Adaptations, alterations and shifted strategies: the pragmatics of knowledge transfer in HIV and AIDS interventions in South Africa

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University of Cape Town

The historical relationship between western and traditional health practitioners in South Africa was always uncomfortable and remote. This paper does not rehearse the complex colonial history of this disjunction, but rather focuses on some of the effects of that history on contemporary medical relationships, especially concerning interventions in the prevention and treatment of HIV and AIDS. The controversy about the rights of HIV positive patients to choose 'traditional' African remedies over biomedical antiretroviral drugs (ARVs) is considered first. The paper argues that by attaching the notion of 'pseudoscience' to traditional medicine in this debate AIDS activists' are reproducing an unhelpful contemporary version of the familiar 'scientific knowledge' versus 'traditional belief' dichotomy, an attitude that alienates traditional health practitioners and discourages useful dialogue and cooperation. The paper then introduces ethnographic coverage of an HIV/AIDS intervention in the Western Cape Province, in which Xhosa traditional health practitioners (THPS)1 have adopted and adapted the techniques of HIV/AIDS counselling, and advocacy of HIV/AIDS testing and ARVs, into their conventional practice. The testimony of the healers themselves is used to discover the effects of this process of medicalisation and the extent to which it has changed the THPs' relationship - real and perceived - with western medicine. The paper will show that although these THPs are eager to be involved with western medicine, this does not constitute surrender to a superior system, but is simply a pragmatic act of conciliation in the face of the HIV/AIDS epidemic. In their practical approach, the healers can be recognised not as 'ignorant' or naïve, but realistic. The paper argues that the 'ignorance' and ineptitude of which traditional practitioners are often accused is in fact a consequence of the disinterest shown by western medicine towards them.