1.4.

1 AIM
The aim of the study is to evaluate the use of CAM and its impact on the quality of life of people
living with HIV in Connaught, George Brook and Rokupa health facilities in Freetown.
1.4.2 OBJECTIVES
1. To determine the prevalence of CAM among people living with HIV
2. To determine the different types and patterns of CAM use in people living with HIV
3. To evaluate the factors associated with CAM use in people living with HIV
4. To assess the impact of CAM on the quality of life of people living with HIV

DATA ANALYSIS
Data was entered on epicollect5 and imported into a statistical analytic software (Statistical
package for social sciences - SPSS version 26) in which they were analyzed. Quantitative data
such as ages, number of dependents and number of household members were expressed in terms
of averages and standard deviations using the mean and standard deviation function under
descriptive statistics of SPPSS. The frequencies and subsequent percentages of qualitative data
were calculated using the frequency function under the descriptive statistics of SPSS. A chi-
squared bivariate test was done to determine association between socio-demographic factors and
CAM using the chi-squared function under crosstab statistics of SPSS. The MOS –HIV 35
question instrument was used to determine the quality of life of participants of which each
question were allocated standard points and scaled to give a total average score ranging from 0 to
100, an independent t-sample test was done to determine correlation between the use of CAM
and the quality of life.

CHAPTER FOUR: RESULTS

4.0 SOCIODEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF
PARTICIPANTS
4.0.1 SOCIODEMOGRAPHIC CHARACTERISTICS OF PARTICIPANTS
A total of 350 participants were involved in the study with 140 participants from the Rokupa
Government hospital and 210 participants from the Connaught Hospital. The average age among
participants was 38.0 years (+/- 11.9SD). A total of 200 participants were between the\ ages of
20 to less than 40 years (young adults),. A total of 244 were females and 246 were Muslims.
Majority (163) of the participants were married. On highest level of education attained, 169 had
attained secondary level of education,. A total of 179 were unemployed. Most (144) participants
reported a monthly income between le1 to le800,. On the source of support, 180 reported self-
reliance.
 Table 4.1: socio-demographic characteristics of participants.
Variable Frequency (Percentage %)
(N=350)
AGE
Mean age = 38 years (+/- 11.9 SD)

< 35 years 151 (43.1)

≥ 35 years 199 (56.9)

GENDER

Female 244 (69.7)

Male 106 (30.3)

RELIGION

Christianity 104 (29.7)

Islam 246 (70.3)

MARITAL STATUS

Divorced 37 (10.6)

Married 163 (46.5)

Single 94 (26.9)

Widowed 56 (16.0)
Table 4.1 continued…

EDUCATIONAL LEVEL

No Education 56 (16.0)

Primary school 66 (18.9)

Secondary School 169 (48.2)

Tertiary Education 59 (16.9)

EMPLOYMENT STATUS

Employed 169 (48.3)

Unemployed 179 (51.1)

No response 2 (0.6)

MONTHLY INCOME

> Le 2000 35 (10.0)

>Le 800 - Le 2000 87 (24.9)

Le 1 – Le 800 144 (41.1)

No income 84 (24.0)

SOURCE OF SUPPORT/FINANCE

Family Support 76 (21.7)

Family Support and Self-reliance 56 (16.0)

Non-governmental organization 6 (1.7)

Non-governmental organization and 32 (9.2)

Self-reliance

Self-reliance 180 (51.4)

 Table 4.1continued…

NUMBER OF DEPENDENTS

Average number of dependents 3 (+/-

2SD). Maximum = 14

No dependents 53 (15.1)

1 to 5 dependents 258 (73.7)

Above 5 dependents 39 (11.2)

NUMBER OF HOUSEHOLD
MEMBERS (CROWDING
INDEX*)

Average number of household

members = 5 (+/- 2SD).

< 2 household member 18 (5.1)

≥ 2 household members 331 (94.6)

*Crowding index was defined as the average number of people living per room, excluding the
kitchen and bathroom (Naja et al., 2016).

4.2 CLINICAL CHARACTERISTICS OF PARTICIPANTS

Majority (185) of participants had been aware of their HIV status for 1 to 5 years duration and
majority (273) are in their 1st stage of HIV Most (228) of the participants in the study felt that
they were in good/excellent health, 332 responded that they are currently on HAART, and most
(278) has no other health condition/comorbidity Table 4.2 summarizes the clinical characteristics
of participants.
 Table 4.2: clinical characteristics of participants.
Variable Frequency (Percentage %)
(N=350)
DURATION OF
AWARENESS OF HIV
STATUS
< 1 year 49 (4.0)
1 – 5 years 185 (52.9)
> 5 years 116 (33.1)

PERCEIVED HEATLH
STATUS
Very poor/poor 7 (2.0)
Fair 115 (32.9)
Good/excellent 228 (65.1)

CURRENTLY ON HAART
No 18 (5.9)
Yes 332 (94.1)

DURATION ON ART
Average duration on ART
< 1 year 55 (15.7)
1 – 5 years 216 (61.7)
> 5 years 78 (22.3)
No response 1 (0.3)
Table 4.2 continued…
DO YOU SUFFER FROM
ANY OTHER HEALTH
CONDITION OR
COMORBIDITY
No 278 (79.4)
Yes 72 (20.6)

CURRENT MEDICAL
COMPLAINTS
Body pains 121 (34.6)
Stomach ache 11 (3.1)
Rash 6 (1.7)
Headache 115 (32.9)
Vaginal discharge 1 (0.3)
Common cold 13 (3.7)
Fever 13 (3.7)
Cough 6 (1.7)
Frequent loose stool 2 (5.7)
Dizziness 11 (3.1)
Nausea and vomiting 6 (1.7)
Fatigue 4 (1.1)
Swollen lymph node 2 (5.7)
Loss of appetite 1 (0.3)
Insomnia 4 (1.1)
None 158 (45.1)
TOTAL NUMBER OF
SYMPTOMS REPORTED
0 159 (45.4)
1-2 165 (47.1)
≥3 26 (7.4)

STAGE OF HIV OF
PARTICIPANT
Stage 1 273 (78.0)
Stage 2 56 (16.0)
Stage 3 21 (6.0)
Stage 4 0 (0.0)
4.3 PREVALENCE OF CAM AMONG PARTICIPANTS
A total of 176 participants had history of CAM use, 174 had never used CAM before. Figure 4.1
shows the prevalence of CAM use among participants.

Prevalence of CAM use among patients diagnosed

with HIV

50.3% 49.7%

Has history of CAM use Has no history of CAM use

Figure 4.1: prevalence of CAM use among participants

4.4 TYPE AND PATTERNS OF CAM USED AMONG PARTICIPANTS
Figure 4.2 present the types of CAM used among participants, majority 146 (83.0%) had used
dietary supplements, followed by spiritual healing methods 34(19.3%).

TYPES OF CAM USED

Herbal based (eg ginger, garlic, moringa, aloe vera)
Spiritual healing (Prayers, lighting candles, consuming holy water and fasting)
Special foods (honey, black seed, soya, pomegranate, others)
Dietary Supplement(vitamins and mineral supplement)
No response
160

140 150

120

100

80

60

40
34
20

0 12
7 6

Figure 4.1 Types of CAM used by participants

On the source of information in choosing type of CAM, majority (97) indicated health
practitioners as their only source of information on CAM, 122 reported using CAM regularly per
month, and most (131) reported spending between Le1 to Le50 per month.

Majority of participants (138) stated to use CAM in order to improve general health and ensure
long time survival.
Table 4.3 summarizes the patterns of CAM use among participants.
A total of 174 (49.7%) participants did not use, the majority (99 – 56.9%) refused to use CAM
because the doctor did not prescribe it and most of the participants not using CAM were
undecided about using it in the future (160 – 92%).
Table 4.2 summarizes the characteristics of non-CAM users.
 Table 4.2: characteristics of CAM use among participants
Variable Frequency (Percentage %)
(N=176)
SOURCE OF INFORMATION ON CAM?

Friends, family and relatives 29 (16.4)

Media (internet, magazines, TV) 10 (5.7)

From another patient using CAM 10 (5.7)

Family beliefs 14 (8.0)

Health practitioner 110 (62.5)

Personal choice 38 (21.6)

No response 8 (4.5)

HOW OFTEN DO YOU USE CAM?

Once per month 19 (10.8)

one time 24 (13.6)

Regular (2 or more per week for a 122 (69.3)

No response 6 (3.4)

IF THE USE OF CAM WAS REGULAR

WHAT IS THE ESTIMATED COST PER
MONTH?

> Le50 – Le500 le 37 (21.0)

> Le500 3 (1.7)

Le1-Le50 le 131 (37.4)

Table 4.2 continued…
DID YOU OBTAIN ENOUGH
INFORMATION ABOUT THE EFFICACY
AND SAFETY OF CAM BEFORE YOU
STARTED IT?
Yes 110 (62.5)
No 60 (34.1)
No response 6 (3.4)

WHY HAVE YOU USED CAM?

To improve general health and ensure long time 138 (78.4)

survival

To reduce side effects of conventional treatment 12 (6.8)

It is more natural 15 (8.5)

To feel more in control over your health care 10 (5.7)

To avoid taking HIV medications 11 (6.3)

To reduce viral load 10 (5.7)

To improve CD4 count 9 (5.1)

DID USING CAM WORK?

Yes 145 (82.3)

No 12 (6.8)

Difficult to judge 12 (6.8)

No response 7 (4.0)
Table 4.2 continued…

HOW SATISFIED ARE YOU WITH IT?

Average 38 (21.6)

Dissatisfied 8 (4.5)

Satisfied 123 (69.9)

No response 7 (4.0)

ARE YOU AWARE OF DRUG

INTERACTIONS WITH CAM?

No \ I don’t know 153 (86.9)

Yes 18 (10.2)

No response 5 (2.8)

LIST SIDE EFFECTS EXPERIENCED USING CAM

Allergic reaction 2 (1.1)

Digestive symptoms , “Body, bone, muscle, 1 (0.6)

and/or joint pain”

No response 173 (98.3)

DID YOUR DOCTOR OR OTHER MEDICAL

PROFESSIONAL ASK ABOUT CAM USE?
No 43 (24.4)
Yes 130 (73.9)
No response 3 (1.7)
Table 4.2 continued…
DID YOU MENTION YOUR CAM USE TO
YOUR DOCTOR?
No 42 (23.9)
Yes 131 (74.4)
No response 3 (1.7)

IF ‘YES’ HOW DID YOUR DOCTOR RESPOND?

Encourage you to continue using 75 (57.3)
Advise you to stop using 38 (29.0)
Was neutral about using (neither encourage or 14 (10.7)
discourage)
No response 4 (3.1)

IF NO, WHY DID YOU NOT MENTION IT

TO YOUR DOCTOR?
Anticipating negative response about CAM use 10 (22.2)
Don’t need doctor’s approval 1 (2.2)
Insufficient information on CAM 7 (15.6)
No need to consult with doctor 19 (20.0)
It was not important for doctor to know about my 14 (31.1)
CAM use

HAVE YOU EVER USED CAM PRODUCTS

AND ANTIRETROVIRAL DRUGS AT THE
SAME TIME?
Yes 128 (72.7)
No 37 (21.0)
No response 11 (6.3)
 Table 4.3 characteristics of non-users of CAM
Variable Frequency (Percentage %)
(N=174)
IF YOU HAVE NOT USED CAM, WHY
NOT?
I have never heard of it 12 (6.9)
I’m afraid of the side effects 17 (9.8)
I don’t believe in it 37 (21.3)
The doctor didn’t prescribe it 99 (56.9)
Not to have additional burden 25 (14.4)
Satisfied with conventional treatment 5 (2.9)

WOULD YOU CONSIDER USING CAM

IN THE FUTURE?
Yes 1 (0.6)
No 4 (2.3)
Undecided 160 (92.0)
No response 9 (5.1)

4.4 FACTORS ASSOCIATED WITH CAM USE AMONG PARTICIPANTS

Socio-demographic factors showing significant association with CAM use among participants
(using a multivariate analysis) included: the age, and the monthly income of participants.
Participants with ages less than 35 years, were 0.48 times less likely to use CAM (AOR: 0.48, p-
value: 0.02) than ages 35 years and above and participants with a monthly income ranging
between Le800 and Le2000 were 0.23 times less likely(AOR: 0.23, p-value: 0.008) to use CAM
than participants with Le0 monthly income. Clinical characteristics of participants showing
significant association with CAM included: the duration of awareness of HIV status, and the
total number of symptom reported. Participants with 1 to 5 years duration of awareness of HIV
were twice as likely to use CAM as participants with less than 1 year duration of awareness of
HIV (AOR: 2.12, p-value: 0.02). Participants with more than three symptoms were thrice as
likely to use CAM as participants with no symptoms (AOR: 3.26, p-value: 0.03). Table 4.4
shows the results for the multivariate logistic regression analysis between socio-demographic
and clinical factors and use of CAM among participants.
Table 4.4: shows the multivariate logistic regression analysis between socio-demographic and
clinical factors and use of CAM among participants.
Variable Had used Had not COR P- AOR P-
CAM since used (95%CI) value (95%CI value
diagnosis CAM )
since
N(%)
diagnosis
(N=176)
N(%)
(174)
Yes No
AGE
< 35 years 62 (35.2) 89 (51.1) 0.52 (0.34 – 0.003 0.48 0.02
0.80) (0.26 –
0.88)
≥ 35 years 114 (64.8) 85 (48.9) 1 (ref) 1 (ref) 1 (ref) 1
(ref)

GENDER

Female 122 (69.3) 122 0.96 (0.61- 0.87

(70.1) 1.52)

Male 54 (30.7) 52 1 (ref) 1

(29.9) (ref)

RELIGION

Christianity 63 (35.8) 41 1.81 (1.13 – 0.013 1.38 0.31

(23.6) 2.88) (0.74 -
2.59)

Islam 113 (64.2) 133 1 (ref) 1 1 (ref) 1

(76.4) (ref) (ref)
Table 4.4 continued…
MARITAL STATUS

Divorced 23 (13.1) 14 (8.0) 1 (ref) 1

(ref)

Married 79 (44.9) 84 1.23 (0.53- 0.63

(48.3) 2.88)

Single 42 (23.9) 52 0.71 (0.38 – 0.26

(29.9) 1.30)

Widowed 32 (18.1) 24 0.61 (0.31 – 0.14

(13.8) 1.12)

LEVEL OF
EDUCATION

No Education 21 (11.9) 35 0.51 (0.24 – 0.073

(20.1) 1.07)

Primary school 43 (24.2) 23 1.58 (0.77 – 0.215

(13.2) 3.24)

Secondary School 80 (45.5) 89 0.76 (0.42 – 0.362

(51.1) 1.37)

Tertiary Education 32 (18.2) 27 1 (ref) 1

(15.5) (ref)
OCCUPATION

Employed 76 (43.1) 93 0.81 (0.05 – 0.88

(53.4) 13.12)

Unemployed 99 (56.3) 80 0.66 (0.43 – 0.06

(46.0) 1.01)

No response 1 (0.6) 1 (0.6) 1 (ref) 1

(ref)
Table 4.4 continued…

MONTHLY
INCOME

> Le 2000 20 (11.4) 15 (8.6) 1.30 (0.59 – 0.512 1 (ref) 1

2.87) (ref)

>Le 800 - Le 2000 15 (8.5) 72 0.21 (0.11 – <0.00 0.23 0.00

(41.4) 0.42) 1 (0.08 8
–
0.68)

Le 1 – Le 800 97 (55.11) 47 2.02 (1.17 – 0.012 2.34 0.09

(27.0) 3.48) (0.88
–
6.24)

Le 0 44 (25.0) 40 1 (ref) 1 1 (ref) 1

(23.0) (ref) (ref)

SOURCE OF
SUPPORT/FINAN
CE

Family Support 38 (21.5) 38 0.67 (0.35 0.23 1.26 0.59

(21.8) - .29) (0.55-
2.88)

Family Support and 6 (3.4) 50 0.84 (0.50 – 0.50 1.32 0.51

Self-reliance (28.7) 1.40) (0.58
–
3.01)

Non-governmental 3 (1.7) 3 (1.7) 0.44 (0.14 – 0.16 0.92 0.90

organization 1.38) (0.23-
3.66)

Non-governmental 3 (1.7) 29 0.27 (0.10 – 0.008 0.37 0.12

organization and (16.7) 0.70) (0.10
Self-reliance –
1.30)

Self-reliance 100 (56.7) 80 1 (ref) 1 1 (ref) 1

(46.0) (ref) (ref)
Table 4.4 continued…

NUMBER OF
DEPENDENTS

No dependents 23 (13.0) 30 1 (ref) 1 1 (ref) 1

(17.2) (ref) (ref)

1 to 5 dependents 127 (72.2) 131(75. 1.27 (0.70 – 0.44 1.50 0.44

3) 2.29) (0.54
–
4.53)

Above 5 dependents 26 (14.8) 13 (7.5) 2.61 (1.11 – 0.03 1.17 0.74

6.16) (0.46
–
3.01)

NUMBER OF
HOUSEHOLD
MEMBERS
(CROWDING
INDEX*)

< 2 household 5 (2.8) 13 (7.5) 1 (ref) 1

member (ref)

≥ 2 household 171 (97.2) 161 0.64 (0.39 – 0.09

members (92.5) 1.07)
Table 4.4 continued…
DURATION OF
AWARENESS OF
HIV STATUS
< 1 year 25 (14.2) 24 1 (ref) 1 1 (ref) 1
(13.8) (ref) (ref)
1 – 5 years 72 (40.9) 113 0.61 (0.33 – 0.128 2.12 0.02
(64.9) 1.15) (1.13
–
4.01)

79 (44.9) 37 2.05 (1.04 – 0.04 2.00 0.09

> 5 years (21.3) 4.06) (0.91
–
4.44)
PERCEIVED
HEATLH STATUS
Very poor/poor 5 (2.8) 2 (1.1) 1 (ref) 1
(ref)
Fair 40 (22.7) 75 0.21 (0.04 – 0.07
(43.1) 1.15)
Good/excellent 131 (74.5) 97 0.54 (0.10 – 0.47
(55.7) 2.84)

CURRENTLY ON
HAART
No 8 (4.5) 10 (5.7) 1 (ref) 1
(ref)
Yes 168 (95.5) 164 0.78 (0.30 – 0.61
(94.3) 2.03)
Table 4.4 continued…
DURATION ON
ART
< 1 year 24 (13.6) 31 1 (ref) 1
(17.8) (ref)
1 – 5 years 90 (51.1) 126 1.48 (0.95 – 0.08
(72.4) 2.32)
> 5 years 62 (35.2) 16 (9.2) 1824888248 1.0
.4 (0.00-)
No response 0 1 (0.6) 0 1.0

DO YOU SUFFER
FROM ANY
OTHER HEALTH
CONDITION OR
COMORBIDITY
No 131 (74.4) 147 1 (ref) 1 1 (ref) 1
(84.5) (ref) (ref)
Yes 45 (25.6) 27 0.54 (0.31 – 0.02 1.71 0.14
(15.5) 0.91) (0.83
–
3.49)
TOTAL NUMBER
OF SYMPTOMS
REPORTED
0 119 (67.6) 40 1 (ref) 1 1 (ref) 1
(23.0) (ref) (ref)
1-2 46 (26.1) 119 0.25 (0.11 – 0.001 0.44 0.11
(68.4) 0.58) (0.16
–
1.21)
≥3 11 (6.3) 15 (8.6) 0.13 (0.08 – <0.00 3.26 0.03
0.21) 1 (1.12
–
 9.47)
STAGE OF HIV OF
PARTICIPANT
Stage 1 121 (68.8) 152 0.49 (0.20 – 0.13
(87.4) 1.22)
Stage 2 42 (23.9) 14 (8.0) 1.85 (0.63 – 0.26
5.37)
Stage 3 13 (7.3) 8 (4.6) 1 (ref) 1
(ref)
Stage 4 0 (0.0) 0 (0.0) 0.00 000
Note: the Crude odds ratio (COR) was done and significant variables were then used to calculate
the adjusted odds ratio (AOR)

4.5 IMPACT OF CAM ON QUALITY OF LIFE AMONG PARTICIPANTS

A Mann-Whitney U test was done to compare the effect of CAM use among participants on the
quality of life. The median scores of participants that used that used CAM were significantly
higher under the following domains: General health perception, physical function, social
function, cognitive function, pain, overall quality of life, and health transitions with respective p
–values of 0.032, <0.001, <0.001, 0.002, <0.001, and <0.001. But significantly lower in only the
energy/fatigue dimension (p-value <0.001).

Table 4.5: Effect of CAM use on the Impact of the quality of life
Variable Used CAM Did not use Mann- Z score p-value
CAM Whitney U (95%CI)
Median Median
(Q3-Q1,IQR) (Q3-Q1,
IQR)
General health 45 (60-30, 45 (45 – 40, 13318.5 -2.15 0.032
perceptions 30) 5)
Physical 100 (100 – 83.3 (100-50, 11487.0 -4.38 <0.001
function 75, 25) 50)
Role function 100 (100 – 100 (100- 15188.5 -0.21 0.84
100, 0) 100, 0)
Social function 100 (100-80, 80 (100-60, 10469.5 -5.71 <0.001
 20) 40)
Cognitive 60 (80-50, 30) 55 (65-45, 12469.0 -3.03 0.002
function 20)
Pain 100 (100 – 77.8 (89-56, 8217.0 -7.74 <0.001
78, 22) 33)
Mental Health 60 (68 – 48, 60 (64-52, 15207.5 -0.11 0.91
20) 12)
Energy/Fatigue 55 (73.8 – 25, 65 (75-50, 11297.5 -4.29 <0.001
18.8) 25)
Health distress 80 (100 – 60, 77.5 (100 – 15308.0 -0.004 0.99
40) 65, 35)
Overall QOL 75 (100 – 75, 75 (75-75, 0) 12589.5 -3.59 <0.001
25)
Health 100 (100 – 75 (100 – 75, 11709.0 -4.351 <0.001
transition 75, 25) 25)

CHAPTER FIVE: DISCUSSION

This study aimed:
1. To determine the prevalence of CAM among people living with HIV: About 50% of
participants had used CAM.
2. To determine the different types and patterns of CAM use in people living with HIV:
For which the most common CAM used was dietary supplements and the various other CAM
types and patterns were illustrated in the previous chapter.
3. To evaluate the factors associated with CAM use in people living with HIV:
Factors showing significant association with CAM included: the age, the monthly income of
participants, the duration of awareness of HIV status, and the total number of symptom reported..
Participants with ages less than 35 years, were half as likely to use CAM (AOR: 0.48, p-value:
0.02) as ages 35 years and above and participants with a monthly income ranging between Le800
and Le2000 were about a quarter times less likely(AOR: 0.23, p-value: 0.008) to use CAM as
participants with Le0 monthly income. Participants with 1 to 5 years duration of awareness of
HIV were twice as likely to use CAM as participants with less than 1 year duration of awareness
of HIV (AOR: 2.12, p-value: 0.02). Participants with more than three symptoms were thrice as
likely to use CAM as participants with no symptoms (AOR: 3.26, p-value: 0.03). Table 4.4
4. To assess the impact of CAM on the quality of life of participants using CAM:
For which the median scores of participants that used that used CAM were significantly higher
under the following domains: General health perception, physical function, social function,
cognitive function, pain, overall quality of life, and health transitions with respective p –values
of 0.032, <0.001, <0.001, 0.002, <0.001, and <0.001. But significantly lower in only the
energy/fatigue dimension (p-value <0.001).

5.0 PREVALENCE OF CAM AMONG PARTICIPANTS

A total of 176 (50.3%) reported using CAM since diagnosis and 151 (43.1%) are currently using
CAM this is quite a large proportion, however, with HIV being such a debilitating disease it can
be logical to think that most patients will seek all methods of care to manage the disease
including complementary and alternative medicine. The this prevalence is similar to other studies
(within 10% Standard deviation), for example, a study in Southern Iran showed 46.5%
prevalence in use of CAM among HIV patients (Mohammadi et al., 2021), another study in
southeastern united states showed about 60% prevalence of CAM use among HIV patients (Burg
et al., 2005), another study done in a public hospital in Kwazulu-natal, South Africa found 53.5%
of the HIV participants used CAM (Niksic et al., 2020), In Uganda, the prevalence ranged from
40 to 60% (Lamorde et al., 2010). However, other studies showed a great difference in
prevalence of CAM use among participants (+/-10SD), including: a study in Trinidad and
Tobago – 32.9% prevalence (BMC complementary Medicine and therapies, 2021), Niger –
89.3% (Idung and abasiubong, 2014). This difference in prevalence may be due to different
cultures and social practices in these various countries.
5.1 TYPE AND PATTERNS OF CAM USED AMONG PARTICIPANTS
Most (146 - 83%) of the participants who use CAM, used dietary supplements. In the study done
in southern Iran, the most common type of CAM used was herbal medicine (Mohammadi et al.,
2021) while in the study from type of CAM used were dietary supplements (vitamins and
minerals) (Niksic et al., 2020). HIV and drugs used in the treatment of HIV and it comorbidities
have been shown to cause deficiency of vitamins and other nutrients required for normal bodily
function (WHO, 2019). Dietary supplements in patients with HIV has been shown to be
beneficial, hence, participants using only dietary supplements are wisely using CAM (CDC,
2022). However a significant portion (65 – 17%) of participants used other forms of CAM such
as spiritual healing, herbal based drugs and special foods which have not shown any scientific
basis for their value. Herbal base drugs are without dosing and can cause more pathologies
(WHO, 2020).
Majority (97 – 27.7%) of participants to use CAM under the advice of medical practitioners, as
stated previously, dietary supplements are advised in people living with HIV, however, a
significant portion (40 – 11.4%) of participants got their information on CAMs from family
members, friends and personal choice only, despite not being medical practitioners and are not
qualified to give medical advice.
Many (122 – 34.9%) participants use CAM regularly per month, and as previously discussed,
with the context of HIV, it is logical to think that most patients with HIV will seek out all
treatment means necessary to manage their disease condition.
Most participants spend only Le1 to Le50 on CAM and as stated previously the majority (144 –
41.1%) of participants monthly income ranged between Le1 to Le800, hence there is limited
funds available to spend on CAM. However, for participants only making Le1 to Le800 per
month, spending Le50 per month on CAM is still a significant proportion (6.3%), which may
imply the value placed on these CAM.
The majority (110 – 62.5%) of participants using CAM stated to have don due diligence in
obtaining enough information on the efficacy of CAMs before they started using it but very few
participants (18 – 10.2%) could give drug interactions of CAM.
The most reason given by patients using CAM on why they decided to use CAM was to improve
their general state of health and as previously discussed, it is understandable that patients
diagnosed with HIV will seek out all management means to manage their disease, however, 11
(6.3%) stated to use CAM to avoid taking HIV medication, despite this, there has been no study
to show that CAM substitutes the function of HIV medications, hence this is a very harmful
stance that can lead to significant morbidity and mortality.
A total of 145 (82.4%) of CAM users stated that it had worked in treating their illness, this
however will be difficult to assess without further research and might be due to a placebo effect
of using CAM.
Most participants (89 – 50.6%) using CAM had informed their doctors about it and in most cases
their doctors had advised them to continue or were neutral, however 38 were advised to stop, this
can be due to the fact that the majority of CAM used were dietary supplements and even with
spiritual healing being used as CAM, there has been no scientific evidence of spiritual healing
having negative effect on the outcomes of HIV patients despite as stated previously herbal
medications can be harmful to people and hence are not encouraged.
A total of 45 (25.6%) participants did not mention their CAM use to their doctors of which the
majority (14 -31.1%) did not see the need to mention CAM use to their doctors. This shows that
there is some hindrance in patient to doctor relationship and communication which is especially
necessary in lifelong illnesses like HIV.

5.2 FACTORS ASSOCIATED WITH CAM USE AMONG PARTICIPANTS

Monthly income and source of income showed a statistically significant association CAM use. A
monthly income of Le800 to Le2000 was about one-fourth times less likely to use CAM
compared to a monthly income of Le0 (AOR=0.23, p-value 0.08). This may be explained by the
fact that the cost of majority of CAM methods are within monthly income range of most of the
participants, which can allow them to participate in CAM use. The age of the participant also
showed strong association with the use of CAM. With participants less than 35 years being about
half as likely to use CAM (AOR=0.48, p-value 0.02). This might be due to the fact that older
generation tend to be more open to traditional and spiritual healing methods allowing for more
use of CAM (WHO, 2017). The duration of awareness of HIV status, and the total number of
symptom reported. Participants with 1 to 5 years duration of awareness of HIV were twice as
likely to use CAM as participants with less than 1 year duration of awareness of HIV (AOR:
2.12, p-value: 0.02). Participants with more than three symptoms were thrice as likely to use
CAM as participants with no symptoms (AOR: 3.26, p-value: 0.03). It is logical to think that
with longer duration of awareness of HIV status and with more symptoms of HIV, patients
would tend to seek CAM in order to preserve health and maximize quality of life.

5.3 IMPACT OF CAM ON QUALITY OF LIFE AMONG PARTICIPANTS

In the study, the median scores of participants that used that used CAM were significantly higher
under the following domains: General health perception, physical function, social function,
cognitive function, pain, overall quality of life, and health transitions this might be due to the fact
that majority of CAM users took dietary supplements, which as stated previously holds a lot of
benefits for people living with HIV. However, the median score of the quality of live was
significantly lower in only the energy/fatigue dimension this might be due to the physical toll it
takes to keep up with the various forms of CAM use.
 CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS
6.0 CONCLUSION
This study has revealed that a significant proportion (176 – 50.3%) of participants used CAM
with the most common CAM being dietary supplements, and 21 stated to use herbal based CAM,
however, very few participants know about drug interactions of CAM and 11 participants used
CAM to substitute HIV medications. 45 participants did not reveal their CAM use to their
doctors indicating a strain in doctor-patient communication. CAM use can be beneficial on the
quality of life of people living with HIV when used in a safe and regulated way.

6.1 RECOMMENDATIONS
6.1.0 GENERAL RECCOMENDATIONS
CAM use has been shown to be significant among participants in this study and might reflect an
even larger proportion in the general population, hence, there is need to create awareness on
CAM use such as with herbal drugs which can have negative effect on people and on the fact that
CAM does not substitute antiretroviral therapy. There is also a need to strengthen doctor patient
rapport especially with patients living with HIV, which will allow patients to disclose more
information on addition therapies (whether non-medical or not) they would have been taken.

6.1.1 RECOMMENDATIONS FOR FURTHER RESEARCH

There is the need for more research of CAM use among people living with HIV. Especially on
the effect of the quantity of CAM (in the case of drugs or supplement or special foods) and the
effect on the quality of life over a longer period of time. Also this research was conducted in
only two medical facilities both located in Freetown, Sierra Leone, it is recommendable to do
similar research in other medical facilities both in and out of Freetown to get a broader view on
the prevalence and effect of CAM use among participants.

6.1.2 RECOMMENDATIONS FOR POLICIES

Presently in Sierra Leone, antiretroviral medications are offered freely to people living with HIV.
However, other complementary medications which may be required in the management of other
resulting morbidities associated with HIV is not provided. It is therefore recommendable, that
policies are put in place to ensure that people living with HIV are specifically catered for by
providing free complementary medications in addition to Anti-retroviral drugs. Also, mass
awareness protocols must be put in place to teach people living with HIV on the harmful effects
of some CAM and the correct and safe way to use CAM.