Improved adherence to anti-retroviral therapy among traditionalists: reflections from rural South Africa

Background: Medical pluralism is common place in sub-Saharan Africa. The South African pluralistic health care environment is varied and includes traditionalist beliefs relating to the efficacy of African traditional medicine. Prior research indicates that traditionalism is associated with delays in testing for HIV and treatment interruption. Despite numerous reports about this in South Africa, there is a paucity of documented strategies to counter this trend.Objectives: To develop a strategy to reduce the impact of non-adherence to antiretroviral therapy among traditionalists in Wa- terberg district, Limpopo Province, South Africa. Methods: Qualitative information was elicited from five face-to-face, dual moderated, semi-structured homogenous group dis- cussions. The groups comprised of 50 purposively selected, rurally based, mixed gender traditionalists living with HIV. Ground- ed theory was applied to analyse qualitative findings that emerged from the group discussions.Findings: Self-reported increases in adherence to anti-retroviral therapy and a reduction in internalised stigma by the respon- dents. Both are attributed by the respondents to disease causation differentiation from a traditional explanation to an allopathic explanation.Conclusion: A nascent strategy has been developed which is contributing to improved adherence and a reduction in internalised stigma among traditionalists living with HIV in Waterberg district, South Africa.Keywords: HIV and AIDS; internalised stigma; makgoma; medical pluralism; ‘origins of HIV’