The widespread use of herbal compounds by Africans living with HIV/AIDS should be of concern to clinicians and policy makers. Clearly, patients will continue to access traditional healing systems as it is important to local cultural values and beliefs. Therefore, efforts should be made by mainstream health professionals to provide validated information to traditional healers and patients on the judicious use of herbal remedies. This may reduce harm through failed expectations, pharmacologic adverse events and unnecessary added therapeutic costs. Efforts should also be directed at evaluating the possible benefits of natural products in HIV treatment.
It is not unreasonable to suggest that some products may have therapeutic benefits as examples from history and the recent past have provided us with effective anti-malarials [50
] and cancer treatments[51
]. Indeed, some of the earliest forms of protease inhibitors were derived from natural products [52
]. Efforts should be directed at determining the therapeutic efficacy of these remedies as well as the possibility of interactions through systematic research and clinical trials.
Several studies have highlighted key problems related to primary care delivery by traditional healers in Africa [8
]. Key issues include hygiene, toxicity and financial cost. Traditional healers have been implicated in the spread of blood borne diseases including HIV and other infectious disease by the re-use of medical instruments and lack of hand washing [8
]. Prescriptions to take toxic plants for HIV treatment have also resulted in severe adverse events, including death[56
]. Recent policy efforts have recognized the substantial use of traditional medicines and several African nations have included traditional healers in educational campaigns in order to instruct them on safe and hygienic practices, condom distribution and knowledge dissemination[2
Despite the relatively high concentrations of herbals used in our in vitro work, the results serve as a warning and suggest that biologically active constituents of these herbal remedies clearly may have an effect on HIV drug metabolism as a result of their inhibitory activity on enzymes and efflux drug transporter systems. These results highlight the need for in vivo investigations and circumspection when utilizing herbal drugs as routine care for HIV patients and underscores the need for clinical studies in humans to unveil any possible drug interaction of these herbal agents with antiretrovirals. Failure to do this may result in bi-directional drug interactions that may put patients at risk for treatment failure, viral resistance or drug toxicity.
Cultural values are an inherent part of healthcare and an important component of practicing evidence-based healthcare . In the context of HIV treatment in Africa, patients often choose traditional healing systems as primary care. This, coupled with the difficulties in accessing antiretroviral treatment, justify further efforts to determine the scope of traditional medicine use, identify the negative consequences of this practice and evaluate the benefits of herbal remedies. In addition, it is important to understand the values of those providing mainstream healthcare and those practicing traditional medicine as their perspectives provide highly relevant social inferences and should be interpreted with an attempt to understand their cultural worldviews and practices.
In conclusion, given the Global Fund's recent announcement of funds to make anti-retroviral therapy widely available in Africa, and the South African Ministry of Health, along with member states and NGO's endorsement of the use of traditional African herbs such as Hypoxis
as HIV/AIDS remedies [17
], initiating policy on herbal medicines should be based on research evidence. Efforts are required to determine the safety, efficacy and pharmacological profile of the many herbal compounds used in Africa. Collaboration with traditional healers is justified to fully understand what remedies are in use for HIV and to educate those providing alternative medical services against unsafe practices.