INSTITUT SUR SANTE, POLITIQUES ET SOCIETE EN AFRIC
INSTITUTE ON HEALTH, POLITICS AND SOCIETY IN AFRK
CODESRIA
SESSION 2009-2010
Le VIH/SIDA et le discours sur«I'autre » en Afrique
HIV/AIDS and the Discours of the "Outsider" in Africa
Propositions de recherche / Research Proposals
Directeur/Director Prof. Cheikh Ibrahima Niang
Dakar/Senegal, 07 - 25 fevrier / February 2011
SOMMAIRE / CONTENTS
/.
Yetunde Dehinsilu Aluko
Marn'ed Men's Extramarital Sex and HIV Risk among Women in Ibadan, Nigeria.
3-38
2. Sokhna Boye
[.'experience des personnes vivant avec un traitement anti-retroviral et attentes de lipodystrophies au
Senegal .................................................................................................................. 39-52
3. EdmondVIJMballaElanga
Le SIDA a la "troisieme personne". line analyse des dynamiques de transmission du VIH a travers la
prise de risque par confiance et le paradigme de l'«autre» ..................................................... 53 -67
4. Lucy Wambui Kangara
An Assessment of Factors influencing Stigma and Discrimination on Adherence (A Case Study of
Patients Attending Comprehensive Care Clinic CCC-Jomo Kenyatta University of Agriculture and
Technology -(JKUAT)
68-82
5. Edinam Kola
Migration Internationale feminine, mondialisation du commerce de sexe et risques de diffusion du
VIH/SIDA en Afrique de I'Ouest: L'exemple de Lome ...........................................................
83-93
6
94-113
Salfo LinganiL'autre a I'echelle locale, VIH/SIDA et exclusion sociale
7. Appolme Flore Manguengo
Vulnerable et stigmatisation face au VIH/SIDA: une analyse des tendances et des facteurs explicatifs a partir des
donnees de f'enquete demographique et sante (EDS) au Congo Brazzaville....
114-135
8. Pius Tangwa Tanga
Rural-urban Migration and HIV and AIDS in the Textile and Garment Industry in Lesotho ......................
9.
MashetiBWangoyi
Vulnerability of Men to HIV and AIDS in Kakamega: The Influence of Social Networks of Men,
10. Solomon Chiemene Mandubuike
Culture of HIV/AIDS: Understanding User's Perceptions of Ngborogwu as a Treatment Remedy for
HIV/AIDS within the IGBO Community .............................................................................
136-158
159-192
193-203
//. Elisabeth Yaoudam
SIDA, stereotypes et images feminines dans les chants populates au Nord-Cameroun
204-21412
Billy Kakelengwa Mbilizi
L'« autre»comme objet de representations sociales, A pnopos des relations entre le corps soignant et les
maladesdu SIDA dans funivers hospitalier de Kisangani ............................................................ 215-231
13 Nyandiba Carren Nyang'anyi
Modem HIV Counselling and Testing (HCT) or Traditional Healers? 232-239
14 Juiienne Louise Ngo Likeng
Representation sociale des orphelins du SIDA en milieux scolaire et familial au Cameroun: le regard de
I'autre ....................................................................................................................
240-249
15. Mame Pauline Diop
Genre et VIH/SIDA en Mauritanie; Aspects socioculturels de la vulnerable des femmes a ('infection
au VIH/SIDA...
250-xx
Document 10
Culture of HIV/AIDS : Understanding User's Perceptions of Ngborogwu
as a Treatment Remdy for HIV/AIDS within the IGBO Community Solomon Chiemene Madubuike
Culture and HIV/AIDS : Understanding User's Perceptions ofNgborogwu as a Treatment Remedy fo HIS/AIDS
1.0
INTRODUCTION
This interim report presents the findings from the phase 1, Pilot study: test running of
Instruments of the study: Identification of the key-informants, trado-medical practitioners'
ngborogwu producers and HIV/AIDS patients in the study areas.
1.1
BACKGROUND AND RATIONALE OF THE STUDY
HIV/AIDS is the greatest disease the world faces today. Efforts to prevent its spread and
cure are sure to bring overall benefits to the nations and people living with it. But unless the
efforts being made to prevent its spread are accompanied by complementary alternative
treatment like culturally defined ngborogwu medicinal herbs and roots, the present orthodox
treatment remedies are unlikely to prevent the spread of HIV/AIDS pandemic, especially in the
third world nations like Nigeria. For instance, Igbo people of South Eastern Nigeria are known to
be using herbal medicine for HIV/AIDS treatment, because they see health as a sub-culture
within the culture. This explains why the people both rich and poor in the area consult the
traditional medicine practitioners for various health conditions. The impact of the HIV/AIDS
pandemic is felt on individuals living with the disease, their family and friends. Majority of the
people living with HIV/AIDS in Igboland have serious reservations about the efficacy and safety
of synthetic medicines for HIV/AIDS treatment at the orthodox hospitals in Nigeria. They felt
that the orthodox treatment is not better than ngborogwu treatment for HIV/AIDS prevention and
treatment - only because HIV/AIDS was not defined within the context of socio-cultural illness.
They simply perceive it as a foreign disease that befalls on them as a curse which requires
traditional medicine for its prevention and treatment. For instance, in 1976 WHO passed a
resolution calling on its member nations to give recognition to traditional medicine in their
policies and programs on primary health care delivery services.
Moreover, since people living with HIV/AIDS are being treated with ngborogwu and
they are well, the promotion of ngborog\vu for HIV/AIDS treatment is crucial and will require
specific action to address HIV/AIDS pandemic spread. It will also reduce HIV/AIDS social
stigma in the society once it's culturally defined. Blame and other manifestations of stigma
which serve to compound the psychological impacts of people living with HIV/AIDS, and their
family and friends discrimination will be eliminated (UNAIDS 2004). Some of the reasons for
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Culture and HIV/AIDS: Understanding User's Perceptions ofNgborogwu as a Treatment Remedy fo HIS/AIDS
the increased growth rate are preference of patients for natural therapies which are cheap,
affordable and accessible, concern regarding undesirable side effects of modern medicines and
belief that herbal drugs are free from side effects (Adeyemi 2009).
1.2
RESEARCH METHODOLOGY
The study was conducted in Imo State, one of the Igbo speaking states in Nigeria. The choice of
Imo State is ideal for the study because the state is tagged the 'heart' of the Igbo ethnic group. In
addition the state features the highest number of trado-medical homes due to the people's
preference for trado-medicine for health care delivery. Ten communities were selected in the
State. These were Aboh and Lorji representing Aboh-Mbaise Local Government Area, while
Owerri and Nkede represented Owerri-municipal LGA, Ehime and Okigwe represented Okigwe
LGAJkeduru and Ideato represented Ideato-South LGA, Owerri-nkworji and Oru represented
Nkwerre LGA. In each of the selected communities one trdo-medical home was selected for the
study. Level of economic and social activities, and health facilities in the communities were also
considered as relative denominators in the selection of the study communities. Imo State consists
of 27 Local Government Areas (LGAs), out of which five LGAs, were selected for the study.
These include;
1. Aboh-Mbaise Local Government Area,
2 most popular trado-medical
homes
were selected
2. Owerri-municipal Local Government Area, 2 most popular trado-medical homes were
selected.
3. Okigwe Local Government Area, 2 most popular trado-medical homes were selected.
4. Ideato-South Local Government Area, 2 most popular trado-medical homes
were selected.
5. Nkwerre Local Government Area, 2 most popular trado-medical homes were selected.
In all ten most popular trado-medical homes were selected for the study, out of which 20
HIV/AIDS patients undergoing treatment, 10 trado-medical practitioners and 10 producers of
ngborogwu was purposively sampled. Selection of the respondents for key informants interview,
in-depth interview and focus group discussions was based on the patients observed health
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Culture and HIV/AIDS : Understanding User's Perceptions ofNgborogwu as a Treatment Remedy fo HIS/AIDS
conditions and trado-medical practitioners' home level of patronage by HIV/AIDS patients. The
selection also featured urban/rural representation.
The main method of data collection was in-depth interview of key-informants. In the process ten
trado-medical homes, ten ngborogwu producers and twenty HIV/AIDS patients undergoing
treatment and ten producers of ngborogwu were interviewed at different locations and on
different occasions in the areas; Aboh-Mbuse, Owerri-Municipal, Okigwe and Ideato-South.
These categories of key-informants were purposively selected because of their knowledge,
practice and perceptions of ngborogwu as a treatment remedy for HIV/AIDS. Moreover, the
informants were selected randomly from different communities in order to widen the scope of
information received on the subject matter. We took into consideration the issue of gender
equality as equal number of males and females in each case was equally represented: 12 male
and 8 female HIV/AIDS patients, 6 male and 4 female trado-medical practitioners, 5 male and 5
female producers of ngborogwu. The study lasted for 18 days, between December 24 2010 and
10th January 2011.
Descriptive analysis was employed due to the nature of the data (qualitative). Thus, the data
were treated as single quantity information which allowed configuration of common patterns and
differences recorded and this was done on daily basis when interviews took place.
The key questions asked during the interviews were:
1. What is your perception of ngboro gwu as a treatment remedy for HIV/AIDS in the
community?
2. How well do you think ngborogwu is working at present in HIV/AIDS patients?
3. In what way(s) do you think ngborogwu has cured or prevented HIV/AIDS in recent
years in the community?
4. What do you think is responsible for the people's preference (choice) for ngborogwu as a
treatment remedy for HIV/AIDS?
5. Are there any implications and side effects of ngborogwu's use as a treatment remedy for
HIV/AIDS?
6. How do you identify HIV/AIDS patients?
7. How do you categorize ngborogwu herbs and roots for HIV/AIDS treatment?
8. How do you measure quantity of ngborogwu to be taken by HIV/AIDS patients?
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Culture and HIV/AIDS : Understanding User's Perceptions ofNgborogwu as a Treatment Remedy fo HIS/AIDS
9. What is the duration period of treatment?
10. How do you preserve ngborogwu medicine? And does it expire?
11. Can you tell us what difference is between ngborogwu medicine and orthodox medicine
and why?
12. What are the economic values of ngborogwu in recent times?
13. Can ngborogwu be developed into orthodox medicine as a vaccine for HIV/AIDS?
14. Has ngborogwu medicine been recognized or approved by the government?
The interviews were unstructured so as to allow interviewees to express their perceptions of
ngborogwu medicinal efficacy and safety. Interviewees were drawn from Trado-medical
practitioners, producers of ngborogwu and HIV/AIDS patients for the key-informants interview,
in-depth interview and Focus group discussions. The interviews and FGDs were conducted at the
trado-medical homes.
1.3
FINDINGS
Origin, meaning and uses of ngborogwu
Our informants argued that ngborogwu is one of the unique products of nature that provides
treatment remedy for ill-health and disease for human and even animals. The informants believed
that ngborogwu is culturally defined as an effective and safety treatment and cure for HIV/AIDS
and other ill-health and diseases. This fact was substantiated by Chief B, aged 72 years,
trado-medical practitioner, Aboh-Mbaise community. He asserts that ngborogwu is God in
nature who at all times provides for mankind in times of needs like good health (personal
communication 24th December, 2010).
Informants revealed that the term ngborogwu is a culture-bound expression for traditional
medicine for treating different forms of illness in the community. The prefix ngboro mean
(nature) while gwu means [medicine] for all forms of illness treatment remedy.
Ngborogwu, to Chief Mrs. Y, aged 85 years, ngborogwu producers, Owerri-municipal, is
sourced from herbs and roots. To her, there is an agreement in functions between herbs and roots
when ngborogwu medicine is being prepared for use (personal communication 26th December
2010)
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Culture and HIV/AIDS : Understanding User's Perceptions ofNgborogwu as a Treatment Remedy fo HIS/AIDS
User's Perceptions
The study identified a number of models that might help to develop ngborogwu as an
alternative treatment remedy for HIV/AIDS. Although, it is an ongoing research, the models
include a high demand for ngborogwu among the rich and the poor in the community. The
number of people, young and old, illiterate and literate persons undergoing training in the
production and marketing of ngborogwu products is quite high. The study revealed a high
tendency to prefer ngborogwu as a treatment remedy for illness among the people. Among the
Igbos, HIV/AIDS as a disease came into the body through spiritual-virus (umu-nmmo) which is
not visible to ordinary eyes.
The discussions undertaken during the Focus Group Discussions revealed that participants'
perceptions of ngborogwu as a treatment remedy for HIV/AIDS were positive and
encouraging. Criticisms that were leveled against ngborogwu potency, efficacy, safety,
qualitative and quantitative measurements, mode of production and preservation were discussed.
The discussants showed consensus agreement on its scientific-cultural procedure.
1.4
NEXT STAGE OF THE RESEARCH
The next stage of the research will be conducted to confirm the issues raised by the
respondents during this pilot study. This stage will involve qualitative triangulation interviews
with the respondents. This stage of the fieldwork will be carried out after this workshop.
198
edyfo HIS/AIDS
ANNEX 1: LOGICAL FRAME
Expected Narrative Summary
Outcomes
To Improve health condition
Goal
of people living with
HIV/AIDS through use
ofngborogwu medicinal
herbs and roots. Cogni/ant
of the increasing reah/ation
medicine in the primary
health care delivery system.
Project
Purpose
1. To examine various
aspects of traditional
medicines in I mo state,
Nigeria lor HIV/AIDS
treatment and develop
interactive partnership
model in line with WHO
code of Alternative
Medicines program on
health care delivery 2. To
analyze traditional medicine
practices for
Objectively verifiable
Indicators
Means of Verification
Assumptions/Risks
1. Improved contribution
of Nigeria traditional
medicines to socioeconomic growth and
global trade.
2. Acceptable and
integrated traditional
medicines for HIV/AIDS
treatment
3. Certified complementary
and Alternative Medicine
in Nigeria and WHO
1. Data bank on Nigerian
alternative medicine for
HIV/AIDS created.
2. International and local
acceptance of alternative
medicine for HIV/AIDS
treatment
1. HIV/AIDS Patients
2. Laboratory/Clinical
tests.
3. Monitoring, Evaluation
and Appraisal Reports.
1. Political will and Legislation
backup for positive change in
the health sector.
2. Stakeholders motivated to
report progress and respond to
questionnaire
3. Vehicular support for
extensive monitoring
1. General acceptance of
new code of
complementary and
alternative herbal
medicine for primary
health care, delivery
system.
2. Environmental,
economic and cultural
values of herbal medicine
(ngborogwu) sustained
3. Improved Social and
199
1.Cooperation of stakeholders
secured
2. Stakeholders receptive to
environmental resources
(Plants, herbs and roots) and
sustainable harvesting plans.
Culture and HIV/AIDS: Understanding User's Perceptions ofNgborogwu as a Treatment Remedy fo HIS/AIDS
HIV/AIDS treatment in Imo
State, Nigeria and
associated health impacts.
Expected 1. Herbal Medicine
output
dependent family welfare,
livelihood securely and
commercial interest
assessed
2. Traditional medicine
practitioners' report cards
on HIV/AIDS treatment
and herbal medicine
ingredients production
collected and evaluated.
3. Administration of herbal
medicine on HIV/AIDS
patients' access to and use
of herbs evaluated.
Activities 1. Stakeholders; traditional
medicines practitioners
producer of herbal & roots
ingredients and HIV/AIDS
patients, identification
survey and quantification
impacts through random
sampling
2. Observational appraisal,
1. Competent and properly
motivated work force
2. Two journal articles on
multi stakeholder approach
to alternative traditional
medicine for HIV/AIDS
treatment completed by the
8th quarter of project life.
3. One workshop
proceeding on
comprehensive treatment
for HIV/AIDS with
reference to WHO model
code completed by 6th
quarter of project life.
1. Development, production
and administration of
structured questionnaire to
traditional medicine
practitioners, herbs and
roots (ngborogwu)
ingredients producers;
HIV/AIDS patients users
economic contributions of
herbs and roots
(ngborogwu) ___________
1. Health for all; herbal
medicine (ngborogwu)
sustained for future
generations.
2. Herbal medicine
practice incorporated into
primary health care
delivery system.
3. Capacity-building
strategies recommended.
4. New policy initiatives
in Imo State, Nigeria to
promote traditional
medicines for PHC
1. Generated data bank
2. Monitoring reports.
3. Field records
4. Response to
questionnaires and Desk
study
5. State NGOs Federal and
WHO Reports on
alternative medicines on
200
1. cooperation of respondents
2. Reliability of information
provided by stakeholders
3. Reliability of information
gathered for users' perception
valuation and appraisal NMPI
administration.
1. Cooperation of respondents
2. Reliability of information
provided by stakeholders
3. Reliability of information
gather from users perception
valuation and appraisal of
administration
Culture and HIV/AIDS: Understanding User's Perceptions ofNgborogwu as a Treatment Remedy fo HIS/AIDS
analysis and monitoring
using multi-stakeholder
approach to gather and
analyze data.
3. Evaluate (ngborogwii)
herbs and roots ingredients
in the context of preparation
and storage, packing and
quantity.
4. Determine how
ngborogwu medicine
ingredients are administered
on HIV/AIDS patients.
5. Identify types of herbs
and roots.
6. Estimate ngborogwu
availability, Demand and
supply ________________
perception at 1st quarter of
project life. 2.
Stakeholders on traditional
medicine, producers of
NMPI and HIV/AIDS
patients identified in the
study areas.
primary health care
delivery system in Nigeria
6. Documented
proceedings of workshops,
seminars and lectures on
alternative medicines for
HIV/AIDS Treatment.
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Culture and HIV/AIDS : Understanding User's Perceptions ofNgborogwu as a Treatment Remedy fo HIS/AIDS
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Culture and HIV/AIDS : Understanding User's Perceptions ofNgborogwu as a Treatment Remedy fo HIS/AIDS
UNAIDS (2004) 2004 Global report on the AIDS epidemic: 4th global report, Geneva (as quoted in
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