Patterns and implications of medical pluralism among HIV/AIDS patients in rural South Africa

AIDS Behav. 2011 May;15(4):842-52. doi: 10.1007/s10461-010-9747-3.


In some societies, medical pluralism has been demonstrated to delay access to care. We identified sources of health care, and explored utilization patterns and triggers of care-seeking behavior among HIV/AIDS patients in rural South Africa. A longitudinal qualitative study consisting of in-depth interviews was conducted. We purposively sampled thirty-two adult HIV clinic attendees. A high degree of medical pluralism occurred among participants before initiation of antiretroviral treatment (ART). After ART initiation, participants predominantly used the HIV/ART clinic, and utilization of private and traditional facilities decreased. Patterns included both concurrent and sequential pathways to public, private and traditional health sectors. HIV diagnosis and treatment were delayed despite early contact with health systems. Therefore, use of multiple health care modalities before ART initiation can lead to delayed HIV testing and ART initiation. Integrated-care has the potential to mitigate the impact of medical pluralism on access to HIV-related services over the longer term.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Ambulatory Care Facilities
  • Anti-HIV Agents / therapeutic use
  • Cultural Diversity
  • Female
  • HIV Infections* / diagnosis
  • HIV Infections* / drug therapy
  • Health Behavior / ethnology*
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / ethnology*
  • Qualitative Research
  • Retrospective Studies
  • Rural Health Services / organization & administration
  • Rural Health Services / statistics & numerical data*
  • Rural Population / statistics & numerical data
  • Socioeconomic Factors
  • South Africa


  • Anti-HIV Agents