title: "Driving the devil away": qualitative insights into miraculous cures for AIDS in a rural Tanzanian ward.
abstract: BACKGROUND
  The role of religious beliefs in the prevention of HIV and attitudes towards the infected has received considerable attention. However, little research has been conducted on Faith Leaders' (FLs) perceptions of antiretroviral therapy (ART) in the developing world. This study investigated FLs' attitudes towards different HIV treatment options (traditional, medical and spiritual) available in a rural Tanzanian ward.
  
  
  METHODS
  Qualitative interviews were conducted with 25 FLs purposively selected to account for all the denominations present in the area. Data was organised into themes using the software package NVIVO-7. The field work guidelines were tailored as new topics emerged and additional codes progressively added to the coding frame.
  
  
  RESULTS
  Traditional healers (THs) and FLs were often reported as antagonists but duality prevailed and many FLs simultaneously believed in traditional healing. Inter-denomination mobility was high and guided by pragmatism.Praying for the sick was a common practice and over one third of respondents said that prayer could cure HIV. Being HIV-positive was often seen as "a punishment from God" and a consequence of sin. As sinning could result from "the work of Satan", forgiveness was possible, and a "reconciliation with God" deemed as essential for a favourable remission of the disease. Several FLs believed that "evil spirits" inflicted through witchcraft could cause the disease and claimed that they could cast "demons" away.While prayers could potentially cure HIV "completely", ART use was generally not discouraged because God had "only a part to play". The perceived potential superiority of spiritual options could however lead some users to interrupt treatment.
  
  
  CONCLUSIONS
  The roll-out of ART is taking place in a context in which the new drugs are competing with a diversity of existing options. As long as the complementarities of prayers and ART are not clearly and explicitly stated by FLs, spiritual options may be interpreted as a superior alternative and contribute to hampering adherence to ART. In contexts where ambivalent attitudes towards the new drugs prevail, enhancing FLs understanding of ART's strengths and pitfalls is an essential step to engage them as active partners in ART scale-up programs.
authors.affiliation: Centre for Population Studies, Department of Epidemiology and Population Health, 49-51 Bedford Square, London School of Hygiene and Tropical Medicine, London, WC 1B 3DP, UK. maria.roura@lshtm.ac.uk
authors.forename: Maria
authors.initials: M
authors.lastname: Roura
authors.forename: Ray
authors.initials: R
authors.lastname: Nsigaye
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nhandi
authors.forename: Joyce
authors.initials: J
authors.lastname: Wamoyi
authors.forename: Joanna
authors.initials: J
authors.lastname: Busza
authors.forename: Mark
authors.initials: M
authors.lastname: Urassa
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000517:prevention & control* / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D016488:Medicine, African Traditional / Q000523:psychology; D012424:Rural Population; D026443:Spiritual Therapies / Q000523:psychology*; D013636:Tanzania
chemical_list: D044966:Anti-Retroviral Agents