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A wide range of traditional medical systems continues to flourish in Africa. These include a mixture of herbal and physical remedies intertwined with various religious belief systems.

Two dimensions are paramount in understanding African health beliefs: spiritual influences and a communal orientation. It is common to attribute illness to the work of ancestors or to supernatural forces. Inadequate respect for ancestors can supposedly lead to illness. In addition, magical influences can be both negative and positive, contemporary and historical. Thus, illness can be attributed to the work of some malign living person. The role of the spiritual healer is to identify the source of the malign influence. African culture has a communal orientation. Thus, the malign influence of certain supernatural forces can be felt not just by an individual, but also by other members of his/her family or community. Thus intervention may be aimed not only at the sense of balance of the individual, but also at the family and community.

Nemutandani et al. (2015) explored HIV- and tuberculosis-related beliefs among traditional practitioners in South Africa. Findings suggest that the belief that HIV/AIDS and tuberculosis patients were bewitched was still prevalent. In particular, it is believed that HIV is caused by sexual promiscuity and that transmission of this disease is a punishment from God. Similarly, in a study exploring beliefs on family planning in Kenya, Nigeria and Senegal, it was suggested that the most prevalent beliefs were that modern contraceptives are dangerous and can harm women’s wombs (Gueye et al., 2015).

Using the 2010 Malawi Demographic and Health Survey, Sano et al. (2016) found that knowledge about prevention was associated with a lower likelihood of endorsing misconceptions around HIV transmission. Socio-demographic factors such as marital status, ethnicity, income, religion and urban or rural residence also showed significant associations with misconceptions around HIV transmission. Thus, it is important that cultural and ethnic considerations are taken into account when developing and implementing HIV education programmes in the region. (Further discussion on community-based health promotion and education on HIV can be found in Chapter 22.)

Although cultural beliefs play a crucial role in shaping health behaviour, it is important to recognize the social and structural barriers that impact upon people’s ability to utilize health education and services. For example, Lim and Ojo (2017) explored the barriers preventing women from utilizing cervical screening services in sub-Saharan Africa. Findings from this systematic review suggest that despite cultural and linguistic diversity in the region, participants reported similar barriers, such as fear of the procedure and the possibility of a negative outcome, lack of awareness, embarrassment and stigma, lack of spousal support, and other factors such as cost of accessing the service, travel costs, waiting times and negative staff attitudes. Similarly, Skinner and Claassens (2016) explored the factors that influenced initiation and adherence to tuberculosis treatment in South Africa. Poor knowledge, lack of awareness and stigma around tuberculosis and its connection to HIV were raised as key issues. Structural factors such as poverty, lack of access to transport, the need to continue working, and problems related to the poor functioning of health systems were also raised as major constraints to long-term adherence.