Municipality worker Metse Mabote recalls a rather awkward incident when members of a traditional council in a Limpopo village walked out of a presentation on sexuality and HIV and AIDS in disgust.
“Just [looking at the presenter] holding that artificial penis, […] people turn[ed] their faces away and some walk[ed] out,” he said on the sidelines of the ninth South Africa Aids Conference in Durban recently.
Mabote works for the Capricorn District municipality as part of a programme engaging in dialogue with amakhosi (traditional leaders) to involve them in efforts to spread awareness about HIV and AIDS, sexually transmitted infections, teenage pregnancy and general issues around sexual health and sexuality.
The ongoing project aims to make traditional leaders key players in the fight against HIV and AIDS and tuberculosis. As part of the project, teams address members of traditional councils that usually comprise magoši (elderly people), in the hope they will spread the message in their communities.
Asking magoši to help promote health awareness
Such engagements with magoši are important, especially in a country with the highest number of people infected with HIV and in areas such as Limpopo, where more than 70% of the population lives in declared tribal trust areas under traditional rule.
Estimates by the United Nations Programme on HIV and Aids (UNAIDS) show there were some 270 000 new HIV infections in 2017, including approximately 77 000 among adolescent girls and young women aged between 15 and 24 years.
At the opening of the National House of Traditional Leaders early this year, President Cyril Ramaphosa applauded magoši for the role they played in promoting awareness about HIV and tuberculosis and for encouraging people to get tested and seek treatment.
Ramaphosa said that as government moves to place two million more people on antiretroviral (ARV) treatment, it was critical that traditional leaders “join hands with us to mobilise rural people to access the services and to remain in treatment to prolong their lives and also to reduce the chances of transmitting HIV.”
Government and the Congress of Traditional Leaders have had previous engagements, notably in the Eastern Cape and KwaZulu-Natal, to get magoši actively involved in projects to combat HIV and AIDS.
Sexual conservatism and the elders
However, although the response from magoši has been generally positive, Mabote and his team still face conservative attitudes among elders in discussing issues of sex and sexuality.
“We cannot talk about issues of sexuality in the open [because of issues of cultural stereotypes]. When you do, people feel you are undermining the situation. That’s the attitude,” he told Mukurukuru Media.
He recalled one particular incident when a presenter was stopped right in the middle of a presentation by elders who walked out because they objected to the use of words such as “vagina” and “penis” and demonstrating the act of sexual intercourse using props.
But the engagements must continue despite such attitudes, he argues, because traditional leaders play a key role and can influence their societies by getting involved.
However, not all traditional councils have displayed this kind of attitude. Mabote cites one instance where a female traditional leader was so receptive to the engagement that she even invited her counterpart from another province to attend the session with her council.
He said that to combat such negative attitudes as displayed by some conservative elders, it is important for traditional leaders to sit in on the sessions and show leadership by guiding their councils to embrace the message.
Progress in southern Africa
The conference heard that in other South African Development Community areas, engagement with traditional leaders has yielded good results.
“Traditional leaders are rocks because they are a permanent structure. Unlike politicians who are elected into office, they are always there,” said Ngoni Chibukire, part of the Rock Leadership Programme that aims to strengthen the capacity of 120 traditional leaders in four countries “to champion and lead the response to the ending of HIV by 2030”.
The 16-month-long programme targeted areas in eSwatini, Malawi, Zambia and Zimbabwe between March 2016 and July 2017. Chibukire said that one of the interesting findings during the project was that men preferred discussing HIV-related matters with traditional leaders, while women were more comfortable doing so with religious leaders. There was no clear explanation for this trend.
Mandisa Zwane-Machakata, who runs a similar project to roll out ARV treatment in eSwatini, said the involvement of amakhosi made it easier for people to get tested and enrol for treatment.
Establishing examples in a situation of respect
The MaxART (Maximising Access to antiretroviral treatment) programme “led and implemented community mobilisation activities, including leadership, community and policy dialogues, as well as demand-creation community dialogues and door-to-door home visits,” she explained.
Zwane-Machakata said that it was very important for citizens to see amakhosi get tested and disclose their status publicly, regardless of the result of the test, because amakhosi are widely respected as upholders of the law and social order.
The involvement of traditional leaders also exposed the ongoing conflict between Western medicine and traditional health practices in the fight against HIV and AIDS in South Africa.
In a country which boasts the biggest ARV treatment programme in the world, and where 80% of the population is still deeply rooted in the use of herbal medicine, conflict between the two worlds is inevitable. Added to this complex issue is the involvement of religion, in which some people seek spiritual, rather than medicinal or herbal intervention in HIV and AIDS.
According to UNAIDS statistics, by the end of June 2018, there were more than 4.5 million people on ARV therapy, which amounts to 20% of all people on treatment worldwide.
Finding harmony between medical traditions
However, Gabriel Gyang Darong, an anthropologist at the University of KwaZulu-Natal, argued that harmony can be found between the worlds of traditional health practice and Western medical practice, based on a study he conducted into the issue in the Umkhanyakude District in northern KwaZulu-Natal.
He said some HIV and AIDS patients have found harmony between the two by taking herbal treatment and ARVs at different times of the day to minimise conflict, and that some traditional health practitioners have also advised their patients on ARV treatment to minimise the dose of the prescribed herbs.
This has not, however, eliminated the serious issues, as research by University of Venda sociologist, Faith Mary Musvipwa, has revealed.
Her study, The influence of Traditional Healing Practices on ART Adherence in Vhembe district, South Africa, finds that some traditional health practitioners discourage their patients from taking ARV treatment because they believe “HIV doesn’t exist according to the ancestors.”
Furthermore, Musvipwa’s study examines how as patients who abstain from ARV treatment in order that their CD4-count remains low ensures that they remain on the government’s social disability grant which assists indigent HIV-positive people.
Musvipwa said some of the challenges involving traditional health practitioners could be addressed through legislation such as the Traditional Health Practitioners Act, and explained that the Act doesn’t clearly define the role of traditional health practitioners with regards to the fight against HIV.
Psychologist Lehlogonolo Makola’s study through the Human Sciences Research Council found that some pastors encouraged patients to stop their ARV treatment because they promised that they could offer healing through faith.
The study conducted in Limpopo, Caring for patients living with HIV, found that some patients defaulted from ARV treatment because they believed their infection had been caused by witchcraft.
The UNAIDS said that as a result of South Africa’s ARV treatment programme, the number of AIDS-related deaths dropped significantly from 200 000 in 2010 to 110 000 in 2017. But the challenges that still plague the fight against HIV and AIDS suggest much work still lies ahead.