part of the healing process.As a result, any form of treatment/therapy given without this understanding may confuse the patient, thus compromising the tre a tm e n t's e ffe c tiv e n e ss and acceptability (Abdool Karim et al. 1994: 6).The medication given by a traditional health practitioner may not alleviate the symptoms of illness, but the reassurance and the psychological effect o f the consultation on the patient might play a vital role in restoring the patient's overall wellness.Similarly, the medication given by the western health practitioner may not provide psychological and spiritual comfort, but may alleviate the physical discom fort of illness.These aspects in d icate the in te rd e p e n d e n t and complementary role that biomedicine and traditional healing play in the healing process.
Despite this interdependency between the traditional and western health care systems, efforts to include traditional health practitioners in the official health care system appear to be more advanced in other A frican countries, such as Uganda and Tanzania, than in South Africa.Considering that health services in South Africa still reflect the injustices and irrationality of apartheid.South Africa requires the provision of equitable health care which should be guided by the aspirations of the population, and the principles w hich reflect T raditional Health Care and the Primary Health Care Approach adopted by the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) at Alma-Ata in 1978(Rakolota 1992:3;WHO 1978:2).The Alma-Ata Declaration emanates from the International Conference on Primary H ealth C are, w hich to o k p lace in September 1978 to express the need for urgent action by all governments, health and development workers, as well as the world community, to protect and promote the health of all people worldwide.It specifically stated that the mobilisation of traditional medicines would be the only way in which health for all could be a reality.Many other organisations and government agencies have also called for closer collaboration between traditional and western medicine throughout the past decade.The African Union (AU), for one, declared the period 2001-2010 as the D ecade o f A frican T ra d itio n al Medicine, and the New Partnership for A frica's D evelopm ent (NEPAD) has noted tra d itio n a l m ed icin e as an important strategy in its Plan (African Union 2001:2;NEPAD 2001:31).Despite these d ec la ra tio n s, le g a lisin g and officially recognising traditional health practitioners have been characteristically slow in the leg islatu res o f A frican countries (Gbodossou, Floyd & Katy s.a.:4).
Before the election of the democratic government of South Africa in 1994, the African National Congress (ANC) made a p roposition in its health plan.It proposed to include traditional health practitioners as an integral recognised part of health care in South Africa.It claimed that consumers would be granted the right to consult a provider of their choice for their health care, and that legislation would be changed to facilitate controlled use of traditional practitioners (ANC 1994: 33).The White Paper fo r the Transformation o f the Health System in South Africa 1997 states: "the regulation and control of traditional healers should be in v e stig a te d fo r th e ir leg al em pow erm ent.C rite ria o u tlin in g standards of practice and an ethical code of conduct for traditional practitioners should be developed to facilitate their re g istra tio n " (M in istry o f H ealth 1997:34).In 2004, the Traditional Health Practitioners Bill fo r South Africa was unanimously approved in Parliament and was enacted on 11 F eb ru a ry 2005 (Republic of South Africa 2005).
South Africa finds itself in the wake of the devastating effects of the HIV/AIDS epidemic on all its sectors.After much debate and controversy surrounding the provision o f qu ality h ealth care to individuals living with HIV/AIDS, the South African Government finally took up the c h a lle n g e o f in clu d in g antiretroviral therapy as part of providing com prehensive health care services.However, on the one hand, South Africa finds itself in a disadvantaged position to provide access for many AIDS patients to life-long antiretroviral therapy due to the high costs asso ciated w ith this treatment.South Africa, therefore, has to resort to other means to reduce AIDSrelated morbidity and mortality among the population that lives below the poverty line and is plagued by malnutrition and other factors that exacerbate the onset of full-blown AIDS.On the other hand, health care is b elief-sen sitiv e.The African belief system and the western belief system , stand divided in their interpretation o f illness and health.(ii) monitor the implementation of policies and guidelines related to the traditional health care system; and (iii) monitor the collaboration between traditional and western health practitioners.
The utilisation o f A frican traditional medicines by an estimated 70-85% (WHO 2002: 1) of South A fricans, and the proposed high costs associated with providing equitable antiretroviral therapy in the midst of an HIV/AIDS epidemic, point towards an urgent need for a more vigorous approach towards the inclusion of traditional health practitioners in the official health care system of the country.The AIDS epidem ic in South Africa c o n tin u e s to th re a te n so cial and econom ic developm ents through its adverse effects.A dversities include shortened life expectancy, burdened public health care services, poor quality of life, and escalating number of AIDS orphans due to maternal and paternal A ID S -related d ea th s.H ence, the traditional healing system is an important health resource in South Africa, and efforts to position it in the mainstream of health care are vital in responding to national health care challenges.
Various factors im pede the effective collaboration between traditional and western health practitioners in South Africa.Hammond-Tooke (1989: 185) attributes the difficulty in integrating western and traditional medicine to the prejudicial notion that traditional African beliefs and practices are 'primitive' and 'savage'.Gumede (1990: 153) reiterates this notion by pointing out that western health practitioners' critical view of traditional medicine is based on notions w hich p erceiv e tra d itio n a l health practitioners as posing a danger to the health of their patients.The skepticism with which western practitioners view traditional healing and practitioners thereof, is not wholly unjustified.Various fa cto rs c o n trib u te to w ard s such sk ep ticism , in clu d in g the lack o f knowledge among western practitioners about traditional theories of disease and health, mysticism surrounding traditional m ed icin es (c o n te n t), and h arm ful tra d itio n a l h ea lin g p ra c tic e s and m edicines.However, these negative factors associated with the traditional health care system might not justify the ex c lu sio n o f tra d itio n a l h ealth practitioners from the realm of health care in general, and priority programmes such as HIV/AIDS.It is to this end that this paper explores the views o f western health practitioners pertaining to the benevolent and malevolent functions of traditional practitioners as health care providers, with specific reference to HIV/ AIDS treatment and care.Hence, this p ap e r ad d resses the v alu e and weaknesses of the traditional health care system as perceived by western health practitioners.

Research approach, methodology and participants
Q ualitative research m ethods w ere applied due to the nature of the study, namely, to explore the strengths and weakness of the traditional health care system as perceived by western health p ra ctitio n ers.Q u a litativ e re searc h m ethods, in relation to quantitative methods, are flexible in that they allow the researcher to develop concepts during data collection.Hence, as data are collected the researcher may reflect on the data collection process and develop new ideas.T his ensures co n tin u al interaction between data and existing ideas during data collection.In other words, as the researcher gathers data, he/ p ro fessio n al n u rse s, H IV /A ID S counsellors, home-based caregivers and general p ra c titio n e rs.S electio n o f respondents continued up until a point of data saturation was reached, namely 23 interviews (sequential sam pling).Table 1 p  A combination of semi-structured and indepth interview s, as w ell as d irect observations were utilised to collect data (Laws, Harper & Marcus 2003: 30-36).U tilising both sem i-stru ctu red and u n stru ctu re d in terv iew tech n iq u e s resulted in interview schedules that contained broad topic areas as well as specific probing questions.Also, the in terv iew sch e d u le s allo w ed for questions to be added and omitted based on the responses of each interviewee, which guided the interview process.The in terv iew sch e d u le s fo llo w ed the structure for field research interviewing, namely they constituted three types of questions: descriptive, structural and contrast questions (Neuman 2000: 288she uses some pre-existing constructs to 293).assist in data collection, and then incorporates the existing ideas with new ideas that are developed from the data (Neuman 2000:46-48 & Mouton 2001:499-500;Strauss 1987: 56-63).This entailed coding the data by closely scrutinizing the transcribed material, line by line and word by word, and extrapolating the essence of words, phrases and sentences so as to attach a relevant code.Furthermore, associated subcategories which were reflected either in the same sentence, or other sentences within the same or different interview were also coded.Initially the codes were crude.H ow ever, as the process of scrutinisation of transcripts continued, so codes became saturate and, thus, modified and elaborated.Thematic codes were, therefore, created and changed throughout the process of analysis.It is important that codes do not remain mere descriptions, but rather to be analytical by giving meaning to data.The data were summarised into the created conceptual themes.Findings were inferred from the summarised data, and quotations were used to highlight, su b stan tiate and illustrate points.

Views of western health practitioners
Discussion of data focuses on three main them es, namely reasons for the high utilisation of traditional practitioners, the value of traditional healing, and the w e ak n esse s/d isa d v a n ta g e s o f the traditional health care system.Although the attitudes and views expressed by western health practitioners differed from one individual to another, similarities in views were evident within, as well as betw een categories o f respondents.Reference is made to such similarities and d iffe re n c e s w here re le v a n t, and substantiated by direct quotations from respondents.

Reasons for consulting traditional practitioners
W estern p ra c titio n e rs had v ario u s notions as to why they believed patients opted to consult traditional practitioners, irresp ectiv e o f the ac cessib ility o f w estern h ealth care fa c ilitie s and practitioners.The following reasons are attributed to individuals utilising the services of traditional practitioners: Shared worldview and traditional theories of disease causation between patient and traditional health practitioner.Two of the aforementioned attributes to the utilisation of traditional practitioners were more prominent than others.These are further elaborated upon.

A traditional cure for HIV/AIDS
Western practitioners are of the opinion that PWAs are m ainly lured to the co n su lta tio n room s o f tra d itio n a l practitioners because of the hope of a "miracle cure", as opposed to the "no cure" message reiterated in the corridors of western health care facilities.On the one hand, trad itio n al p ra c titio n e rs believe that illnesses are curable through the correct diagnosis of the cause, often associated with supernatural phenomena.This belief leaves room for hope that, with the correct diagnosis of the cause of HI V/ AIDS, one may be cured.On the other hand, w estern p ra c titio n e rs unequivocally and unambiguously state that HIV/AIDS still remains incurable.Faced with two contradictory views about HIV/AIDS, PWAs are believed to opt for the practitioner that offers some hope that they will return to their normal 19 Curationis August 2006 state of health and become HIV-negative.

Inefficient western health care system
The reported absence of an intermediary level of care (district hospital) between primary health care clinics/community health centres and the tertiary hospital in Buffalo City, is perceived to contribute to the influx of patients to traditional practitioners.In this event, traditional health practitioners are perceived by patients as the only other alternate health care providers.According to national referral policies, the typical referral chain consists of three levels of care, namely primary (clinic/community health centre/ day h o sp ita l), secondary (d istric t h o sp ital) and te rtia ry (p ro v in c ia l hospital).The reported absence of a district hospital in Buffalo City interrupts the re fe rra l ch ain , w ith neg ativ e repercussions for patients.In other words, patients who suffer from an HIV/ AIDS-related illness, but cannot receive the appropriate care and treatment at a primary health care facility, are typically not referred to the tertiary hospital, because they will reportedly not receive the necessary treatment and care due to their HIV status.Therefore, failure to receive appropriate treatment and care from the western health care system, often results in patients choosing to go to traditional practitioners as their next best option.
The limited resources available to primary health care practitioners in the absence of an in term ediary referral facility (between primary health care facilities and the provincial hospital), diminishes a patient's health care options, thus, d riv in g p atien ts to tra d itio n a l practitioners.
The n eg ativ e attitu d e s o f w estern practitioners, privacy and unlimited time offered by traditional practitioners per c o n su ltatio n w ere re ite ra te d as c o n trib u tin g facto rs to the high utilisation rate of traditional practitioners.
The fo llo w in g re sp o n se serves as example in point: "Patients get to traditional healers and fin d that the atmosphere is so conducive and they feel comfortable.I f we (western p ra c titio n e rs) co u ld ch a n g e our attitudes ... how we treat our people ... the way we speak to them, we can win society in that w ay".Traditional healing: beneficial or not?Western practitioners are divided in their stance on w hether or not traditional healing has any benefits, as well as on the nature of such benefits.By and large, the benefits of traditional healing are perceived to be directly proportionate to an individual's b elief in traditional healing, more especially in the theories of disease causation upon which the traditional healing system is founded.Some western practitioners believe that traditional healing is beneficial only in ad d ressin g p sy ch o so m atic and psychological aspects o f illness, as opposed to providing scientifically significant physiological changes in the health of patients.This notion is evident in the following responses: "Definitely, psychologically it does help a lot, because clients get the attention from a traditional healer that they want.That in itself is o f value, in addition to th e ir little co n c o ctio n s.T here is som ething called the placebo effect which means som ething will alw ays work as long as you believe that it does "."I t' s what you believe in that heals you.I believe that panado works, but my husband will say that I should not give him panado, because it doesn' t w ork"."People believe in traditional healing.I t ' s all about psychology.I am sure that if we could come together and fo r there to be intersectoral collaboration, not so many people will die, because they will get more comprehensive help Other practitioners believe that traditional healing has the ability to affect beneficial physiological changes.This notion is based on scientifically unexplained physiological relief of the symptoms of illness in some patients.At the same time, some western practitioners are of the opinion that traditional medicine is more effective in treating certain illnesses, such as cancer, than western medicine.The following responses are examples in point: "You will fin d that from time to time you meet a patient who will tell you that they had certain symptoms and that they went to a traditional healer and this and this happened.And you cannot explain it either, but you will fin d that this person did get a cure fo r whatever he/she had.I even remember a patient o f mine who had breast cancer.She said that she had been to doctors, hospitals ... wherever, wherever, and they c o u ld n 't see anything wrong with her.She went to a traditional healer who diagnosed her with breast cancer and treated her.When 20

Curationis August 2006
she cam e to me ... n o t th a t the traditional healer had cured her, but she had less severe symptoms ... she had a sepsis and this big ulcer which was evident that she had cancer" .What I see is that these herbs that they claim cure HIV/AIDS are in actual fa ct boosting the immune system, because patients come to them weak and frail, and then they become stronger after getting treatment from them.However, they give them (patients) false hope by making them think that they are cured"."In my view, cancer is mostly treated best by traditional healers, which is why we sh o u ld c o lla b o ra te w ith them .Sometimes, western doctors do not see what is wrong with a patient.They will tell you that they have lo o ked and looked and looked, but ca n n o t see anything wrong.But, when that person goes to a traditional healer, the healer will diagnose him/her with cancer and treat them thereafter.This does happen sometimes.This is why they need to get together and collaborate " .In summary, traditional healing is seen as beneficial only in as far as it provides some sort of psychological relief for p atients who believe in trad itio n al healing, more especially in the theories of causation pertaining to illness and health, which form the backbone of the traditional healing system.However, observations have been made, which point tow ards evidence o f im m une boosting effects of traditional medicine, w hich have not been c lin ic a lly substantiated.

Disadvantages of traditional healing
A lack of sufficient knowledge about HIV/AIDS am ongst both traditional practitioners and PWAs who consult traditional practitioners appears to be the most salient problem associated with the traditional healing system in Buffalo City.Harmful treatment regimens and delaying seeking appropriate health care when prescribed traditional medicines do not produce the desired results are two of the m ost sev ere co n se q u en ce s o f insufficient knowledge about HIV/AIDS among traditional practitioners.One o th er neg ativ e co n seq u en ce is the experience o f psychological torm ent when clients are made to believe that they can be cured through traditional healing.These consequences lead to an increase in the workload of primary health care p ra c titio n e rs, and also d estro y interpersonal relationships o f patients who need a strong social support system.

Harmful treatment regimens
The typical traditional treatment regimen for patients who present with an HIV/ AIDS-related illness (diagnosed as HIVpositive either by a western practitioner, or traditional practitioner), is the use of enem as and in d u cin g v o m itin g , as reiterated in the follow ing response: "There are a group o f p eo p le who believe very much in traditional healers, in so much that they undermine western medicine.They will say that traditional medicines will cure them and they will be healed, because those medicines are good and they are strong because they make them vomit and have diarrhoea, which will excrete the illness in them ".The danger of this treatment method is that it exacerbates dehydration in already em aciated patients, possibly causing more harm than good.It is also reported that some of the traditional medicines used by traditional practitioners further destroy the immune system of HIV/AIDS patients due to the strength o f their reaction.Some traditional practitioners are also accu sed o f d isc o u ra g in g patients from using western medicines o nce they h ave s ta rte d tra d itio n a l treatment.As a result, the patient's health deteriorates to the extent that either the traditional practitioner refers the patient to a western health care facility, or the patient refers himself/herself to such a facility as a last resort.This referral often takes place once the patient is in the final stages of illness when the chances of su cc essfu l tre a tm e n t have been minimised drastically.This problem is b est ex p ressed by the fo llo w in g responses: "They keep their patients even while their patients are deteriorating, instead o f bringing them to clinics or hospitals, until the patient dies.Or else, they only bring the patient to a clinic or hospital once the patient is obviously dying".
"I 've seen p a tien ts who have been emaciated badly, and when I ask them where they have been, they say that they were in this sangom a' s hut fo r the past two months and now they have given up.They come here as a last resort.Patients who come herefrom traditional healers arrive here term inal"."Some children who are diagnosed as HIV-positive are under-age.Because they are under-age, and many parents are still from the old school o f thought where traditional healers are believed to be the best source o f help, they end up taking their children to traditional healers first, and that is w here the children start experiencing problems.What happens is that by the time the parents fin d out that the children are HIV-positive, it is already too late.By then, time has gone by and the children' s health has deteriorated too m uch".

Delaying seeking appropriate health care
Prolonging seeking appropriate health care when traditional treatment does not produce the desired effec t, can be perceived as a manifestation of a sense of denial of one's HIV status.This sense of denial is reportedly sustained and nurtured by traditional practitioners' lack of sufficient knowledge of the complexity of HIV/AIDS.A sense of denial of one's HIV status creates room for the belief that one will return to one's natural state of health (absence of disease).This belief is supported and fuelled by the notion held by many traditional practitioners, nam ely that all recu rren t illn esses/ diseases have a supernatural cause.Based on the correct diagnosis and, thus, adherence to the appropriate treatment (corrective action), all diseases/illnesses are curable.The following responses are indicative of a sense of denial of HIV status by PWAs: "I know o f a professional nurse who died at a traditional healer.She was my friend.For a professional nurse to run to a traditional healer means that they are in a state o f denial where they do not want to admit that they are HIVpositive.They deny it up to the last end".
"Sometimes patients are diagnosed as HIV-positive, but they do not even start to take the tre a tm e n t a n d h e a lth / nutritional education that we give them a fter th eir diagnosis.Instead, they believe that they do not have HIV/AIDS, Instead, they see it as a sign that they should perform a cerem ony to their ancestors -'isiko '.Or else they say that they do not have a w hite (w estern) illness, but a fam ily illness (traditional illness).That is why I say that patients run to herbalists, because they are in denial about their HIV status".A lso p ro b lem a tic, and re la te d to traditional healing, is denial o f the im plications o f being H IV -positive, namely having to live with the illness for the re st o f o n e 's life.T ra d itio n a l practitioners who propagate that all illn e sses can be cured through the appropriate corrective action, provide a 21 Curationis August 2006 scapegoat for PWAs who are not willing to accept a life-long illness.

Increased workloads and negative psychological effects
The adversity of claims of traditional cures for HIV/AIDS is evident in the number of patients who reportedly insist on multiple HIV tests after undergoing various traditional treatments to cure HIV/AIDS.In addition to increasing the workload of western practitioners who have to repeatedly counsel and test the same patients, as insisted upon by the patients, and as advised by traditional p ra c titio n e rs c o n su lted , the psychological turmoil and em otional torment experienced by the patients upon receiving the same HIV-positive result after each test remains unparalleled.The following statement is such a case in point: "For example, a person will be tested positive the first time, then they return fo r another test and again fo r a third test.When you ask them why they are repeating the test, they will tell you that they are testing repeatedly because they have heard that there is a specific herbalist that cures HIV/AID.So, they decided to go themselves.They will tell you that when they went to him, they told him that they were tested positive and even showed him their results.Now they have to come back fo r another test to confirm that they are cured, because they have completed his treatment.When you test them, the results come back positive again".

Destroying interpersonal relations
Traditional practitioners are also said to compound volatile interpersonal relations w ith in h o u seh o ld s, and b etw een h o u seh o ld s in co m m u n ities, by attributing the symptoms of HIV/AIDS to witchcraft or malevolent magic.In the case where witchcraft is the presumed cause of illness, there is typically an accused who is often someone known by the ill person.During consultation with a traditional practitioner, the identity o f the accu sed is e ith e r re v ealed descriptively, or through a course of ev en ts w hich im p licate a sp ec ific individual.A ttributing the cause of illness to w itchcraft only serves the purpose of aggravating the emotional and psychological repercussions of HIV/ AIDS, by straining relations between the person living with HIV/AIDS and his/her re la tiv e s, frien d s, n eig h b o u rs and colleagues, who are usually implicated in the process of identifying the cause of illness.This adverse effect of traditional healing is best described by the following statement: "Instead o f people supporting each other, they end up looking at each other suspiciously, because they believe that some people bewitch others ".This finding is substantiated by literature about the interpretation of HIV/AIDS by traditional practitioners.Very often, illness is believed to be a manifestation of witchcraft, and rituals are performed to cast away evil spirits.This results in strained human relations in communities, since neighbours and relatives are named as witches (Shabalala 2003: 2).
In essence, the acclaimed physical and psychological benefits o f traditional healing for individuals who utilise this health care system are matched with grave consequences.The identified negative repercussions of traditional healing are indicative of weaknesses in the traditional healing system, which often outweigh and ultimately undermine the benefits of this system.It is, therefore, imperative that these weaknesses are ad d ressed u rg en tly as a m eans to im prove the standard and safety of tra d itio n a l h ealth care fo r those individuals who, by choice, utilise this health care system.

Recommendations
Form al d elib e ra tio n s ab o u t the relationship between traditional healing practices and harmful reactions thereto, especially for people living with HIV/ AID S, should be conducted.These discussions should focus specifically on the relationship between the immune system of people living with HIV/AIDS, enemas and vom iting.D eliberations should be interactive and culture-specific as opposed to being authoritative and b io m ed ically -b a se d .
T ra d itio n a l practitioners should be encouraged to adapt h arm fu l tra d itio n a l healing practices to the benefit of their patients in a non-judgemental and non-critical manner.Care should also be taken to avoid prescribing western practices as the superior and more effective form of treating people living with HIV/AIDS.This approach will merely deter traditional practitioners from taking cognisance of any useful information that will benefit their patients.

Conclusion
The ravaging impact of the HIV/AIDS epidem ic on societies, especially in developing countries, has evoked a renew ed urgency to consolidate all available resources to address the health needs of individuals living with HIV and AIDS.One such resource in resourceridden countries is the traditional healing system .In general, w estern health practitioners see value in traditional healing.Value is attributed to the ability o f trad itio n al p ra ctitio n ers to treat patients psychologically and relieve psychosomatic symptoms.However, the harm ful p ra ctices o f tra d itio n a l practitioners, especially pertaining to the treatm ent regim ens for patients that present with HIV-related illnesses, and the belief that HIV/AIDS can be cured, undermine the perceived effectiveness of the traditional healing sector amongst western practitioners.
It is of the utmost importance that the weaknesses of the traditional healing system do not deter efforts tow ards integration of the two systems of health.These efforts are essential to improve the quality and accessibility of health care for a significant proportion of the South A frican p o p u latio n w hich u tilise traditional medicines.Furthermore, the critical view of western practitioners towards traditional practitioners needs to be ad d ressed in o rd e r to prom ote effective collaboration between the two groups of practitioners.After all, the South African traditional healing sector has survived illegality and criticism from the western health fraternity for decades.The fact that traditional practitioners are flo u rish in g all over the country is evidence of the continuous need for their services amongst South Africans.Were there no need for traditional healing, traditional practitioners would not exist.

Limitations
Although the findings of the research undertaken may not be generalised due to the non-probability sampling methods applied and sm all sam ple size (23 respondents), they serve to inform interventions and policies aim ed at improving the accessibility and quality of health care for people living with HIV/ AIDS.
ro v id es a p ro file o f the re sp o n d en ts.T he m ajo rity o f the resp o

Table 1 : Western health practitioners by category
).
LSA m an ag em en t, selec ted individuals from various strata of p rim ary h ea lth care, nam ely 18 Curationis August 2006 categories of health practitioners.The least busy days (m inim al expected workloads), and times were selected for conducting interviews, in order to cause the least disruption to the operation of the health care facilities, as well as the respondents' work schedules.This tactic pro v ed su c c e ssfu l, alth o u g h som e