The findings of the first clinical trial of the traditional African medicinal herb Sutherlandia could bring succour for people living with HIV/Aids, but probably not for beleaguered Health Minister Manto Tshabalala-Msimang.
The trial, which will begin in September, was announced this week with the results expected in August 2009, by which time Tshabalala-Msimang — who has proposed traditional remedies to combat HIV/Aids — will almost certainly be out of a job.
The research, led by the International Centre for Indigenous Phytotherapy Studies (Ticips), will be conducted at Pietermaritzburg’s Edendale Hospital.
Medical Research Council president Anthony Mbewu says it is important not only to combat HIV/Aids progression from its early stages, but also to tap traditional medicinal knowledge — an issue he believes has been ”politicised”.
Mbewu says traditional medicinal practice was ”suppressed and denigrated as superstition and witchcraft during colonialism”. More recently, opposition from civil society groups has been launched because of the polarised nature of the HIV/Aids debate, created to some extent by Tshabalala-Msimang’s unwavering position on traditional remedies.
He says that with 80% of South Africa’s population using traditional medicine, assessing its validity by using ”Western scientific rational methodology” is imperative.
Ticips says a research consortium led by the American University of Missouri, Columbia Medical School and the University of the Western Cape’s African Herbal Science and Medicine Institute says there are more than 21 000 species of plants in South Africa, of which ”approximately 3 000 are used medicinally”.
Nceba Gqaleni, deputy dean of the University of KwaZulu-Natal’s Nelson R Mandela School of Medicine and head of the African Healthcare Systems Research Initiative (AHSRI), says Sutherlandia (Lessertia frutescens, commonly known in isiZulu as unwele or by its Afrikaans name, kankerbos) is one of the most widely used herbs in traditional medicine.
It is a staple ingredient in remedies concocted by traditional healers to combat ailments ranging from loss of appetite to liver and kidney infections. It could be useful in fighting opportunistic secondary infections accompanying HIV/Aids and dealing with depression and anxiety.
The study will be led by Douglas Wilson, head of Edendale’s department of medicine. Kathy Goggin from Missouri University will monitor the effects of Sutherlandia on 124 people in the early stages of HIV/Aids who have a CD4 count higher than 200 and therefore do not medically qualify for government’s antiretroviral (ARV) treatment.
Trial
The trial follows experiments on the safety of the herb, completed on vervet monkeys and then on 20 healthy human volunteers, which, says Ticips co-director Quinton Johnson, of the University of the Western Cape, ”showed that the phytotherapy was well tolerated by humans”.
Wilson says the randomised, double-blind, placebo-controlled trial ”means that neither the patients nor the staff know who is taking the Sutherlandia and who is taking the inert powder”. Patients will be assigned the Sutherlandia and placebo by chance with the randomisation code likely to be broken only at the end of the study.
”It is scientifically robust and the best way to find out about the safety of Sutherlandia and its effects,” says Wilson.
Although this study will help tap into ancient African medicinal knowledge, it also attempts to incorporate traditional healers and their methods in the mainstream battle against a pandemic in a country where more than 5,5-million people are estimated to be HIV-positive.
”We are getting a set of more learned people — teachers, policemen, people like that — who are coming to us and are impressed when they see we have patient record forms with the department of health and University of KwaZulu-Natal logos on them. The forms give them more confidence in us and they help us keep a record of the progression of Aids,” says Makhosi Bongi Nkomo-Gwala, one of the 221 traditional healers who are participating in the clinical study at Edendale.
The AHSRI seeks to create an enabling environment for traditional healers and medical institutions to operate in tandem, while facilitating greater understanding between the biomedical and traditional spheres.
”There is training of traditional healers in HIV/Aids education and prevention strategies — but there is also cross-training between traditional healers and medical institutions like clinics,” says AHSRI head Gqaleni.
Wilson says the healers have already provided ”invaluable” assistance in the clinical study. ”With their knowledge of how patients describe illness, the healers helped translate the standardised questionnaires to be filled in by patients on their wellbeing from American English to idiomatic isiZulu.”