THE INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT

Int J Health Plann Mgmt 2012

Published online in Wiley Online Library
(wileyonlinelibrary.com) DOI: 10.1002/hpm.2133

Perceptions of the use of complementary

therapy and Siddha medicine among rural
patients with HIV/AIDS: a case study from India
Maria Costanza Torri*
Department of Sociology, University of New Brunswick, Canada

ABSTRACT
Allopathic practitioners in India are outnumbered by practitioners of traditional Indian medicine,
such as Ayurveda and Siddha. These forms of traditional medicine are currently used by up to
two-thirds of its population to help meet primary healthcare needs, particularly in rural areas.
Gandeepam is one of the pioneering Siddha clinics in rural Tamil Nadu that is specialized in
providing palliative care to HIV/AIDS patients with effective treatment. This article examines
and critically discusses the perceptions of patients regarding the efcacy of Siddha treatment
and their motivation in using this form of treatment. The issues of gender equality in the access
of HIV/AIDS treatment as well as the possible challenges in complementing allopathic and
traditional/complementary health sectors in research and policy are also discussed. The article
concludes by emphasizing the importance of complementing allopathic treatment with traditional
medicine for short-term symptoms and some opportunistic diseases present among HIV/AIDS
patients. Copyright 2012 John Wiley & Sons, Ltd.
KEY WORDS:

HIV/AIDS; Siddha medicine; alternative medicine; India; rural areas

INTRODUCTION
Indian Systems of Medicine (ISMs) include Ayurveda, Siddha, Unani, naturopathy,
homeopathy and yoga. Although Ayurveda is the most widely ISM in India, Siddha
is more prevalent in the state of Tamil Nadu. According to the ISMs, Siddha included,
disease emerges when there is a lack of harmony between human beings and nature,
thus disturbing the balance between humors (basic substances present in the body).
The therapy, which aims to restore this balance, is based on natural substances, mainly
herbal preparations, and diet; Siddha also uses minerals and metals (Subbarayappa,
1997; Sowmyalakshmi et al., 2005; Thas, 2008).
While allopathy represents the primary source of healthcare of the majority of people
in India, 6085% of primary care provision takes place in the largely unregulated
private sector. It is also estimated that between 70% and 80% of the population uses
*Correspondence to: M. C. Torri, Department of Sociology, University of New Brunswick, Canada.
E-mail: mctorri@yahoo.it

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M. C. TORRI

medicines from one of the various ISMs at some point in their lifetime (Gupta and
Sankar, 2003).
Although there are no ofcial rates at which people in India with AIDS/HIV are
turning to alternative and complementary therapies to treat AIDS/HIV, this practice
is likely widespread, especially in areas with poor access to healthcare generally and
antiretroviral therapy (ART) specically.
The ofcial estimate shows that there are around 2.4 million people affected by
HIV/AIDS in India (Saple et al., 2002; NACO, 2003). Although the benets of
ART to signicantly reduce morbidity and mortality and improve the quality of life
of HIV/AIDS patients have been shown, less than 20% of those that qualify for ART
are currently receiving it (UNAIDS, 2008). Access to ART is still limited in India,
especially in poor rural areas.
The article examines the case study of Gandeepam, a Siddha clinic located in
Southern India that is specialized in proving palliative care treatment of HIV/AIDS
through a form of alternative and complementary medicine. This case study had been
selected, as it represents one of the few Siddha clinics established in the rural areas of
Tamil Nadu specializing in providing palliative care treatment of HIV/AIDS and its
opportunistic diseases.
This article does not aim to provide an assessment of the impact that Gandeepam
initiative has produced on the health of the HIV/AIDS-affected patients. On the
contrary, it aims to critically analyze the perceptions of patients with regard to
the efcacy of Siddha treatment and their underlying motivations in choosing this
form of treatment. As we shall see later on in the paper, serious concerns can be
raised regarding the efcacy and safety of this alternative treatment, especially
for patients affected by HIV/AIDS. The issues of gender equality in the access
of HIV/AIDS treatment as well as the possible challenges in complementing
allopathic and traditional/complementary health sectors in research and policy will
also be discussed.
Traditional medicines and HIV/AIDS: the current approach
Medicinal plants have formed an integral part of healing practices since time immemorial. At present, the majority of the people in developing countries rely on traditional
medicine for their primary healthcare, and about 85% of traditional medicines involve
the use of plant extract (Godoy et al., 2000; Gollin, 2004). It has been estimated that
about 25% of the medicines contain over 3000 antibiotic active ingredients that come
from micro-organisms (Gollin, 2004).
In all countries of the world, there exist different forms of traditional knowledge
related to the health of human beings and animals. According to the World Health
Organization (WHO), the denition of traditional medicine may be summarized as
the sum total of all the knowledge and practices, whether explicable or not, used
in the diagnosis, prevention and elimination of physical, mental or social imbalance
and relying exclusively on practical experience and observation handed down from
generation to generation, whether verbally or in writing. Traditional medicine might
also be considered as a solid amalgamation of dynamic medical know-how and
ancestral experience (WHO, 2008).
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The interest in traditional knowledge is more and more widely recognized in

development policies, the media and scientic literature. In India, traditional healers
and remedies made from plants play an important role for the health of millions of
people (Kisangau et al., 2007; Pesek et al., 2009).
The efcacy of traditional medicine has been an object of debate among medical
practitioners, public health scholars and social scientists for at least three decades.
Studies on traditional medicine carried out by anthropologists and other scholars
of social science have broadened the understanding and knowledge on medicinal
systems that are different from the biomedical model. These alternative systems
tend to go beyond physical and biological benets and encompass other dimensions
of well-being (Unschuld, 1987; Villanueva-Russell, 2005).
Efcacy and effectiveness are central issues in healthcare systems and medical
research. They are also of equal importance in the evaluation of therapeutic interventions in addition to the issues of the safety and cost of treatment modalities (Kleinman,
1980; Pittler and White, 1999). The concepts have been employed to judge the
superiority of one modality or one medical system over another.
Philosophically, the reductionist characteristic of positivist epistemology that underpins biomedicines view of efcacy and focuses on the removal of symptoms and
diseases is too narrow to evaluate complementary and alternative medicine that deals
not only with diseases but also with aspects of holistically affective, social and spiritual
well-being. Theoretically, the difference in knowledge about human anatomy and
physiology, disease aetiology, classication and diagnosis between biomedicine and
other medical systems entails different sets of denitions and measurements of effectiveness as well as criteria for evaluating the success.
Shankar (1995) stresses that because of their signicantly different epistemologies,
Indian medicine and Western medicine are hardly comparable, both in the knowledge
itself and the way to acquire knowledge. Therefore, there are limitations in accuracy to
compare different diseases according to the different medical systems.
According to Siddha, all diseases have existed on earth since the beginning of
time but emerged in particular historical periods. Therefore, HIV is not considered
a new disease and is understood to be an epidemic at this point in history. In Siddha,
HIV is known as Megavettai or more specically Pommpalai Seekku. The theory
here is that HIV is contracted through imbalances that can occur during sexual
intercourse. These imbalances alter the Sukkila cells, the reproductive cells in the
body, which can lead to infection. This infection is then rapidly spread through
intercourse, and from mother to child.
In 2008, UNAIDS estimated that there were 2.31 million people living with HIV
in India, which equates to a prevalence of 0.3%. Although this may seem a low rate,
because Indias population is so large, it is third in the world in terms of greatest
number of people living with HIV. With a population of around a billion, a mere
0.1% increase in HIV prevalence would increase the estimated number of people
living with HIV by over half a million (UNAIDS, 2008).
Antiretroviral drugs (ARVs), which can signicantly delay the progression from
HIV to AIDS, have been available in developed countries since 1996. Unfortunately,
as in many resource-poor areas, access to this treatment is limited in India; an estimated
300 000 adults (aged 15 years and older) were receiving free ARVs by April 2007
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(UNAIDS, 2008). This represents less than half of the adults estimated to be in need of
antiretroviral treatment in India. In India in 2004, only 5% of pregnant women living
with HIV received antiretrovirals to prevent mother-to-child transmission. By 2007,
this had risen to 14%, but with such low coverage, 21 000 children below the age of
15 years are still infected every year through mother-to-child transmission (UNAIDS,
2008). According to the National AIDS Control Organization, only a third of all
estimated HIV-positive mothers were reached with Preventing Mother-to-child
Transmission (PMTCT) services in 2007 (Milan et al., 2008).
The problem of the access to ARVs also means that an increasing number of
people living with HIV in India are developing drug resistance. When HIV becomes
resistant to the ARVs, the treatment regimen needs to be changed to second-line
ARVs. As in many other parts of the world, second-line treatment in India is far
more expensive than rst-line treatment (WHO, 2002). By 2007, second-line therapy
was available in a total of eight states, but treatment remains very limited (UNAIDS,
2008). Ironically, India is a major provider of cheap generic copies of ARVs to
countries all over the world. However, the large scale of Indias epidemic, the diversity of its spread, and the countrys lack of nances and resources continue to present
barriers to Indias antiretroviral treatment programme. The access to antiretrovirals is
indeed very limited for poor people in India, especially those who live in rural areas
(UNAIDS, 2008).

METHODOLOGY
The eldwork has been conducted in India in 2010 between JulyAugust in the
Gandeepam Namakkal district clinic in the state of Tamil Nadu. The research is
based on a sample of 40 semi-structured and open-ended interviews. In order to carry
out a comparative analysis in terms of perceptions of Siddha medicine in the treatment of HIV/AIDS, 30 interviews were conducted with the patients at the Siddha
clinic and 10 interviews with the patients at the governmental hospital in the town
of Namakkal. Four Siddha practitioners and three Western doctors have also been
interviewed in order to gather different points of view of the effectiveness of Siddha
medicine and the allopathic medicine in the treatment of HIV/AIDS.
Respondents were selectively sampled on the basis of parameters such as age, gender,
family income, family status (single, married or widows) and willingness to participate.
The fact of having or not having children has also been kept into account in the selection
of the interviews as we aimed at analyzing if this factor could have inuenced the
motivation of the patients to seek for the treatment, as well as their perception on Siddha
medicine. In order to keep the sample representative of the two gender, half (n = 20) of
the patients selected were men and the other half women. The age of the interviewees
ranged between 23 and 56 years, the majority of the patients having an age between
35 and 40 years. The relatively young age of the patients reected the fact that sexual
activity was more likely to occur during the reproductive years, thus in younger patients.
The Namakkal district has been selected for this study, as it has been identied by
the Indian government as the district having one of Indias fastest growing HIV/
AIDS populations in Tamil Nadu. Namakkal is Indias major truck building and
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trucking centre that distributes products and services all over India. As a result, there
are over 60 000 individuals in and out of Namakkal every day.
The interviews whose duration ranged between 45 min and 1 h each consisted of
semi-structured questions aimed to gain insight regarding the motivations of the
patients to be treated with Siddha doctors as well as their perceptions concerning
the effectiveness of Siddha medicine in treating HIV/AIDS.
In an attempt to compensate for the lack of linguistic background, two local translators who were familiar with the local cultural context have been hired. One of the
translators, recruited with the support of Gandeepam, was a eld worker with previous professional experience among Tamil-speaking villagers. Aware of the fact that
a translator from a different background may help facilitate access to different social
groups, an English-speaking villager has been recruited. In order to avoid the gender
difculties that may arise when a male interpreter approaches women, a female
translator who was a social worker in a local NGO has also been used. In order to
protect the privacy of the respondents, we ensured that interpreters who assist with
translation lived in different villages of those of the interviewees. All the interviews
were recorded and transcripted in Tamil language. These scripts were subsequently
translated in English by professional translators, and the two versions were
compared in order to triangulate the data.
Anonymity and condentiality of the participants have been assured by omitting
names. In addition, permission from the informants has been required before starting
audio recording the interviews. The participants have been informed of their right to put
the information off the record in its entirety or any part of it after the recording nished.

RESULTS AND DISCUSSION

Presentation of the case study: Gandeepam
Gandeepam provides healthcare services through the traditional Siddha medical system
to both rural and rural populations through four clinics located in Tamil Nadu. The
main objective of this grass-roots organization is to provide low cost medicines using
natural readily available plant materials and to present and control HIV/AIDS through
education, testing, treatment and care. Gandeepams rst and largest Siddha hospital is
located in Kilavayal, a rural area recognized by the Indian government as one of the
most impoverished regions of Tamil Nadu (Dr. Vr. V. Ramani, personal communication, August 2010). This was started as a Siddha clinic in 1990, treating common
ailments and also a range of other conditions including cancer and diabetes. One additional clinic was established in Thuvarankurichi in 2001 (Trichy district), in Viralimalai
in 2002 (Pudukkottai District) and in Puthan Santhai in 2003 (Nammakkal district).
The facilities at Viralimalai and Puthan Santhai provide comprehensive healthcare,
and HIV/AIDS patients represent the bulk of cases.
Gandeepam has been providing palliative care to HIV patients according to Megavettai
guidelines and local traditions for 12 years. Treatments to reduce some symptoms of the
disease in the short term and some opportunistic diseases are developed by Dr. Ganeshan
and Dr. Ramani, and are used as standard protocols for HIV patients at all Gandeepam
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clinics. Gandeepam is currently providing palliative care for approximately 2000 HIV
patients at three locations throughout Tamil Nadu: Kilavayal, Namakkal and Viramalai.
The majority of patients are in stages I and II, and 100 patients are in the chronic stage.
The majority of the Siddha practitioners interviewed emphasized that Siddha treatment
did not want to provide an alternative to allopathic treatment (chemical antiretrovirals)
but only aimed at reducing short-term symptoms for HIV/AIDS patients.
In addition to standard testing for HIV status, Siddhas primary diagnostic tool,
naadi, or pulse reading, is used to diagnose opportunistic infections that are associated
with HIV/AIDS. The diagnosis is conrmed by analysis (envagai thervu) of the other
body systems: tongue, voice, eyes and the body as a whole. A patient suffering from a
chronic or serious illness such as HIV/AIDS will exhibit an unbalanced pattern and
intensity in all three pulses. The Siddha medical theory identies three broad mind
body types: Vatha, Pitta and Kapha. These can be further differentiated as combinations of any one or two or all three of these. An individuals body type informs the
diagnosis and determines the most effective treatment (Dr. Vr. V. Ramani, personal
communication, August 2010). All Siddha treatments, including those for HIV, are
prescribed on an individual basis and aim at reducing some short-term symptoms such
as fatigue and lack of energy among the patients. Recognizing HIV manifestations
according to body and type is required for proper diagnosis treatment.
Only one of the four Siddha practitioners involved in our study had received a formal
training ofcially recognized by the Government. Almost the entire staff have learned
their profession from a member of their family or by reading books on their own.
The practitioners interviewed believed that a blood test was necessary to diagnose
HIV/AIDS. Despite this, they afrmed that the presence of this disease could be
diagnosed also by examining the pulse of the patient. This diagnostic method is
common to the ISM practitioners and is considered to be very reliable. This diagnostic
method seems quite controversial for a disease such as HIV/AIDS because of its severe
implications, and one can wonder whether the diagnostic tool of taking the pulse is
always reliable. A lack of appropriate diagnosis of this disease could in fact increase
the risk for other people to be exposed to this disease.
Most of the practitioners believed that the Siddha treatments could help restore the
balance of humors, which is manifested by improved health and reduction or disappearance
of symptoms. Nevertheless, the practitioners were conscious that they were unable to
eliminate the disease but only to improve the life quality of their patients in the short term.
All the practitioners reported using herbal ingredients and minerals and metals when
appropriate. Some admitted some minerals and plants have a high toxicity and afrmed
that specic procedures were necessary in order to neutralize the toxicity of these
elements before giving them to the patients. Most treatments were to be combined with
lifestyle modications, most often involving diet restrictions.
The practitioners also emphasized how the drug preparations were of their own
invention and that each drug was targeted to the single patients needs, age, gender
and stage of disease. Each practitioner makes up his or her own treatment regime,
slightly personalizing the protocol developed for general use in the clinic.
Gandeepams Siddha HIV treatment is a combination therapy consisting of three
categories of medicines: immune stimulants, antivirals and treatment of opportunistic
infections. The treatment with immune stimulants takes place within 12 days and lasts
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for up to 7 days if needed. The treatment consists of natural liquid extract from medicinal
plants. An extract containing 27 plants is given for oral consumption every morning to
the patient on empty stomach. The antiretroviral treatment begins on day 4. The objective of this treatment is to raise haemoglobin and to build immunity. This medication is
given in the form of capsules, containing 1015 medicinal plants. The treatment for
opportunistic infections also begins on day 4.
Four different medicines treat opportunistic infections:

a powder consisting of 210 herbs,

a semi-liquid lotion consisting of 1520 herbs,
capsules of 1015 herbs and
an oil for external application and/or for internal consumption.

After this rst phase of the treatment, the patient will return for a check-up every
710 days from 3 months (Photos 1 and 2).
Siddha treatment is accompanied by dietary guidelines and restrictions. Patients
are instructed to avoid excessively bitter food, as they are considered likely to inhibit
the potency of the medicines.
The Gandeepam clinic also treats the psychological conditions associated with
HIV such as depression, anxiety and suicidal tendencies. This treatment includes
Siddha medicines, as well as psychological counselling. The patients psychological
state changes with the progression of the disease, requiring mental health treatment
throughout all HIV stages.

Photo 1. Preparation of a Siddha medicine (photo credit: Maria Costanza Torri)

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Photo 2. Preparation of a Siddha medicine (photo credit: Maria Costanza Torri)

Counselling is based on the Siddha principles of bodymind integration (yoga).

Disharmony between body and mind is believed to contribute to illness. Gandeepam
doctors routinely ask patients to pray according to their individual religious tradition.
There are plans to integrate yoga and meditation into treatment regimens.
The combination of the psychological aspects with the drug treatment makes
Siddha treatment suitable in complementing the allopathic treatment in order to
address short-term symptoms for the patients.
Gandeepam also gives patient and family counselling. This counselling includes
education on the nature of HIV/AIDS, how to treat and manage opportunistic infection, and regular ow of information on the patients conditions.
During our research, the majority of the patients interviewed at the clinic (i.e. 90%)
afrmed that this counselling had a positive inuence on their psychological state, that
is, mental well-being. Most patients interviewed reported that they felt more comfortable
with Siddha practitioners than with allopathic doctors. HIV/AIDS patients who had previously received treatment from allopathic doctors reported a strong preference for the
warm doctorpatient relationship they found with the Gandeepam Siddha practitioners.
A male patient in his mid-thirties afrmed: Before coming to Gandeepam, I went to
a clinic in the city. . .the doctors were quite detached and they never use to talk to me or
explain things to me. . .. I always felt inferior and I was afraid to speak or to ask some
clarications. Here things are different. . .the Siddha practitioners are kind and open
with the patients. . .they ask me how things are going with my work and family. . .they
understand how difcult it is to straggle with poverty and to be ill. . ..
The belief that good physicianpatient relationships are associated with better
adherence to antiretroviral regimens for HIV infection is widespread and supported
by qualitative studies (Holzemer et al., 1999; Malcolm et al., 2003).
Opened in September 2003, the Namakka district clinic serves as the primary
treatment and research centre from the Gandeepam programme. At other locations,
HIV patients are also seen but in lower numbers. In the last year, Namakkal received
180 patients through referrals. Ninety six were diagnosed with HIV. Between 6 and
15, new patients are seen each week. Each Sunday, an average of 20 patients receive
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HIV testing at the clinic for a fee of 60 Rs ($1.5). This charge is signicantly less
than 120 Rs ($3) commonly charged by private hospitals, where poor people can
hardly afford to pay this amount of money.
Description of patient study participants. Most patients (i.e. 45%) are between the
ages of 16 and 35 years, the prime of their wage earning years. Given this fact,
returning to work is of paramount importance to patients.
Two-thirds of the patients that come to the clinic are men, although the presence
of women has increased slightly in these last few years. Of the women, 70% are
widows, reporting infection from their husbands.
Both interviews with patients from the hospital and the Gandeepam clinic highlighted
that the traditional patriarchal societies put women at low risk of HIV infection but
mens behaviour is tolerated, even high risk behaviours such as having sexual unprotected relationships with prostitutes. The greatest risk being husbands behaviour
ranging from 1% in general population of antenatal cases to 14% in monogamous
women attending STD clinics (Piot, 2001; Parker and Aggleton, 2003). The social hierarchy and the differential power relations that exist blame women for bringing the infection in the family, especially seen when the women have been tested for HIV before their
husbands, as what happens in several antenatal clinics (Singhal and Rogers, 2003).
Coping with her HIV status and looking after her child is a double burden that she
has to manage along with her own health and social vulnerabilities. Social norms, such
as subservience in marriage, which is often reinforced by violence, can compromise
womens ability to protect themselves, whereas a husband although asymptomatic
HIV positive gets opportunity to leave his wife with AIDS and his children to nd
another wife (Fife and Wright, 2000).
When women are diagnosed with HIV/AIDS, the psychosocial implications,
rather than the physiological impact, become the focus. Although research indicates
that the method of transmission affects the level of stigma, this is not true in women
(Fesko, 2001). Those infected by their husbands or blood transfusions suffer as
much stigma as those who contracted the virus from a sexual encounter with an
unknown individual (Reece, 2003).
The interviews highlighted that the majority of the patients are sex workers and
truck drivers. Whereas few patients were immediately forthright about their profession as a sex worker, many patients later revealed that they were engaged in
commercial sex activity. At rst, many sex workers had started their profession as
housewife. Truck drivers often attribute infection to contact made with sex workers
while away from their families. Then, infection is further spread by mother-to-child
transmission. It is not uncommon for a family to experience the deaths of more than
one baby before the woman receives testing and becomes aware of her HIV-positive
condition (Chandra et al., 2003).
Thirty of the affected families (i.e. 75%) interviewed both at the hospital and the
clinic reported signicant economic hardship. Most families receive a total income
of less than 2000 Rs ($43) per month, whereas many others survive on less than
1000 Rs ($22) per month. Only a small minority of families owned any assets such
a land, cattle, vehicles, television or radio. All patients reported that they had no
savings. Every family indicated that they spend the salary they gain to buy food
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and other goods for daily life. Furthermore, families were often burdened by debt.
Overwhelmingly, a debt had been incurred to cover the cost of medical treatments.
Healthcare is a leading cause of rural family indebtedness in India.
Patients motivations and knowledge of Siddha treatment. The patients interviewed
were generally aware of the different options available for the treatments for HIV but
showed a poor knowledge regarding HIV transmission and prevention, especially those
interviewed at the governmental hospital. Many (n = 22, i.e.73%) had heard of Siddha
treatments for HIV, and 75% believed that these treatments could be curative. In this
respect, a woman in her early forties afrms, When I found out I had HIV/AIDS after
the death of my husband, I was devastated as I thought I was going to die soon as well
and I need to provide for my children. Then I talked to relative of mine. . .he referred
me to a Siddha doctor, telling me that this doctor had treatment that could lengthen
my life by 10 years. This Siddha doctor said that he would be able to lengthen my life,
and that he would also be able to decrease my viral load. I feel much better now as I
know that I can live some more years and help my family. . ..
There is also a number of patients (n = 23, i.e. 76%) who were informed of
allopathic treatments for HIV, although only a few understood its role in treatment.
A small number of patients (n = 7, i.e. 23%), especially women (four of seven
patients), were not aware of the existence of either allopathic or Siddha treatments
for HIV/AIDS, having learnt about this possibility by some social activists that came
in their village. These women highlighted that they were not aware of being infected
by HIV till the emergence of the symptoms. Some of them, especially those interviewed at the hospital, afrmed that they realized they were affected by HIV/AIDS
after their husband was diagnosed with the disease or after his death.
Most women who had used Siddha treatments afrmed doing so upon the recommendation of their husband or a community leader. A woman in her early forties
declares, When I was diagnosed with HIV, I wanted to go to Chennai to get treated
with the Western medicine. I trust allopathic treatment more than traditional
medicine. I think it is more reliable and effective. . .anyway. . .my husband dissuaded
me from going saying that it would have been too expensive for us as the clinic was
quite far away from here. . .he also thinks that Siddha is good to treat my disease as
he has been treated by a local practitioner here and wanted me to have the same kind
of treatment. . .so I had no choice but to go to a Siddha practitioner. . ..
This lack of information regarding the therapeutic options available shows that the
women have no agency in dealing with diseases and also in deciding about the way
they want to be treated, whether with allopathic treatment or Siddha medicine.
Here, too, relationships of power, control, authority and equity may be played out
with varying consequences for womens health. The household is the most intimate
setting for the playing out of dramas of power, authority and control, all of which
may affect women in a number of ways. Male partners, and sometimes in-laws,
may control womens access to money and health services (Nussbaum, 2001; Reece,
2003; Martin, 2004).
Patients, mostly men, afrmed that they approached Siddha practitioners to seek a
treatment of their HIV infection, usually after some time after the disease was diagnosed.
As one male patient in his late twenties stated, At the beginning I could not believe that I
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was affected by HIVAIDS. I was feeling well, had the same energy I had before and I
had any kind of symptoms. I thought that perhaps there was a mistake in the diagnosis
and I continue carrying out my normal life. After some time I started feeling weary. I also
stated losing weight and having a temperature. . .. I could not work as hard as before and
thus I decided that I needed to look for a treatment. . ..
Some other patients reported seeking Siddha for treatment after the emergence of
specic symptoms such as genital lesions or skin problems. This attitude was especially
frequent among women. One 48-year-old woman declares, After I found out I was
affected by HIV, as I was symptoms-free, I thought that I did not need a treatment. . .when I developed genital lesions my husband took me to see a Siddha doctor.
This delay in health seeking from the women affected by HIV can be
explained by several factors. These can be linked to fear of social isolation,
economic constraints, and inadequate staff attitudes and poor quality of health
services (Stein and Nyamathi, 2000). Stigma attached to HIV/AIDS is described
in the literature as closely related to contextual factors such as gender roles,
socio-economic status and level of education and seems to be mediated via denial and concealment of HIV/AIDS diagnosis and disease, thus causing delay
(Chandra et al., 2003).
Generally, women with HIV/AIDS are hesitant to access healthcare for fear of
breach of condentiality and perceive stigma from provider, and are reluctant to take
medications that identify them as being ill (Sullivan et al., 2004). Women are afraid
that disclosing that they are HIV-positive status may result in physical violence,
expulsion from their home or social ostracism, or their property being seized after
their partner died (Bird et al., 2004).
Other important factors contributing to delay among women can be represented by
fear of individual costs of diagnosis and treatment, especially when the women are
widows (Reece, 2003; Sharma, 2004). Staff attitudes and quality of health service facilities are also described in the literature as not always corresponding to womens expectations of appropriate health services. Women saw themselves and were seen by others
as being more sensitive than men to poor service conditions and staff attitudes.
A majority of patients (n = 23, i.e. 76%) cite the short duration of the Siddha treatment
(3 months) as one of the primary reason on their choice to be treated by Siddha practitioners.
Another important factor that is kept into account by the patients interviewed in
selecting the treatment for HIV/AIDS was the cost of the treatment. Two-thirds of
the patients, especially the women who were widows, afrmed that they were not able
to pay the money to have access to an allopathic antiretroviral treatment offered in
private clinics. The high transportation costs to reach the closest city where the allopathic treatment was available also represented an important aspect that dissuaded these
patients, especially women, to take allopathic antiretrovirals. As a 32-year-old man
afrmed, I went to the city to have an allopathic treatment. I was feeling better and
my health conditions improved but I was only able to take the treatment for 4 months
because I couldnt pay for more. . .so I had to stop and I stated being treated here as
it much more economical. . ..
Another reason mentioned by the patients who for their recourse to Siddha treatment was the fear of side effects from allopathic treatments. A young man in his late
twenties declares, I decided to use Siddha treatment as I did not want to experience
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the side effects of antiretroviral drugs such as diarrhoea, nausea and vomiting and
skin rashes. . .. A friend of mine was given an allopathic drug and he developed a
very bad skin itching. . .so I did not want to nd myself in the same situation. . ..
It is important here to emphasize how most side effects are not uniquely associated
with a particular drug, and sometimes it can be difcult to identify the cause. HIV itself
is capable of producing many of the symptoms that also occur as drug side effects.
Other possible causes include opportunistic infections, stress, diet and non-HIV drugs
(Kumarswamy et al., 2003; Alberg et al., 2009).
Symptoms and improvements. In the majority of the cases (i.e. 70%), patients have
been treated for an average of one/one and half years. HIV-positive patients commonly
reported symptoms of cough, fever and body pain. In numerous cases, some symptoms
were alleviated within 2 weeks of the beginning of the treatment. Moreover, patients
reported weight gain (+3 kg) and a corresponding increase in energy and strength by
the end of the rst months treatment course. Despite this encouraging result, doubts
still remain regarding how this outcome has been produced and how it can possibly
be explained. Could the alleviation of the symptoms be explicable by a better state of
mind or as a form of relief at having treatment? Further studies would be necessary
in order to provide a possible explanation of the effectiveness of Siddha medicine for
the treated patients.
Another important concern is represented by the effectiveness of this alternative treatment in the long term. Indeed, another important question that needs to be answered is
how long the health improvement highlighted by the interviewees will last. At the
moment being, considering the paucity of scientic studies on the efciency of Siddha
medicine, it is hard to establish if effective results have actually been achieved. In fact,
it cannot be proved that the symptoms associated with HIV/AIDS can disappear in the
long term, as this can take a few years to know.
In the absence of long-term patients (more than 2 years) for the moment being, it is
hard to have reliable data that allow to show how the health conditions of the patients
treated with Siddha medicine evolve in the long run and thus to show the effectiveness of the treatment.
Besides, it would also be important to understand up to which point long-term
patients (those who have been treated for more than 2 years) would be ready to bear
the costs of a treatment that is prolonged in the long run. This aspect is particularly
crucial in terms of the efcacy of the Siddha treatment for HIV/AIDS. As a Siddha
doctor interviewed at the clinic points it, It is important in order to ensure the effectiveness of the treatment that the patients continue it for at least 2 years. . .sometimes
the patients see a fast improvement in their health conditions within the rst four to
six months and they stop coming to the centre. . .this is detrimental as it can undermine
the positive results of the treatment in the long term.
Some patients reported improvement in their symptoms with Siddha treatment,
which in some cases, they and their practitioners misleadingly equated with a possible
cure of HIV/AIDS. One patient declared that he was affected by constant fever and a
loss of appetite but these symptoms were resolved by taking the Siddha medications. A
Siddha practitioner at the clinic highlights that one patient had constant cough and
diarrhoea when he was initially diagnosed, but he is symptoms-free now, after the
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treatment. . .. In fact he was cured from HIV and now he was to get married and lead a
normal life.
This aspect seems not to be fully considered by the Siddha practitioners interviewed. The latter are more concerned with the efcacy of the treatment in terms
of improvement of the symptoms and the subsequent capacity of a patient to resume
a normal life.
The association of these patients between lack of symptoms and lack of disease,
especially in the case of HIV/AIDS, constitutes a particularly alarming phenomenon,
as it can easily lead to risky behaviours and thus to an increased spread of the
infection. The lack of understanding of the difference between perceived short-term
benets by the patients and actual clinical benets has in particular been highlighted
by the allopathic doctors interviewed at the hospital. These latter emphasized how
the reduction of HIV/AIDS symptoms, especially in the initial stages of the
treatment, could lead to the adoption of risky behaviour among the patients with
deleterious effects on the spread of HIV/AIDS. This aspect should be addressed
by local health authorities through awareness campaigns that emphasize that there
is no cure for HIV/AIDS at the moment and that it is extremely important for the
people affected by HIV/AIDS to use protective measures in order to avoid the spread
of this disease.
One woman in her mid-thirties afrmed, All my family is HIV+. Since we contracted infection, we have lost two new born babies to HIV/AIDS. I was feeling very
weak and I was also suffering from depression. My husband was also very ill. The
disease drained his strength and reduce his energy to the point that he was unable
to lift himself off the oor once sitting. He was an electrician and the loss of strength
cost him his job. My son was also very ill with cough, fever and diarrhoea. We were
really in a desperate situation. After three months of treatment, my husband reported
a full return of strength and energy. He has gained 4 kg and can now ride the bicycle
every day. His symptoms arrested after a few weeks of treatment. As a result he
could return to work. I am also symptom free although I always feel depressed.
A 43-year-old woman afrmed, I have three children and I am a widow. I am a
ower seller. Before the treatment I was just at the edge of economic survival when
HIV undermined my capacity to work. I was terried that my children would grow
up as orphans with no one to care for them, and at the same time I felt suicidal. When
my family and neighbours became aware of my condition, they rejected me. I was
feeling completely exiled by my community and family. My eldest daughters marriage
was also negatively affected by my condition. When I heard about the treatment available at Gandeepam I was really motivated to try, especially for my children. Now, after
4 months of treatment I feel much better, and I have the same level of energy I had
before the infection. Moreover, despite the recommendations from neighbours that I
should have turned to prostitution to gain my living, I am able to avoid this occupation
by returning to work as a ower seller. I feel much more condent now that I am able to
provide for my family and send my children to school.
Being a parent seems to be a very important factor capable of motivating patients
to try the Siddha treatment for HIV/AIDS. This is especially the case for women who
are single mothers and who feel stronger the moral responsibility to support and
assist their own children. Seventy-ve per cent of the interviewees who were single
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mothers emphasized how their family status pushed them to seek for a treatment and
to go for the Siddha medicine.
In India, as elsewhere, AIDS is often seen as someone elses problemas something
that affects people living on the margins of society, whose lifestyles are considered
immoral. Even as it moves into the general population, the HIV epidemic is still misunderstood among the Indian public. People living with HIV have faced violent attacks,
been rejected by families, spouses and communities, been refused medical treatment,
and even, in some reported cases, denied the last rites before they die (Gupta and Sankar,
2003; Kumarswamy et al., 2003).
The denial of these rights increases women and girls vulnerability to sexual
exploitation, abuse and HIV infection and re-infection. The impact of epidemic on
women and girls is especially marked as they face heavy economic, legal, cultural
and social disadvantages. According to the Centers for Disease Control and
Prevention, the number of women with HIV/AIDS continues to increase. Women
with HIV/AIDS are not rare but hidden.
Discrimination is also alarmingly common in the healthcare sector (Kumarasamy,
2004; Sharma, 2004). Negative attitudes from healthcare staff have generated anxiety
and fear among many people living with HIV and AIDS. As a result, many keep their
status secret. It is not surprising that for many HIV-positive people, AIDS-related fear
and anxiety, and at times denial of their HIV status, can be traced to traumatic experiences in healthcare settings.
A recent study found that 25% of people living with HIV/AIDS in India had been
refused medical treatment on the basis of their HIV-positive status. It also found strong
evidence of stigma in the workplace, with 74% of employees not disclosing their status
to their employees for fear of discrimination. Of the 26% who did disclose their status,
10% reported having faced prejudice as a result (Milan et al., 2008).
Stigma is made worse by a lack of knowledge about HIV/AIDS. Although a high
percentage of people have heard about HIV/AIDS in urban areas (94% of men and
83% of women), this is much lower in rural areas where only 77% of men and
50% of women have heard of HIV/AIDS (NACO, 2003). This lack of information
and knowledge about HIV/AIDS in rural areas in India is also conrmed by more
recent studies (Rogers et al., 2006; Chandrasekaran et al., 2008).
A 38-year-old man afrms, After the Siddha treatment I feel much better. . .I also
feel less depressed. The Siddha doctors treated me with compassion and closeness
and this uplifted my spirits and helped me to recover from the dejection I felt upon
being rejected by my neighbours and family.
Challenges to healthcare-seeking behaviour in Gandeepam. After having presented
these positive cases, where the Siddha treatment has had a positive impact in improving
the life conditions of these HIV/AIDS patients, there are also some different experiences.
Some patients (n = 7, i.e. 23%) stated that they had stopped taking their Siddha treatment because of some side effects they experienced. One patient in his forties declared,
After taking these remedies, my skin became red and itchy and started having nausea
therefore I stopped the treatment. A woman shortly after the treatment also afrms, I
started the Siddha treatment but I was still feeling very tired and without energy. . .I
continued having diarrhoea, so I decided to stop taking the treatment.
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For a number of patients, Siddha treatment, often aimed at symptom relief and
boosting of the immune system, was unable to cure a serious but treatable underlying
condition. One patient started having high temperature and took some herbal
remedies for some time without any improvement. As the fever was coming back
all the time, he was nally hospitalized after a few months and diagnosed with
advanced tuberculosis and serious health conditions that could have been effectively
treated should he have been diagnosed before.
A few patients also afrm that the Siddha treatment was very effective in the rst
few months, but its efcacy decreased afterwards: I took the Siddha treatment for
almost a year, at the beginning I did a blood test and viral load went down. . .. After
eight months I checked my blood tests again and I have seen that my viral load had
risen again. . .I dont know why this happened.
Although there are very few studies on the efcacy of Siddha on viral diseases
such as HIV/AIDS, we can possibly explain this phenomenon with the fact that
perhaps the patient might have developed a form of resistance to the active ingredients present in the Siddha treatment in the same way that people can develop resistance to antiretrovirals.
Community outreach
Gandeepams HIV programme has developed out of its community outreach
efforts. At the Namakkal clinic, there are ve eld staff members who are responsible for covering specic geographic zones within the district. These bare foot
doctors spend part of their time on the eld trying to build relationships with their
communities so that they can effectively raise awareness of HIV. This position of
eld staff members can facilitate the process of trust building with the members of
the local communities and place them in the position to learn of the individuals
health problems. The creation of these relationships with the villagers can make
these local communities increasingly receptive to messages about HIV education
and prevention.
A patient interviewed afrms, I got to know about the Namakkal clinic through
the meetings organized in our villagers by the members of the clinic. They came
to our village and started talking to us and explaining to us the importance of natural
ingredients like plants and minerals to treat our diseases. . .they also explained the
side effects of allopathic treatment. . .. They also talked about the issue of HIV/AIDS
and what we can do to deal with it.
In order to promote traditional medicinal knowledge in the long term, it may be
necessary to increase the villagers awareness of the importance of using
medicinal plants as an effective and side effect-free form of treatment. It nevertheless
sends a somewhat false message because medicinal plants also have side effects if
one does not know how to use them properly. Presenting traditional medicine as a
panacea may create the same problem as what we are currently seeing with allopathic medicine. That traditional medicine has no side effects seems to be a strong
message spread by the NGOs that could not be accurate.
Community outreach is also a key mechanism through which community members
are motivated to be tested for HIV/AIDS. As the eld staff become aware of the health
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ailments experienced in the community, they are in a position to recommend testing for
HIV/AIDS. This is not always easy, as the villagers sometimes fear to be rejected and
discriminated against by the community and they are likely not to easily disclose their
health conditions.
Given the taboo status of HIV/AIDS within Indian society, Gandeepams community
outreach is proving effective in promoting AIDS awareness and prevention.
Interviewees (n = 21, i.e. 52%) revealed that few patients had been aware of
Siddha treatments for HIV prior to Gandeepams introduction through its eld staff.
For the many HIV-positive individuals who cannot afford allopathic ARV treatment,
patient interviews conrmed that the Siddhas treatment is widely seen as the only
viable opportunity for patients to experience a return to health.
Providing accessible treatment is a part of the Gandeepams community outreach
programme. This aspect is particularly important: the interviews have conrmed that
affordability is a major criterion for patients considering different treatment options.
Although Gandeepam receives some occasional funds from international NGOs, the
clinic is mainly funded by local patients fees.
The cost of the treatment is much lower if compared with allophatic treatment, and
many poor families, unable to pay for private healthcare, turn to government facilities that are also free. Despite this, as previously emphasized, one can wonder regarding the safety of this treatment and its effectiveness in the long term.
The aspect of price seems very important to motivate local patients to undertake
the Siddha treatment. Interviews at the government hospital in Nakkal with patients,
doctors and nurses indicated that government facilities are not yet able to provide
ARV. Only limited medication is available to treat opportunistic infections, and
many patients interviewed reported that they had received only a glucose drip when
they went to the hospital. Nearly all patients interviewed reported feeling no better
than they had at the time of admission to the governmental hospital.
Gandeepam is not alone in providing Siddha treatment for HIV/AIDS. Many
patients interviewed had taken Siddha treatment at the government hospital of
Thoracic Medicine, Tambaram Sanatorium in Chennai. The hospital also gives free
treatment to HIV/AIDS patients. The hospital is well recognized for its use of Siddha
medicine for anti-viral and immunity-enhancing effects. Overwhelmingly, however,
patients interviewed indicated that the clinics location in Chennai, 400 km from
Namakkal, caused considerable burden in travel time, expense and loss of wages.
While encouraged by the results they experienced at the Gandeepam clinic, patient
interviews conrmed that Gandeepam proved to be a more viable treatment option
for individuals living within the Namakkal district, although some of them declared
their scepticism regarding the efcacy of Siddha treatment for their condition.
Final considerations
There are not many studies available in India that illustrate the healthcare-seeking
behaviour among HIV-infected people and how people are treated among the
community (Bhat, 1996). Despite the fact that rural practitioners currently represent
one of the most popular forms of healthcare resource in Indian rural areas, HIV/AIDS
included, there is a paucity of studies focused on them (WHO, 2002).
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Therefore, although antiretroviral implementation programmes continue to expand, it

is important to determine whether the knowledge, attitudes and treatment practices of
HIV-infected individuals and their healthcare providers are aligned with current treatment recommendations. Failing to acknowledge and address local beliefs and healthcare practices may compromise the long-term success of HIV treatment programmes
(Sharma, 2004; Thomas et al., 2007; Hardon et al., 2008).
In many countries, the inclusion of anti-HIV ethnomedicines and other natural products in ofcial HIV/AIDS policy is an extremely sensitive and contentious issue
(Homsy et al., 2004; Kayombo et al., 2007; Langlois-Klassen et al., 2007). In the past
decade, there has been a sustained bioprospective effort to isolate the active leads from
plants and other natural products for preventing transmission of HIV and managing
AIDS (Asres et al., 2001; Vermani and Garg, 2002). Screening of plants based on
ethnopharmacological data increases the potential of nding novel anti-HIV compounds (Fabricant and Farnsworth, 2001). Indigenous knowledge of medicinal plant
use also provides leads towards therapeutic concept, thereby accelerating drug discovery; this is now being called reverse pharmacology (Sharma et al., 2006). Thus, it is
important to search for novel antiretroviral agents that can be added to or replace
the current arsenal of drugs against HIV (Klos et al., 2009).
Several important elements have been emphasized by our interviews with HIV/
AIDS patients and local Siddha practitioners.
First, a high number of patients interviewed turned to Siddha treatment for essentially a reason of economic nature rather than ideological (e.g. desire to be treated
with a more natural form of medicine).
As previously emphasized, the patients living in the area under study, especially
the women who were widows, do not possess sufcient nancial resources to access
allopathic treatment. This lack of nancial means and the traveling distance to the
clinics represent factors that play an important role in determining the exclusion of
these HIV/AIDS patients from the allopathic system.
Another point that explains the popularity of the Siddha treatment in the area
under study is the belief, among certain patients, that such practitioners offer a permanent treatment for HIV.
A central concept in Siddha, as well as in the other Indian traditional medicinal
systems, is the idea that the disease is produced by a lack of balance between human
beings and nature. This disharmony has negative repercussions for the body humors,
and it can be restored through therapy. Relief of symptoms, perceived as a successful
restoration of balance, is generally equated with a cure (Gogtay et al., 2001; Saper
et al., 2008). As previously emphasized, such a symptom-based concept of health
and illness, when applied to a disease entity such as HIV/AIDS, can have deleterious
effects on the spread of the disease, as it can help facilitate the transmission of HIV
through the adoption of risky behaviours. This idea can also prevent patients from
receiving allopathic therapy in the future and from being treated for serious opportunistic infections such as tuberculosis.
Another important point that needs to be considered is the fact that traditional
medicine such as Siddha can also have side effects in certain circumstances. This
risk is not remote, considering the fact that there is a paucity of studies on the efcacy and safety of this form of alternative medicine. Although in theory it is possible
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that certain herbs and minerals may boost the immune system, exert antimicrobial
activity, relieve symptoms and provide other signicant benets to HIV patients,
certain compounds have a high potential for adverse events (Deivanayagam et al.,
2001; Mills et al., 2005; Oguntibeju et al., 2007; Saper et al., 2008).
A growing literature illustrates that the use of dietary supplements and other forms of
complementary and alternative medications (CAM) is common among HIV-infected
persons in developed countries (Bagchi et al., 1999; Oguntibeju et al., 2007; Milan
et al., 2008).
This type of coexistence of allopathic and non-allopathic approaches is likely to
be relatively safe, provided that patients communicate clearly with their physicians
about the CAM therapies that they are using. We suspect that this type of healthy
coexistence will be far more difcult to achieve in India, where traditions of and
beliefs about Siddha are long standing and deeply held, and where the collaboration
between traditional medicine and allopathy is hindered by a growing competition
and strong economic incentives.
Little is known about traditional medicine use or its risk and benets in HIV/AIDS
management (UNAIDS, 2008). A survey of 1667 HIV-infected persons in four
regions of India found that 41% reported using some form of traditional medicine,
although only 5% believed traditional medicine was more effective than allopathic
ART (Saple et al., 2002; Brugha, 2003). With many products prepared locally as
well as available on the market and claims of cure being made (Ahmad, 2007;
Thomas et al., 2007), there is a need for patients, providers and policy makers to
assess systematically the potential benet as well as potential harm associated with
traditional medicine therapies for HIV/AIDS.
Overall, studies found the methodological quality of published research on traditional medicine for HIV/AIDS to be poor, regardless of study design. General
reasons for this poor methodological quality included lack of details on products
and their standardization, small sample sizes and high loss-to-follow-up rates.
Design aws included selection of inappropriate and/or weak outcome measures,
uncertain representativeness of the study population, inadequate methods for determining exposure and outcome in observational studies, and short follow-up periods.
Another important point that emerged in the interviews is the fact that gender represents a factor that inuences the access to treatment for HIV/AIDS, also in the context
of the Siddha medicinal system. As emphasized previously, the women interviewed
demonstrated less knowledge than men concerning the treatment available for HIV.
The interviews also show how women have less capacity to take autonomous decisions
regarding the type of treatment for HIV/AIDS they want to have. This can be explained
by the less access to nancial resources and more difculties they have in leaving their
home and family duties to access care. More than one-third of the women interviewed
afrmed that at the beginning of their disease, they did not seek medical care because of
perceived good health and a lack of symptoms or limited knowledge about the available
treatments. This contrast with the situation of men: the latter appeared in general to be
much more aware of the different options for the treatments and seemed to have greater
access to them. They were more likely to consult Siddha practitioners for treatment of
HIV/AIDS and the associated diseases, to self-medicate, and to undergo multiple
different treatment regimens throughout their disease course.
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What possible way forward?. Since 2001, Gandeepam has made clear its intention to
pursue randomized control clinical trial (RCT) evaluation of its HIV medicines. A
model for such a trial has been designed through dialogue between Gandeepam Siddha
medical personnel and the University of Oxfords GIFTS of Health research team.
GIFTS of Health in conjunction with Gandeepam physicians and clinical
researchers at the Delhi Society for the Promotion of Rational Use of Drugs,
National Institute of Immunology, has developed a clinical research methodology
for both pilot studies and for full RCTs. This methodology takes into account the
patients mind/body type, disease stage, age and gender. Patients and control
subjects will be divided for clinical testing according to this matrix.
Attempts to measure the efcacy of CAM by using RCTs and other forms of scientic
assessment, which are highly ranked in the hierarchy of evidence, are philosophically
and theoretically problematic (Borgerson, 2005; Barry, 2006; Villanueva-Russell,
2004; Goldenberg, 2006). Philosophically, the reductionist characteristic of positivist
epistemology that underpins biomedicines view of efcacy and focuses on the removal
of symptoms and diseases, is too narrow to evaluate CAM that deals not only with
diseases but also with holistically affective, social and spiritual well-being aspects. Theoretically, the difference in knowledge about human anatomy and physiology, disease
aetiology, classication, and diagnosis between biomedicine and other medical systems
entails different sets of denitions and measurements of effectiveness as well as criteria
for evaluating the success.
Many studies observed a distinction between epistemologies that underpin biomedicine and Asian medical systems. Unschuld (1987) insists that epistemological
differences between Siddha and Western medicine actually lie in the differences in
attitudes towards truth or what he calls patterned knowledge in Indian knowledge
tradition versus homogeneity in Western monoparadigmatic science. Shankar (1995)
traces ancient inscriptions of indigenous Siddha and Ayurvedic knowledge to its
origin. Brahmaa state of mind that unites one with natureis considered the
core of knowledge attainment in Indian tradition. He also points out the distinction
between modern and traditional approaches in knowledge verication. Whereas
modern experiments need to isolate a study object from its environmental context
and limit confounding factors in order to measure the effects of varied controllable
parameters, the traditional approach attempts to examine a study object in its entirety
together with its interlinkages and complexities.

CONCLUSION
The article shows how the perceptions of rural HIV/AIDS patients regarding Siddha
treatment Indian system are positive. The data show that according to the point of
view of the interviewees, this alternative form of medicine might be useful in
improving the quality of life for the patients affected by this disease in rural areas
in the short term.
The article also highlights that Siddha treatment for HIV/AIDS is used in many
cases by poor people in the area under study as a last resort when allopathic treatment is either unavailable or unaffordable. Indeed, the motivation for which these
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patients used Siddha medicine is not always explained by being perceived more
effective than allopathic medicine but for the aforementioned factors.
The study also shows that while increasing the access to rural HIV/AIDS patients,
the Siddha system has the tendency to reproduce a gender division in terms of access
to health services. While having more ready access to healthcare overall, men with
HIV/AIDS may be more likely to use Siddha and to engage in multiple different
treatment regimens, either simultaneously or sequentially. Likely reasons for this
include a greater awareness of available treatments, greater mobility and greater
access to nancial means. This aspect of gender inequality is particular delicate
and needs to be tackled.
The question of whether traditional medicinal systems such as Siddha can be a
complement to allopath treatment for short-term symptoms in HIV/AIDS needs to
be explored more in depth.
Although it seems that according to the perceptions of the patients the Siddha
treatment has alleviated some of the initial symptoms of HIV/AIDS, further research
is essential in order to assess the degree of safety and efcacy of Siddha medicine,
especially in the long term. Indeed, confusion between perceived short-term benets
by patients and actual clinical benets may encourage risky behaviours that can help
further spread the disease. It needs to be stressed that there is no scientic study
showing that Siddha can represent an alternative in either short or long term for
patients affected by HIV/AIDS. Assuming this, as it is the case among some of
the Siddha practitioners interviewed, is particularly delicate, as it can endanger the
health of patients and contribute to the spread of the disease.
Another aspect that needs to be considered at this point is that anti-HIV ethnomedicines and other natural products can easily become a scapegoat for denial and inertia to
roll-out ART. Reliance on anti-HIV plants and other natural products can also lead to
poor adherence to ART. Keeping into account these aspects, many governments still
have contradictory attitudes towards the use of anti-HIV plants and other natural products in the management of HIV/AIDS, discouraging them within ART programmes
and supporting them within other initiatives of public health and primary healthcare.
The adoption of anti-HIV ethnomedicines thus remains a delicate issue.
Further research on how traditional and allopathic systems of care interact in the
care of persons with HIV/AIDS in India is needed, not only to investigate potential
benecial and synergistic effects but also potential toxicities and drug interactions.
Previous studies have shown that some natural medicines such as botanicals and
herbal products can be potentially harmful to patients, and thus, this is a research
area of crucial importance that requires further investigation.
In addition, education campaigns aimed to increase knowledge about HIV/AIDS
and the different treatments available (e.g. allopathic and non-allopathic) and their
possible risks are needed, especially in the rural areas.

ACKNOWLEDGEMENT
The author has no competing interests.
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