Over the past few months, hundreds of people have been streaming into an office building in Pinetown, on the outskirts of South Africa's east coast city of Durban, looking for the clinic that sells ubhejane - a herbal mixture they believe can treat HIV/AIDS.
The controversial traditional medicine has received vast media coverage, mainly due to the backing it has received from influential political figures such as the country's health minister, Dr Manto Tshabalala-Msimang, and provincial health officials in KwaZulu-Natal. Tshabalala-Msimang and KwaZulu Natal's health minister Peggy Nkonyeni reportedly recommended to the mother of the deputy president, who runs a hospice in Durban, that she should give ubhejane to her patients.
The city's mayor, Obed Mlaba, is also supporting the herbal remedy, and is sponsoring its supply to patients at a hospice in Inchanga, a rural village about 40 km from Durban. But ubhejane, a dark brown liquid sold in old plastic milk bottles, has yet to undergo clinical trials to test its efficacy. All that has so far been confirmed, according to tests by the University of KwaZulu Natal's (UKZN) medical school, is that it is not toxic.
Despite the negative publicity in the national media, on the ground in KwaZulu-Natal there seems to be far greater willingness to accept the traditional medicine as an effective remedy. As a result, AIDS activists warn that the government's apparent support for ubhejane could undermine the roll-out of antiretrovirals (ARVs) - the orthodox treatment that can prolong the lives of HIV-positive people.
The cost of ubhejane does not seem to have dented its appeal. Government-supplied ARVs have been free since 2003, but a full course of the herbal remedy retails at R374 (US$62.8), in a country where an average low-income salary is around $250. Just 100,000 South Africans are receiving ARV therapy out of the estimated 500,000 in need of treatment now. A total of five million people are HIV-positive and will eventually require AIDS medication.
LOOKING FOR AN EASIER WAY?
Antiretroviral treatment has long been a fraught issue. The government adopted a cautious approach from the start to the provision of the life-prolonging medication, and has engaged in a bitter stand-off with AIDS activists over the pace of the rollout. President Thabo Mbeki has appeared willing to listen to AIDS dissidents; misleading statements by the health minister over ARV toxicity, and a damaging debate that tended to frame nutrition in opposition to ARVs, have all sent mixed signals.
Back in Pinetown, a scruffy industrial location, Dudu (last name withheld) a staff member at the 'Nebza AIDS Clinic' where ubhejane is sold, was explaining how to take it. The bottle with the blue lid was for making the viral load undetectable; the bottle with the white lid was for boosting the CD4 count - a measure of the strength of the immune system. Patients are advised to stop smoking and drinking while on the treatment, and abstain from sex or use condoms.
A more precise explanation of how the mixture reduces the amount of virus in the body or increases the CD4 count was not forthcoming. But the first-time clients she was instructing were more interested in whether their appetites would increase, or if they could stop taking ARVs.
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Thirty-five year old Lindiwe (not her real name) has been on ARVs for the past year, but said she would prefer traditional medicine. "ARVs are for life and you must remember to take them everyday ... at least with this one [ubhejane] it's something from my culture and it's easier," she told PlusNews.
According to South Africa's department of health, 70 percent of South Africans consult traditional healers regularly. Queen Ntuli, who has been practising for the past 20 years, explained that it was an issue of familiarity with the community. "People come to us because they trust us," said the petite 40-year old healer. "We live with them and we've been given power by the ancestors. We also don't just focus on the disease, we go beyond the sickness."
Despite high levels of awareness surrounding ARVs, "people who are on ARVs already will still come to me [for treatment] ... they are scared about taking it forever and are always looking for an easier way," said Ntuli, who is a member of the KwaZulu-Natal Traditional Healers Council, and also works with UKZN's medical school instructing western-trained medical students on herbal medicine.
But a problem was that traditional healers themselves often did not understand how HIV worked, she noted. Some genuinely believed they could get rid of the virus, while others deliberately misled people into believing that they could cure HIV/AIDS. Ntuli explained that many traditional healers did not realise that their medication was just treating the symptoms - and not the virus.
Zeblon Gwala, who makes ubhejane and runs the Nebza AIDS clinic, is not a traditional healer, but told PlusNews that his grandfather, who was, appeared to him in dreams and gave him the recipe. He said its recent popularity has meant he has been staying up till late brewing the medication, grinding the ingredients by hand, and trying to get more plastic bottles. The 89 different herbs found in ubhejane are sourced, he said, from as far a field as the Democratic Republic of Congo.
Gwala is adamant that he has never claimed he can cure AIDS, and since there have been no trials looking at whether people on ARVs can also safely take ubhejane, he strongly advises his clients against mixing the two.
SCIENCE vs TRADITION
Deputy dean of UKZN's medical school, Professor Nceba Gqaleni, who led the pre-clinical tests on ubhejane's toxicity, said he does not reject the potential value of the remedy. However, "when you want to put the product on shelves and provide it in hospitals, you have a duty to do it properly ... you are now entering a different terrain altogether".
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Gqaleni, who also sits on the World Health Organisation's expert committee on traditional medicine, acknowledged the slow pace of research into traditional medicine in Africa. "We have missed so many opportunities to study [traditional medicine]," he commented.
But researching traditional medicine is not easy. Professor Herbert Vilakazi, who has teamed up with Gwala to promote ubhejane, argued the rules for registering medicines were "pharmaceutical-industry friendly".
"Where do they expect this laboratory evidence to come from? Especially where there is no tradition of studying or testing African traditional medicine," he commented.
The health ministry seems to share those concerns, and announced in a press release earlier this year that "in finalising the regulation of these [complementary, alternative, African traditional] medicines, we are avoiding the pitfall of putting such products in the same regulatory environment as pharmaceutical drugs whose testing is very different".
However, in a recent report on 'AIDS, Science and Governance' director of the AIDS and Society Research Unit at the University of Cape Town, Professor Nicoli Nattrass, warned that "the most pernicious legacy of President Mbeki's dissident stance on AIDS has been the erosion of the authority of science and of scientific regulation of medicine in South Africa."
According to Nattrass, scientists - including the regulatory body the Medicines Control Council - have been portrayed "as, at worst, biased spokespeople for the pharmaceutical industry, and at best, as promoting scientific protocols that are inappropriate for traditional or alternative medicines".
"Once science is discarded as the best yard-stick of efficacy, patients are at the mercy of charlatans selling unproven substances. Responsible governments should not place them in this position – especially in this age of AIDS when so many people's lives are at stake," the report concluded.
Traditional medicine had to be "comprehensively studied, marketed and licensed properly", Gqaleni said. "We have to define what ubhejane is, find out the ingredients, the exact dosages ... it has to be subjected to proper scientific scrutiny".
He added there was still not enough information on the effects of traditional medicine on ARVs - which in some cases have proved to be incompatible. AIDS lobby group, the Treatment Action Campaign, has also reiterated the need for more research into traditional remedies: "Many people use traditional medicines, but they continue to die of AIDS. This shows why it is important to invest more money into researching traditional medicines so that safe and effective treatments can be identified, and that medicines that harm people can be withdrawn."
The country's politicians, particularly health minister Dr Manto Tshabalala-Msimang, have long supported the need for 'African solutions' to the AIDS problem. Traditional healers are seen as crucial to the revival of indigenous knowledge systems suppressed during the apartheid era.
Nozuko Majola, deputy director of the NGO the AIDS Foundation, warned however, against romanticising traditional medicine, particularly when dealing with people living with HIV/AIDS. "We have to protect people from exploitation and we cannot afford to jeopardise the public health system," Majola said.
While ubhejane and other traditional medication were easier to accept and more familiar for many people, politicians and traditional healers should not use double standards, she added. "There is proof that ARVs work, all medicine must go through the same procedures."