Knowledge and Practices of Tradtional healers on HIV and STIs

[Guest guest]

Dear Moderator

 

I would like to share the findings from some studies that I have conducted among

Traditional Healers in Tamil Nadu.  This study was taken up as part of research

work conducted earlier this year through my organization Kalanjiyam Trust,

based in Chennai. The findings from this study were presented as an abstract at

the World AIDS conference held in Mexico in August 2008.

 

Kindly post these findings on the news group.

Regards

Munusamy Raviraaj

email: raviraaj@...  / kalanjiyam@...

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Knowledge and views of Traditional Healers on STIs and HIV in Tamil Nadu

by Munusamy Raviraaj, Director, Kalanjiyam Trust, Chennai

Practice of unprotected pre marital and extra marital sex among men is growing

factor that contributes the increasing prevalence of both STIs and HIV among

males and females in India.  In India the National AIDS Control Organization

estimates that 6% of population affected by STIs with 40 million new cases per

year in the country.  In Tamil Nadu the State AIDS Control Society estimates

that there are 2.4 million infected with STIs.

In addition to the poor knowledge there is considerable stigma associated with

having STIs. Therefore health seeking for sexually transmitted diseases is very

poor and the public health system is largely underutilized for these services.

Yet there is high level of concern among male population about sexual problems,

in particular for deficiencies in sexual performance.

A significant number of these men go to traditional healers, who are non

allopaths, generally practicing siddha or combinations of alternative /

traditional medicines.  These practitioners are most sought as they are more

readily accessible, often charge less and promise a definite cure.

Yet we know little about these traditional practitioners, their training and

background, their knowledge or their practices for providing treatment.

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About Siddha Practice

India has long history of different types of traditional healing / medicines;

most commonly: Ayurveda, Siddha and Unani.  These alternative medicines are

sought by a segment of population for treatment of common illness such as colds

to serious more illnesses such as cancer.

In Tamil Nadu, Siddha is the most common form of traditional medicine

practiced.  Siddha means achievements and Siddhars were saintly persons who

achieved results in medicine. Siddha uses substances of all possible origins in

a way that balances the possible harmful effect of each substance.

Preparations are made out of the parts of the plants and trees such as leaves,

bark, stem, root etc,

Keeping the above in mind we conducted a study with the primary objective to

develop a qualitative understanding about the practices of traditional healers,

understand who they are, their profile, types of health problems treated, extent

of treatment of STIs / HIV related problems, knowledge on STIs and HIV, STI /

HIV treatment and management practices and their views and beliefs about STIs /

HIV.

 

Approach and methods

Traditional healers from Chennai and Kancheepuram district were included in the

study.  Initially a few traditional healers practicing in Kancheepuram district,

were identified through our local village sources.

Following this, the traditional healer networks were used to identify and

recruit more healers in the study. Each healer contacted was asked to suggest

another healer practicing in different geographic areas.  Finally healers were

randomly selected and approached for participation in the study.  Participation

in the study was completely voluntary and hardly any healers refused to

participate.

 

A Qualitative questionnaire was developed in English and translated into Tamil. 

In-depth interviews were conducted with traditional healers on training and

practice profiles, reasons for getting into traditional practice and the types

of health problems most commonly treated.  Following discussions on their

practices the healers were asked about their knowledge and practice on treating

STIs and HIV and in general their views on STIs and HIV.

Findings from the study

Profile of healers: Altogether 28 healers participated in the current study.

About 25% of healers were less than 40 years with remainder of them between 40

to over 60 years.  Fifty percent of healers in the study had completed between

5 to 10 years of education. Only 18% of healers had completed 11 to 12 years

schooling and 14% who had completed over 12 years of school.

Types of Practice: A vast majority of healers interviewed were practicing only

Siddha medicine (71%); others were practicing a combination of Siddha and other

types of alternative medicine.  The main reasons for getting into traditional

practice were reported to be belief if siddha and natural medicines and lack of

faith in allopathy and as it was a family tradition.

In addition a number of the practitioners said that they got into practice as

they were inclined to 'heal' and help individuals to improve health and wanted

to impress on the value of siddha not only as a treatment form, but way of

lifestyle for holistic health to more communities.

 

Training received:

The majority of healers (71%) interviewed reported that they were trained only

by a 'guru' or had one or more family members such as father, grand father,

uncle etc, who were traditional healers and through whom they had received their

training.  Only about 11% of healers reported having had formal training through

a recognized training institute / center while 18% reported having no training

at all.

Among all healers, only 6 had received training in HIV/ AIDS, primarily 1 to 3

day workshops by TNSACS or APAC, but no further follow up since the first

training.

 

Practice Profiles:

Just over half of the traditional healers interviewed were in practice for more

than 20 years while 11% were in practice for 11 to 20 years and another 25% for

10 or fewer years.

Volume of patients seen by healers varied ranging from <10 to over 300 in the

last six months. Nearly half reported having less than 50 patients and 30%

reported having more than 100 patients in previous six months.

In terms of types of health problems seen, male and female sexual health

problems ranked as one of the highest with more than 90% of healers reporting

treating these.

About 75% of traditional healers reported preparing their own medicines,

primarily herbal preparations, using various plant sources available locally. 

Some healers reported purchasing materials from large suppliers such as IMPCOPS

for making preparations.  In general, duration of treatment for common health

problems was reported to be between 48 days to 6 months.

Views and knowledge on STIs

Traditional healers refer to STIs as 'palvinai' noi / disease or problems of

genitals.  They also referred to them as 'Vettai' noi / disease, a term used

only by siddha practitioners that refers to a range of symptoms that occur in

the genitals and are related to 'heat' in the body.

 

Only about 54% of healers were aware of two or more symptoms such as foul

smelling white discharge, burning on urination, having genital ulcers and sores,

or itching in the genitals.  Yet it is of concern to note that 75% reported

having treated for STIs and preparing their own medicines for treatment.

There were considerable misconceptions about STIs among these healers.  A

predominant belief among healers was that 'heat' in the body was a primary cause

of STIs and compounded further if the person has poor immunity.

Some believed that STI can be transmitted through 'air', improper foods/ diet,

lack of genital hygiene or even neglected problems in genitals.  A few healers

reported that illicit sex or too much sex could also lead to STIs, without

reference to protected or unprotected sex.

Treatment of STIs constituted primarily of 'reducing heat' in body and

'purifying the blood'.  Most of the healers reported treatment duration ranging

from 48 days to maximum of 6 months.  Treatment primarily included the use of

herbal preparations and sometimes inclusion of small amount of 'metals'. Other

than this all healers insisted that restrictions on diet and sexual practices

were critical factors for complete cure.

Most leaders believed that STIs could be fully cured in six months.

According to them re-occurrence was only possible if person had unprotected sex

with an infected person, if one partner had not been treated, having excessive

multiple partners, over 'heat' due to certain types of foods or a lack of

hygiene.

 

A number of challenges were reported for treating persons with STIs.  The most

common was fear, embarrassment and unwillingness to open up about the symptoms. 

It was reported that considerable counseling is required during treatment but

yet patients do not return for follow up making it difficult to know if the STI

had been cured fully.

A number of healers reported that often patients were continuing to engage in

multi-partner sex and from what they knew condom use was virtually non existent.

 

Views and knowledge on HIV

Healers were asked to differentiate between HIV and STI; many healers are unsure

if STIs and HIV are the same.  Both STIs and HIV are seen as arising from 'heat'

and referred to as 'Vettai' and 'Megam' in the later stages.

Seventy nine percent of healers felt that HIV had been in existence for a long

time, essentially an 'old disease' which had been referred to as 'Elumburriki

noi' previously as it destroyed the bones at the terminal stages.

Many healers believed that HIV can be cured in the early stages of the disease;

while the advanced stage of HIV was referred to at 'Mega vettai'.  Similar to

above the prevailing belief was that purification of blood was the only way to

cure the affected person.

 

Knowledge on methods of transmission were in general very poor among the

healers. Only 11% were aware of at least two ways while the remaining 90% of

could not give two correct ways of transmission.

Yet 82% thought that HIV can be cured while14% were unsure.

 There was much ambiguity about HIV diagnosis in Siddha and only two healers

agreed that there were no ways to directly diagnose HIV in siddha practice.  A

few healers reported that diagnosis was possible by checking pulse, seeing

existence of skin patches, extreme weakness and pallor.

Treatment for HIV in siddha was reported to be primarily through use of herbal

preparations that purify blood.  Nonetheless none of the healers reported having

continued treatment of an HIV infected person.  Here again a main challenge that

they faced was difficulty in having patients return for follow up. Only one

healer reported having referred a patient to allopath.

Discussion

The findings from the above study are a strong indication that traditional

practitioners are an important segment that should not be missed by STI and HIV

prevention programs. There are considerable gaps in knowledge and high level of

misconceptions and yet in reality these practitioners are treating and advising

patients on a regular basis.

At the grass root level in rural areas, there is much indication that

traditional practitioners are a most commonly approached / utilized health care

providers for both male and female sexual health problems, as compared to

allopathic providers.

They are perceived as being able to provide a cure that is not costly and

further acceptable.  It needs to be recognized that traditional healers are a

important segment and as indicated by this current study providing treatment for

sexually transmitted diseases.

The findings presented here necessitate strengthening the gaps in knowledge

among healers on STIs and HIV and addressing the existing misconceptions.

Existing HIV / STI prevention programs can work in a more targeted way with

traditional healers to further sensitize them and improve their knowledge as

well as practices.

Not addressing this important group can certainly be considered a missed

opportunity for strengthening STI and HIV preventions programs at the grass root

levels.

 

www.kalanjyam.org

 

Munusamy Raviraaj

email: raviraaj@...