BACKGROUND: A large proportion of HIV-positive South Africans regularly consult traditional health practitioners (THPs) for their health care needs, despite evidence of negative interactions with antiretrovirals (ARVs) and no published peer-reviewed clinical evidence for the efficacy of traditional medicines in the treatment of HIV. We investigated the dominant practices of THPs towards HIV-positive patients and whether these practices have changed following widespread public awareness campaigns covering HIV and its treatment. METHOD: The study used a semi-structured interviewer-administered questionnaire in the home language of the
interviewee. A total of 52 THPs from four provinces (Gauteng, Limpopo, KwaZulu-Natal and Eastern Cape) were interviewed. Of the respondents 38% were based in the rural areas, and 69% classified themselves as inyangas, the remainder being sangomas.
FINDINGS: All the THPs in the survey offered treatment for HIV, although only 20% claimed to be able to cure the
disease; 88% prepared their own medication, mostly from plant material, and sold their products as aqueous extracts in labelled bottles. None of these products had been systematically evaluated, and there was generally no record keeping, either of the patient or of the medicine itself. Quality control practices such as expiry dates,
controlled storage conditions and batch records were totally unknown in our sample. Only 38% of the THPs had received training on HIV/AIDS, although 75% believed that they were well informed about the disease. Our own assessment was that only 50% had a working knowledge of HIV; more disturbingly, 37% believed that only
traditional medicines should be used for its treatment and a further 50% believed that traditional medicines and ARVs can be taken simultaneously. INTERPRETATION: Despite ongoing public educational campaigns on HIV, some of which have specifically targeted THPs, the care of HIV-positive patients continues to be compromised by the traditional sector. Although some progress is evident, THP approaches to HIV treatment fail to conform to minimum standards proposed by the
World Health Organization and other organisations, and represent a considerable challenge to the integration of THPs with the biomedical sector and the antiretroviral treatment programme in South Africa.