Rights and responsibilities: health seeking amongst southern African

migrants in London

Dr. Felicity Thomas

Rights to health

International Covenant on Economic, Social and Cultural Rights: “Recognises the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” (Art.12).

This includes: Reducing stillbirths and infant mortality and enabling the healthy

development of the child; Improvement of all aspects of environmental and industrial hygiene; Prevention, treatment and control of epidemic, endemic, occupational

and other diseases; The creation of conditions which would assure to all medical service and

medical attention in the event of sickness.

HIV in the UK

Increase in HIV amongst ‘black African’ migrant communities

Research set within biomedical frameworks Barriers to treatment:

– Stigma– Immigration constraints– Knowledge of health services

Beyond biomedical assumptions

Lack of access to anti-retroviral treatment– Seeking of alternative treatments

Cosmology and aetiology – Environmental and spiritual influences

Value and meanings associated with treatments

The study

Focus groups with migrants from Zimbabwe, South Africa and Zambia

Repeat interviews with migrants from these countries accessing HIV support services at a London hospital

Source of treatments

NHS and pharmaceuticals Church Traditional healers and treatments

– ‘DHL is very busy these days’

‘Complementary’ therapies e.g immunity boosters

Why use non-biomedical treatment?

Belief in efficacy of treatments– Trustworthy and familiar

Assertion of culture and identity Respect to family Continuity of links with ‘home’ Suspicion of NHS Difficulties accessing NHS treatment

The doctor who has been consulted in the UK gets the credit – but they don’t know what has happened back in Zimbabwe. There, the family slaughtered a beast, went to the spirits and paid them to accept that they had wronged them – but here they say that it is their medicines that have worked! (Kelvin, Zimbabwean focus group)

Why use non-biomedical treatment?

Belief in efficacy of treatments– Trustworthy and familiar

Assertion of culture and identity Respect to family Continuity of links with ‘home’ Suspicion of NHS Difficulties accessing NHS treatment

Treatment suitability and safety

Illness and treatment beyond the biomedical– Mental and sexual health

Healing and cleansing vs treating and chopping

Relative safety of herbal medicines– Few side effects

Attempts to find a cure

Herbal treatments

ART

Traditional healer in UK

African traditional

healer

African herbaltreatments

Prayer and fasting

Susan

Responsibilities

Responsible behaviour– Taking ART exactly as instructed by clinicians and pharmacists– Maintaining good general health– Modern technology and processed treatments– Low risk

Irresponsible behaviour– Not conforming to ART regimen - ‘wasting the tablets’– Use of non-biomedical treatments – Archaic, backward and ‘unprocessed’ treatments– Risk to self and others

“I believe that if you are talking to someone who is educated medically they won’t understand – ‘you are using herbs, what do you need to use herbs for?’ So I thought they wouldn’t understand why I wanted to use herbs, what I was going to use them for. So I didn’t tell them in case they said I couldn’t use them…………I’m always looking for different types of treatment. I wouldn’t talk to the doctor about that. They would say ‘are you crazy? What are you saying? We are professional people here, we know what we are talking about.” Susan, Zimbabwean

Implications

Clandestine use of treatments Potential for adverse health outcomes

– Interaction with ART– Constitution and dosage issues– Fasting and purging

Implications for late HIV testing

Issues raised

What do we mean by rights to health? How do we reconcile differences between

belief and scientific evidence? Where do responsibilities to self and others

fit in to this?