Perceived decision making factors in the use of traditional and alternative medicine for people living with HIV and AIDS

AIDS is one of the most destructive diseases humankind has ever faced and also brings with it profound social, economic and public health consequences, making it one of the most serious health and development challenges in the world today. Zimbabwe, situated in southeastern Africa, is not spared from the pandemic. It continues to be one of the Sub-SaharanAfrican countries mostly heavily impacted by the AIDS epidemic, with almost 1.2 million people infected and over 1.1 million orphans. It ranks, therefore, as fifth highest in the world in the impact HIV and AIDS has had on the country. The most effective response has been to introduce programmes to reduce the number of new infections. Recent research has demonstrated treatment as a preventative measure to be very effective. This approach involves targeting those who are infected so that they are not able to transmit the disease. The decision that has to be made by an infected person, however, is whether to look for traditional treatment, conventional treatment or a combination of the two. Herbal medicine use is becoming very common in many countries, especially in the developing world, where public health safety has become a concern. It has become common to use herbal medicine concomitantly with allopathic or conventional medicine. The present study focused on investigating perceptions leading to the choice of treatment with the traditional alternative medicines (TAM) as (a)/n alternative or compliment to the conventional or allopathic option. This is a qualitative study that explores and describes participant’s perceptions, beliefs, attitudes and feelings around the use of traditional medicine, within the context of the Integrative Behaviour Model (IBM). Data was collected from 20 people living with HIV and AIDS from urban and rural settings of different ethnicities (Shona and Shangani). The data analysis was informed by The Interpretive Phenomenological Analysis with the aid of NVivo (V.10), a computer-assisted Qualitative Data Analysis Software. As predicted by the IBM, both perceived individual and environmental factors were found to be key in influencing decision-making on the use of TAM by people living with HIV and AIDS. Although there were a number of incidents in which either individual or environmental factors were perceived as independently influencing the TAM-use decision-making process, there was a lot of mutual influence between the environment and the individual. Such mutual causation was abstracted as reciprocal determinism. The IMB model assumed a unidirectional causation in which the environment could affect the individual factors. While the present study identified and demonstrated these environmental effects on the individual, it also identified and presented a reverse causation in which the individual would also affect the environment with respect to motivation for TAM use. Individual factors were psychological properties that drove the individual to use TAM. Attitude, social influence and personal agency emerged as the three dimensions of individual factors. Attitudes helped in identification of orientations that located objects of thought on dimensions of judgment about the use of TAM. Social influence explained social pressure experienced and expected regarding the use of TAM. The study demonstrated the importance of both the descriptive and injunctive norm with participants indicating that they perceived important others to be using traditional medicine and that they felt perceived expectations from others to do the same and hence the motivation to comply. Personal agency pointed to the participants’ capacities to originate and direct actions for the purposes of TAM use. All these constructs were found to be very important as perceived determinants of the behavioral intentions of people living with HIV and AIDS to use traditional medicines. In experiential attitude, generally the respondents showed more perceived positive evaluations of pleasurable experiences in their use of traditional medicines. However, there were other outcome evaluations that seemed to be ambivalent and which appeared to cause a lot of tension. The comprehension of experiential attitude was found therefore found to be trichotomous rather than dichotomous as per the IBM. The effects of the instrumental attitude were revealed in the ratings of the extent to which the use of traditional medicine was perceived as useful or rewarding, with the study revealing high ratings of usefulness. It becomes clear, therefore, that for people living with HIV and AIDS social influence, perceived attitudes and personal agency are important decision-making factors in their use of traditional and alternative medicine. Efforts towards education, integration and behaviour change programmes should design messages targeting these behavioral determinants. Understanding of these perceived determinants is crucial to influencing policy as well as the adoption of health practices through education, marketing and other modes of health promotion