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Integrating biomedical and CAM approaches: The experiences of people living with HIV/AIDS

Rachel D Thorpe
Centre for Health and Society, University of Melbourne; Australian Research Centre in Sex, Health, and Society, La Trobe University VIC

Abstract

This paper discusses the perspectives of 18 people who were living with HIV/AIDS in Melbourne, Australia, and who were using complementary and alternative medicine (CAM) alongside biomedicine. I argue that although people may perceive the holistic focus of CAM to be more desirable than the more pathogenic focus of biomedicine, a holistic approach is also associated with limitations.

In this study, participants were motivated to use CAM because of the perceived limitations of biomedicine and also because of a desire to have control over how their illness was managed. However the majority of participants were not interested in the philosophical principles of CAM, rather in whether these therapies were effective and manageable.

These findings suggest that although people may hold different beliefs about CAM as compared with biomedicine, an approach to healthcare that has a practical focus on both clinical outcomes and patient wellbeing may be acceptable to most people.

Keywords

CAM, HIV, chronic illness, sociology, holism

Article Text

The current popularity of non-biomedical healing modalities, commonly referred to in the literature as complementary and alternative medicine (CAM), has been the subject of considerable research and commentary (Eisenberg et al 1998; Maclennan et al 2006; Sharma 1992; Maclennan et al 1996, 2002; Fisher & Ward 1994). Studies on patterns of CAM use indicate that these modalities are particularly popular for chronic conditions, musculoskeletal disorders and ‘general health' and that most people who use CAM continue to use biomedicine, suggestive of a move towards a model of medical pluralism (Saks 1998; Sharma 1992; Maclennan et al 2006).

In keeping with these trends, a survey of people living with HIV/AIDS (PLWHA) in Australia, first conducted in 1997 and repeated in 1999, 2001 and 2003, found that over half the respondents were using at least one form of CAM and the majority were taking antiretroviral therapy for HIV at the same time (De Visser et al 2000; De Visser & Grierson 2002; Grierson et al 2004). The types of CAM practices used included vitamin and mineral supplements, herbal medicine, Traditional Chinese Medicine, homoeopathy and physical therapies such as chiropractic, massage and shiatsu (Grierson et al 2004).

While the current dominant narrative around HIV in Western societies is that it is a manageable chronic illness, the re-construction of HIV from a highly fatal illness to chronic illness has been relatively recent, coinciding with the introduction of combination antiretroviral therapy (ART) in 1996 (Green & Smith 2004; Persson et al 2003; Siegel & Lekas 2002; Moatti & Souteyrand 2000). ART has resulted in significantly reduced morbidity and mortality among PLWHA in countries such as Australia where these treatments are widely available (Green & Smith 2004; Siegel & Lekas 2002). However, although most PLWHA have experienced improved health as a result of ART, they may also experience side-effects, fluctuating health and uncertain long-term outcomes (Green & Smith 2004). As is the case with other chronic illnesses, the focus of living with HIV has become about day-to-day management, which may require self-care on the part of the individual, such as self-monitoring of symptoms and side-effects (Siegel & Lekas 2002; Pierret 2000). Use of CAM can also be seen as a form of self-care (Siegel & Lekas 2002).

Research conducted in the US, Canada and the Netherlands found that between 38% and 88% of PLWHA were using at least one form of CAM, and that CAM users were at least as likely as non-users to be taking ART (Gillett et al 2002; Knippels & Weiss 2000; Foote-Ardah 2003; Chang et al 2003; Risa et al 2002; Furin 1997; Fairfield et al 1998; Pawluch et al 2000). A qualitative study found that participants used CAM for pragmatic reasons, such as management of medication side-effects, but also to allow them to self-regulate and have control over their daily treatment practices (Foote-Ardah 2003). From these studies it can be concluded that CAM use is relatively common amongst PLWHA in developed countries and that CAM is predominantly used by this group of people alongside biomedical treatments. The use of CAM by PLWHA in developing countries, where ART is often not accessible, introduces a different set of dynamics which are beyond the scope of this article.

The term integrative medicine refers to the inclusion of CAM modalities in a biomedical setting, either at the hospital or primary care level (Barry 2006; Singer & Fisher 2007; Coulter & Willis 2004, 2007). A major focus of how to integrate CAM into the biomedical setting has been the question of evidence, specifically whether there is enough evidence for the efficacy of CAM therapies (Baer 2004; Coulter 2004; Coulter & Willis 2004, 2007). Another perspective on integrative medicine, however, is that the use of CAM in this context is likely to result in a loss of the philosophical basis of the therapy (Singer & Fisher 2007; Coulter & Willis 2004, 2007). Delivering a CAM therapy from within the biomedical context may therefore ‘mainstream' that therapy, such that it becomes something quite different from the traditional practice, and may not be perceived to be CAM by either the practitioner or the patient (Singer & Fisher 2007).

The philosophical principles of CAM therapies, such as belief in the vital force, lead to the holistic focus of these therapies. Holism, in this context, means more than treating the whole person, it implies considering the connection between the physical, mental and energetic selves. As Coulter (2004: 113) writes ‘health is related to the balanced integration of the individual in all aspects and levels of being: body, mind and spirit'. As Lowenberg and Davis (1994) point out, a holistic approach to healthcare considerably broadens the scope for therapeutic intervention. These authors also suggest that the holistic healing model places emphasis on the individual taking responsibility for their own health, and that this model encourages practitioner and client to interact on a more equal level (Lowenberg & Davis 1994). However, CAM practitioners may place varying degrees of emphasis on the philosophical aspects of therapies, and on a holistic focus, and similarly, these may be more or less important to the patient (Sharma 1996; Baer 2001: xiv; Barry 2006).

Thus far, research has largely focussed on the implications of integration to the biomedical or CAM paradigms. If the ideal of integrative medicine is to maximise the benefit to the patient by offering the best of what biomedicine and CAM has to offer, it is also important to understand the perspective of the patient on which aspects of biomedicine and CAM are important to them (Willis & White 2004: 55).

The aim of this paper is to discuss the experiences of a group of PLWHA who were using CAM while also using biomedical treatments for HIV, or having their illness managed within the biomedical framework. These participants were often motivated to engage with CAM because of the perceived limitations of biomedicine. However a holistic focus was also seen to have limitations. I argue that although the holistic model may be perceived to be more desirable than the pathogenic focus of biomedicine, the combined use of therapies from both paradigms in a pragmatic manner seems to be an acceptable solution to most people. This pragmatic approach led to people using therapies they judged to be effective and manageable. Rather than adopting an integrative approach, these participants held different belief systems at the same time and ascribed different meanings to different therapies. ...continues...

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