When science, reason and truth fail the poor, more often than not, seek guidance from God. Treatment for HIV/AIDS is no exception, according to Dr Emmanuel Luyirika, executive director of the African Palliative Care Association.
“Most people in Africa, before they accept they are going to die, will try everything. We have a saying that: somebody who is drowning, even when he sees a straw on top of the water, will try to grab it,” he says.
According to the HIV/Aids organisation Avert, there are currently 1.4 million people living with HIV in Uganda. Healthcare in rural areas is often difficult to access and many are swayed by the charismatic sermons of religious figures who encourage alternative healing approaches.
But it is not just in the rural regions. Even in Kampala, Luyirka says, some pastors encourage members of the congregation to cast away their medications and to raise their hands in prayer. Rev Can Gideon Byamugisha, the first African religious leader to disclose his HIV-positive status, says these church-going members will sometimes trust their pastors so much, and are so much in need for a cure, that they are willing to try prayer and abandon medicine.
Religious organisations play a vital role in the country’s healthcare. About 43 per cent of all healthcare institutes in Uganda are owned by the church, according to Charles Serwanja, the Inter-Religious Council of Uganda’s programme manager for HIV/Aids and Public Health. Catholic, Anglican and other demominations promote and provide medicine and discourage alternative healing.
And then there are the herbalists who use herbal concoctions and ancient spells passed down from generation to generation to treat the sick.
Herbalists have long been controversial and recently their reputation as con-artists has grown. In March, the Daily Monitor reported that the famous witchdoctor, a one Ssenoga, alias Jjaja Kasooba, had had an almost seven-year, non-consensual, incestuous relationship with his biological daughter. The relationship produced three children and allegations that the daughter may have contracted HIV/Aids from her father.
Alternative healing from these sources, and pastors claiming to have cures for HIV/Aids, is especially dangerous for HIV-positive people. Luyirika says the patients sometimes have a strong negative reactions to the herbal remedies given to treat their symptoms. The professional healthcare provider ends up having to treat extra ailments along with the HIV.
Luyirika recalled certain cases where patients would seek palliative care after their bodies had been cut up by a traditional healer and smeared with various concoctions, putting them at risk for tetanus.
Can Byamugisha says he understands why an HIV patient would seek out a “quick fix” to their condition and visit witchdoctors and traditional healers. After all, people living with HIV are not reputed for their saintliness. He believes the stigma can be just as lethal as, if not more so than, the virus itself.
“The quickest way of dying is to accept stigma in your life because stigma kills,” he says.
Can Byamugisha points out that a miraculous cure exclusively from God would also wipe away three crucial fears of those who live with HIV, a quick death, contagion and a continuous, unforgiving banner of their apparent immorality.
For the latter, the reverand alluded to the lepers in the Bible who would have to ring bells and repeatedly cry out “unclean! unclean!” on the streets, only to be met with jest and hostility. Before being cured by Jesus, they were considered unholy and banned from attending any religious services.
While leprosy and Aids are very distinct conditions, the stigma surrounding them is similar. These socially stigmatised illnesses can affect one’s relationship with their peers, family and their spiritual community. Can Byamugisha believes that the desire to deliver people out of this stigma can cause some religious leaders to declare that they know a true cure for HIV/Aids.
Despite the complications that arise when using traditional healing practices, many healthcare officials believe these two seemingly different realms can coexist. He says he is not completely against traditional healing, but instead is against the prospect that one can control the actions of God simply through prayer.
For him, the “God of prayer” and the “God of science” are all one entity. With this belief, he personally uses what he calls a “combination treatment approach” to treat his condition that combines medical science with religious devotion.
“I take medicine as if there is no God, and I pray to God as if there is no medicine,” he explains.
What needs to be done?
Speaking openly and accurately about HIV and the medical treatments that are proven to prolong life can bring more education and understanding of how to combat the complexities associated with HIV, Can Byamugisha says. It can decrease the ignorance and superstition that breeds stigma and religious community enhances the kind of social support that promotes healing.
“We must leave no stone unturned. We must look at the anthropology, look at the medicine and science, look at the religion and culture, look at the legal environment, look at the legal regime, the human rights and human dignities perspective, look at the justice issues of gender, of class, of employment and all those issues,” he says.
Among childrenParents will soon find it easier to give antiretroviral drugs for children below 10 years as scientists have started developing the drug that can be soluble in porridge and other liquids. This is planned to encourage good adherence and viral load suppression.
The study that is still at design stage comes a year after government enrolled the same category of children on sugar-coated drugs in form of pellets, which caretakers can sprinkle on children’s food.
Dr Joshua Musinguzi, the head of the HIV/Aids programme in the Ministry of Health, says the new formulations will be made in form of granules that can be crashed into powder for easier swallowing compared to the pellets, which are bigger.
The new formulation is also expected in a fixed dose combination of four drugs unlike the pellets, which are in a combination of only two.
Statistics by the Ministry of Health indicate that although viral load suppression to undetectable levels among adults living with HIV/Aids in the country has increased to more than 80 per cent, it is still lower in children below 15 years at about 60 per cent.