摘要：Figures See all figures Authors W. Yaba , J.P. Chippaux , G.P. Obiang-Ndong , P. Msellati Université Pierre et Marie Curie, ED 393 de santé publique, 15 rue de l’École-de-Médecine, 75006 Paris, Unité mixte de recherche 216, Santé de la mère et de recherche sur le paludisme, 4 avenue de l’Observatoire, 75006 Paris, Direction générale de la prévention du sida, Libreville, Gabon, Croix-Rouge gabonaise, Libreville, Gabon, UMI 233 TransVIHMI, IRD UCAD Dakar, Université de Montpellier I, Université de Yaoundé Key words: alternative medicine, access to health care, HIV/AIDS, beliefs, public health, Gabon DOI : 10.1684/mst.2013.0247 Page(s) : 403-11 Published in: 2013 Background. According to WHO, 80% of the population in Africa has used alternative medicine for primary health care at least once. Gabon continues to have a high prevalence of HIV, estimated in 2011 at 5.2%. Overall, 22 253 PLWHA (people living with HIV/AIDS) — adults and children — are being treated, including 9976 on ARVs (antiretroviral drugs). The procedures for ARV initiation are very long, ARVs are frequently out of stock, and treatment in care centers for PLWHA is stigmatized: all these factors favor the development of alternative medicine for HIV care in Gabon. Objective. To analyze the impact of alternative medicine in the treatment of PLWHA in Gabon. Methodology. This cross-sectional survey was conducted during a total of four months between May 2009 and September 2010 among PLWHA older than 18 years who had been receiving ARVs for at least 6 months and consented to participate (7 centers) and among physicians and other caregivers of these centers (8 centers). We used a simple random sample method. Epidata software was used for data collection, and the analyses were performed with SAS™ software. Results. Of the 5752 patients on ARVs followed at the 7 study sites, 422 PLWHA were interviewed (58.3% of them women): 284 (67.29%) in Libreville and 138 (38.7) in the provinces. Christians accounted for 90.5% (including 21.5% from Protestant evangelical churches), and Muslins for 5.68%, while 4% stated that they had no religion. 12.5% of doctors referred their patients to religious or spiritual groups. Conclusion. Our study showed that half of PLWHA did not know the procedures for access to ARV treatment and that beliefs about HIV/AIDS differed strongly according to place of residence. Finally, the cultural context related to alternative medicine is very present in the PLWHA treatment settings in Gabon. Although PLWHAs have easy access to ARVs, their association with organized and controlled alternative medicine can be beneficial.
关键词：alternative medicine; access to health care; HIV/AIDS; beliefs; public health; Gabon
