Peltzer, Preez Ramlagan, & Fomundam (2008) carried out an investigation to analyze the use of Traditional Complementary and Alternative Medicine in HIV patients prior to the initiation of antiretroviral therapy. The study was conducted in three public hospitals in South Africa at KwaZulu-Natal.
The population under research encompassed HIV- positive patients from the outpatient departments in three public hospitals. Most of these patients are reluctant to tell their health care providers that they are also using traditional complementary and alternative medicines as a stress and pain reliever as well as for spiritual practices (Peltzer, Preez, Ramalgan, & Fomundam, 2008).
This is despite the fact that the South African National ARV Treatment Guide directs all patients to disclose any use of traditional medicines or over the counter drugs because of the risk of contraindications and dangerous drug interactions (Peltzer, Preez, Ramalgan, & Fomundam, 2008). The freedom of choice for HIV patients to select their mode of treatment, the ease of access to and availability of traditional medicine and healers, as well as the strong cultural beliefs surrounding the use of TCAM increased the likelihood that HIV patients would use ARTs alongside other traditional medicines in the country.
Prior to the research, studies showed that even outside South Africa, many people living with HIV AIDS show high rates of TCAM utilization. The studies also indicate that people infected by AIDS use TCAM at a substantially higher rate than people who suffer from other serious diseases (Dhalla, Chan, Montaner, & Hogg, 2006). The evidence from South Africa intimates that a huge proportion of patients undergoing ART treatment resort to TCAM because of the associated side effects of the antiretroviral therapies. Unfortunately, there is very little data that was available to the researchers on the prevalence and pattern use of the traditional medicines amongst the population under study.
Methods Used to Identify Sample
The research was a cross-sectional study of all the types of treatment that HIV patients received throughout the course of the disease. The patients were recruited from three hospitals in Uthukela health district located in KwaZulu-Natal. The three public hospitals were chosen because they are the designated spots where ART initiation took place at the time. All the ART naïve patients who were about to begin treatment using ARTs and were above 18 years old were eligible for the study.
Systematic sampling was used to select the patients who would participate in the study. The researchers asked the health care providers to give referrals for ART-naïve patients. The patients had to have a CD4 count below 200 and they should not have commenced ARV treatment yet. The health care providers from the three hospitals also needed to ensure that the patients being referred were over 18 years old before they could be integrated into the study.
Once a patient showed interest in participating in the study, he would be referred to an external HSRC research assistant. All the patients were given a background on the study and asked to sign a consent form before the interviews actually began. The researchers gave the patients semi-structured interviews and questionnaires. The questionnaires were anonymous and the recruitment process took nearly four months. The questions were translated to Zulu and verified by an external translator. Five HIV positive persons who did not form part of the population of the study did the Pre-testing of the questionnaire used in the study.
Accuracy of Study Sample
The study sample accurately reflects the population in several different ways. The sample population included 70.9% women and 29.1% men, indicative of the situation on the ground. In the real population, more women than men actually go to the hospital for AIDS related symptoms. More women in South Africa have been diagnosed with AIDS than men in the country owing to higher report rates among women and the fact that more women engage in prostitution than men.
Furthermore, most patients, approximately 27% of the sample population were members of the Zion Christian Church. The institution is the largest African initiated Church in Southern Africa. Therefore, the religious creed of most of the members of the sample population is indicative of the religious following of the real population.
Only a quarter of the patients in the sample population had completed post-secondary or secondary education. Literacy levels in South Africa have continued to be low despite the persistence of the government in promoting educational reform across the country. Thus, the sample population is a true reflection of the population in terms of education levels.
Finally, 63.2% of the population lived in rural areas and experienced high unemployment rates of about 63%. Majority of the people who live in rural South Africa live below the poverty line and are more likely to contract AIDS than the urban dwellers. Due to high poverty levels and lack of employable skills, the rural dwellers are more likely to engage in prostitution and other risky activities that eventually lead to the contraction of the deadly virus.
Efficacy of Research Findings
The study findings can be generalized to the population based on the sampling methods. Systematic sampling was the method chosen for the study and the patients interviewed as well as their habits were a true reflection of the general population. The researchers found that most respondents (51.3%) had used TCAM in the past six months before the study began. The result points to the high level and regular use of traditional medicine amongst HIV patients around the country.
The findings also showed that majority of the TCAM users in the sample population never went to their traditional healers seeking micronutrients. The reason given by the respondents was the fact that micronutrients are usually provided in the local health care clinics. The finding is consistent with other studies conducted across Africa and other parts of the world.
Furthermore, the researchers discovered that most of the patients in the study had not told their health care providers that they were taking herbal medicines. Furler, Einarson, Walmsley, Millson, and Bendayan (2003) concur with the findings as they also discovered that most HIV patients in Canada do not disclose the use of alternative traditional medicines to their primary care providers.
The researchers used systematic sampling because they believed that the population is homogenous and the sample units are uniformly distributed throughout the population. The population is homogenous because those selected are HIV positive, the members have not yet began the ARV treatment, and they are above 18 years old. However, the systematic sampling might lead to errors as it may hide patterns. Any hidden patterns might threaten the random property of the selected sample. The strategy to apply here to avoid any hidden patterns is to select the random starting point as a non-integer.
Dhalla, S., Chan, K.J. Montaner, J.S., & Hogg, R.S. (2006). Complementary and alternative medicine use in British Columbia-a survey of HIV positive people on antiretroviral therapy. Complement Ther Clin Pract 12 : 242-248.
Furler, M.D., Einarson, T.R., Walmsley, S., Millson, M., & Bendayan, R. (2003). Use of complementary and alternative medicine by HIV-infected outpatients in Ontario, Canada. AIDS Patient Care STDs, 17: 155-168.
Peltzer, K. Preez, N.F., Ramlagan, S., & Fomundam, H. (2008). Use of traditional complementary and alternative medicine for HIV patients in KwaZulu-Natal, South Africa. BMC Public Health 8 (255).