An ethnobotanical survey of medicinal plants used by traditional health practitioners to manage HIV and its related opportunistic infections in Mpoza, Eastern Cape Province, South Africa

An ethnobotanical survey of medicinal plants used by traditional health practitioners to manage HIV and its related opportunistic infections in Mpoza, Eastern Cape Province, South Africa

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An ethnobotanical survey of medicinal plants used by traditional health practitioners to manage HIV and its related opportunistic infections in Mpoza, Eastern Cape Province, South Africa Hughes Gail a,n, Blouws Tarryn a, Aboyade Oluwaseyi a, Davids Denver b, Mbamalu Oluchi c, Van’t Klooster Charlotte d, De Jong Joop d, Gibson Diana b a

South African Herbal Science and Medicine Institute, University of the Western Cape, Bellville, South Africa Department of Anthropology and Sociology, University of the Western Cape, Bellville, South Africa School of Pharmacy, University of the Western Cape, Bellville, South Africa d Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam (UvA), P.O. Box 15718, 1001 NE Amsterdam, The Netherlands b c

art ic l e i nf o

a b s t r a c t

Article history: Received 5 March 2015 Received in revised form 13 May 2015 Accepted 17 May 2015

Ethnopharmacological relevance: The aim of the study was to identify and document plants traditionally used to manage HIV and treat its opportunistic infections (OIs) in Mpoza, a rural village located in the Mount Frere Alfred Nzo District, Eastern Cape Province, South Africa. Materials and methods: Semi-structured interviews and focus group discussions (FGDs) were conducted with 18 traditional health practitioners from January 2012 to August 2012 to obtain information about medicinal plants used in the management of HIV and treatment of OIs. Results: Seventeen plant species belonging to 12 families were identified for the management of HIV and treatment of OIs in Mpoza. The identified plant species belonged mostly to the families Asparagaceae (12%), Araliaceae (12%), Apiaceae (12%), Xanthorrhoeaceae (12%) and Lamiaceae (12%). The remaining 40% of identified plant species was evenly split over seven families - Urticaceae, Hypoxidaceae, Leguminosae, Verbenaceae, Rosaceae, Compositae and Rutaceae. The most frequently used medicinal plants were Hypoxis hemerocallidea (85%), Asparagus densiflorus (68%) and Lessertia frutescens (68%). The leaves (43.5%) and roots (21.7%) were the most frequently used plant parts, usually prepared as infusions and decoctions for oral administration. Conclusion: This study provides documentation of medicinal plants used in the management of HIV and treatment of commonly associated OIs, which might provide a potential lead that will significantly contribute in reducing the burden of HIV infections in South Africa. We envisage that this paper will provide some background for further studies in developing new, effective, safe and affordable plantderived medicines. & 2015 Published by Elsevier Ireland Ltd.

Keywords: HIV Tuberculosis Opportunistic infections Traditional medicine Africa South Africa Ethnobotanical survey

1. Introduction The human immunodeficiency virus (HIV) affects millions of people worldwide, which can lead to the acquired immunodeficiency syndrome (AIDS). After an HIV infection, the patient usually remains asymptomatic for a considerable time as the body's immune system tries to control the infection. However, over time the virus replicates rapidly, thereby reducing the number of healthy immune cells and ultimately predisposing the individual to other infections. These other infections are called opportunistic infections (OIs), caused by

n Correspondence to: Gail D. Hughes, DrPH, MPH Professor and Director South African Herbal Science and Medicine Institute(SAHSMI)University of Western Cape Private Bag X17 Bellville 7535 South Africa. Tel.: þ 27 21 959 3397; mobile: þ 27 71 390 1003. E-mail address: [email protected] (H. Gail).

pathogens taking advantage of the compromised immunity/immune system in the affected individual. Opportunistic infections of HIV include tuberculosis (TB), candidiasis of various parts of the respiratory and digestive system, multiple forms of lymphoma and Herpes simplex or zoster. HIV is the greatest risk factor for development or reactivation of previously dormant TB infection. As an OI, TB is a leading cause of death among HIV-positive individuals, accounting for about 26% of HIV/AIDSrelated deaths (Pawlowski et al., 2012). The relationship between HIV and TB, the most common OI, is close enough for these two infections to be described as co-epidemic (Long et al., 2008). The prevalence of HIV for all age groups worldwide was estimated at 35.3 million in 2012, with almost 70% of these cases in sub-Saharan Africa (WHO, 2013). There were 2.5 million new infections in 2011, although this incidence reflected a decrease of more than 20% compared to 2001 data (Piot and Quinn, 2013).

http://dx.doi.org/10.1016/j.jep.2015.05.029 0378-8741/& 2015 Published by Elsevier Ireland Ltd.

Please cite this article as: Gail, H., et al., An ethnobotanical survey of medicinal plants used by traditional health practitioners to manage HIV and its related opportunistic.... Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.05.029i

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Population estimates suggest a one-year HIV prevalence of 10% (about 5.26 million) among the total population (Statistics South Africa, 2013). However, according to the 2012 household survey undertaken by the Human Sciences Research Council (HSRC), an estimated 6.4 million people were living with HIV/AIDS in 2012, with a prevalence increase of 10.6% in the 2008 HIV-household survey to 12.3% in 2012 (HSRC, 2013). Access to antiretroviral drugs for the management of HIV infection and increased awareness to control the rate of new infections have achieved some measure of success, for low- and middle-income countries (Piot and Quinn, 2013; UNAIDS, 2012). While antiretrovirals may lower the occurrence of OIs in patients living with HIV and delay its progression to AIDS, there are still drawbacks to the use of conventional therapies. These include poverty, drug resistance, shortage of health personnel and the associated side effects of antiretroviral therapy (Kisangau et al., 2011; Rawat, 2012; Burch & Reid, 2011). These drawbacks may lead to patients resorting to alternative and/or traditional medicines (TM) as a means of attaining the goal of immuno-restoration. The use of traditional herbal medicine (THM) for the management of HIV and treatment of related OIs is quite widespread among different communities globally, and particularly in Africa (Han et al., 2008; Peltzer et al., 2008; Babb et al., 2007; Bodeker et al., 2006; Mills et al., 2005; Homsy et al., 2004; Kassler et al., 1991). Different communities use medicinal plants in a variety of forms for the management of HIV and treatment of related OIs. Ethnobotanical studies have been utilised in the search for locally important medicinal plants that can be used to manage a variety of ailments, and also as an aid in drug discovery (Fabricant and Farnsworth, 2001). There has been an increased interest in medicinal plants used by traditional health practitioners (THPs) for various conditions and diseases. These plants are widely recognised as sources of active compounds (Fabricant and Farnsworth, 2001; Rates, 2001; Kinghorn, 1987) and lend some credence to their use by THPs.

Traditional health practitioners are widespread in South Africa. According to Bateman (2004), up to 70% of South Africans first seek help from THPs before consulting formal health-care services; however recent studies by Peltzer (2009) suggests otherwise. South Africa has a layered pluralistic health-care system, with clients making use of a variety of health-care options. In the rural areas, as a result of inaccessibility of formal health-care services, patients are more dependent on traditional medicinal healing to treat diseases. The Eastern Cape Province is one of the poorest provinces in South Africa (Makiwane and Chimere-Dan, 2014). According to the latest publication on population estimates, HIV and its most common OI, TB, are among the 10 leading causes of death in both genders, across all ages in the Eastern Cape (Statistics South Africa, 2013). Omoruyi et al. (2012) and Otang et al. (2012) reported on the traditional medicinal plants used for HIV and related illnesses in other sections of the Eastern Cape Province. However, there is no documentation on the medicinal plants used by traditional healers for these illnesses in Mpoza, the study site. Therefore, we conducted a study to document medicinal plants used in the management of HIV and treatment of its suspected OIs in this Eastern Cape village, South Africa. The specific objectives were to identify plants and plant parts used in the management of HIV and treatment of OIs, and to determine the most common method of preparation and administration of these plant products. A necessary point to highlight is the conservation of these plants to ensure sustainability.

2. Materials and methods 2.1. The study area This study is part of a broader study initiated by the Multidisciplinary University Traditional Health Initiative (MUTHI) to document medicinal plants used in several African countries in the

Fig. 1. Study site: Mpoza village in the Alfred Nzo district (http://www.mapsharing.org.za/index.php?route=product/category&path=2&page=6).

Please cite this article as: Gail, H., et al., An ethnobotanical survey of medicinal plants used by traditional health practitioners to manage HIV and its related opportunistic.... Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.05.029i

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treatment of various infectious diseases. The study site, Mpoza, (Fig. 1) is a rural village located in Umzimvubu Local Municipality in Alfred Nzo District (301 550 S 281 590 E). Umzimvubu Local Municipality has a total population of 191 620 of which 99.4% is African (Census, 2011). 2.2. Study design and Sampling Semi-structured interviews and focus group discussions (FGDs) were conducted with 18 THPs at the district health-care facility in Mpoza, in their preferred language (IsiXhosa or IsiZulu) to obtain information about the medicinal plants used and their treatment practices to manage HIV and treat suspected OIs. The interviewed THPs were selected using a non-probability “snowball” sample (Heckathorn, 2011). The head of the THPs' association who is also the chief of the village assisted in identifying potential participants for the FGDs. Focus groups and semi-structured interviews provide two distinct qualitative insights. – The first is in relation to broader group ideas and conventions and the latter on individual insight, experience and thought, albeit in a structured manner. This enhances credibility or internal validity and the ability to triangulate (Schensul et al., 1999). The interviews and FGDs were conducted by field workers, who also acted as translators. With the permission of THPs, the interviews and FGDs were tape recorded. Extensive field notes and photographs were also taken with the consent of the THPs. Field work took place from January 2012 to August 2012. Voucher specimens of each plant were deposited at the herbarium at the University of the Western Cape for identification. All plant species have been checked and scientific names have been updated with Kew's online Plant list (www.theplantlist.org) accessed on July 10th, 2014. 2.3. Ethical considerations Ethical approval for the overall MUTHI project was obtained from the Senate Ethics Committee University of the Western Cape. Prior informed consent was sought from the traditional healers association and village head in Mpoza. Prior informed consent was also obtained from each participant.

3. Results and discussion 3.1. Socio-demographic characteristics of participants Table 1 shows the socio-demographic characteristics of all the THPs who participated in the semi-structured interviews and FGDs. Of the 18 respondents, 28% were males and 72% females.

Table 1 Socio-demographics of traditional health practitioners. Characteristics Gender Male Female Age 30–40 years old 41–50 years old 51–80 þ years Education No education Primary Secondary Tertiary

Total (N¼ 18)

Percentage (%)

5 13

27.8 72.2

10 2 6

55.6 11.1 33.3

4 9 4 1

22.2 50.0 22.2 5.6

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Almost 56% were between ages 30 and 40 years old, 50% had at least primary school education, while 22%, respectively, had secondary or no education, and the remainder tertiary education. All the THPs were registered with the local traditional healers association, had plant collection permits and practiced from their homes. Female participants mostly practised as diviners while the males were herbalists. All participants were full-time practitioners and had no other jobs. 3.2. Medicinal plant species The plant species, family and common names, and plant parts used in the management of HIV and treatment of related OIs by the THPs are presented in Table 2. The survey documented 17 plant species that were used to manage HIV and treat its OIs. The identified plant species belong to 16 genera and 12 families. The families Apiaceae, Asparagaceae, Xanthorrhoeaceae, Lamiaceae and Araliaceae were the most mentioned. A similar study conducted in the Kagera region of north western Tanzania documented the use of the Asparagaceae family to increase CD4 count in HIV/AIDS patients (Moshi et al., 2012). In this study, the plants most frequently used by participants to manage HIV and treat related illnesses were Hypoxis hemerocallidea Fisch, C.A.Mey. and Avé-Lall. (85%, from the family Hypoxidaceae), Lessertia frutescens (L.) Goldblatt and J.C. Manning (68%, from the family Leguminosae) and Asparagus densiflorus (Kunth) Jessop (68%, from the family Asparagaceae). Lamorde et al. (2010) reported that 103 plant species belonging to 47 families were being used in the management of HIV/AIDS and its related conditions in Uganda. Another study that surveyed plants with anti-HIV activity in Namibia, documented 46 plant species belonging to 36 families to manage HIV and treat associated conditions (Chinesembu and Hedimbi, 2010). The family Apiaceae was well represented in these studies, indicating their importance in the management of HIV/AIDs and related ailments. 3.3. Inventory of medicinal species Medicinal plants with proven anti-HIV properties usually have other medicinal values which may be an indication for these to be new drugs that can be used against the virus and commonly associated OIs (Asres et al., 2005). Table 3 indicates the specific uses of the documented medicinal plants for various illnesses and symptoms related to HIV and its associated OIs. Of the 17 plant species used by THPs in this study to manage HIV and treat symptoms of associated OIs, at least 14 have been reported in a minimum of one scientific study documenting their use. Omoruyi et al. (2012) reported on the use of Aloe ferox Mill., in combination with other plants, by THPs in the management of HIV/AIDS infection and its associated OIs such as TB and sores. The inhibition of HIV-1 protease by aqueous and ethanol extracts of Bulbine alooides (L.) Willd. (Klos et al., 2009) gives credence to the use of this plant for the treatment of HIV-related skin infections in Mpoza. Scientific studies have documented the use of Mentha longifolia (L.) L. for chest ailments in HIV patients, and as an antidiarrhoeal and antispasmodic agent, lending authenticity to its use by THPs (Philander, 2010; Shah et al., 2010; Naghibi et al., 2005). The inhibition of HIV by this plant is thought to be attributable to the presence of flavonoid compounds (Amzazi et al., 2003). Cussonia paniculata Thunb., widespread and abundant, is primarily used for inflammation, pain, infection and malaria (Trivedi et al., 2010). Roots of the well-known Helichrysum herbaceum (Andrews) Sweet, are reportedly utilised for coughs and colds (Verschaeve and van Staden, 2008; Reid et al., 2006) as well as to invoke favour from the ancestors. This brings to light one of the basic cornerstones of traditional medicine, where the medicinal

Please cite this article as: Gail, H., et al., An ethnobotanical survey of medicinal plants used by traditional health practitioners to manage HIV and its related opportunistic.... Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.05.029i

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Table 2 Plant species used to manage HIV and treat related opportunistic infections. Family

Scientific name

Voucher number

Local name

Parts used

Araliaceae

Cussonia paniculata Eckl. and Zeyh.

TB/DD/4

Umsenge (Zulu)

Leaves and bark

Cussonia spicata Thunb.

TB/DD/ 14

Intsenge (Zulu)

Apiaceae

Asparagaceae

Compositae

Hypoxidaceae

Lamiaceae

Leguminosae

The bark and leaves are utilised together on the skin to treat shingles or drank as part of a remedy to treat HIV symptoms. It is also given as a general immune booster and tonic. The flowers, fruits and roots are used to treat stomach Flowers, roots, fruits complaints They are also used to treat shingles by directly applying to the skin. Also used as a general tonic and an and stems immune booster. Roots and Used as incense to communicate with the ancestors. Inhaling stem the smoke can result in hallucinogenic sensations and “bad” dreams. Leaves Frequently used to treat TB. Administered to the chest and given as a warm brew in a remedy to treat coughs, chest pains and inflammation. Decoctions (50 g of fennel leaves to 500 ml water) used to treat genital thrush as well as thrush of the mouth in cases of HIV infection. Bulbs The bulbs are used fresh or dried, warmed or even burnt and administered externally to treat shingles in clients with suspected HIV. The lobes of the bulbs are used in a decoction (a few lobes added to 100 ml of boiling water) to treat shingles. Leaves THPs reported that uNwele is one of the “strongest” plants used for HIV.

Alepidea capensis (P. TB/DD/1 J.Bergius) R.A.Dyer

Iqwili (Zulu)

Foeniculum vulgare Mill.

TB/DD/2

Imboziso (Zulu)

Merwilla plumbea (Lindl.) Speta

TB/DD/ 13

Blouberglelie (Blue mountain Lily), and Blouslangkop (Blue snake head) Inguduza (Zulu)

Asparagus densiflorus (Kunth) Jessop Helichrysum herbaceum (Andrews) Sweet

TB/DD/17 uNwele (Zulu)

TB/DD/8

Natal guarri, Natal ebony or largeleaved guarri; Umtshekesane (Zulu)

Roots

Hypoxis hemerocallidea Fisch., C.A.Mey. & Avé-Lall. Mentha longifolia (L.) L.

TB/DD/5

Inkomfe (Zulu)

Roots

TB/DD/9

Imboya (Zulu)

Leaves

Hlodlwana (Zulu)

Leaves

Kankerbossie; uNwele (Zulu)

Leaves

Leonotis leonurus TB/DD/ (L.) R.Br. 10 Lessertia frutescens TB/DD/6 (L.) Goldblatt and J. C. Manning

Rosaceae

Prunus africana (Hook.f.) Kalkman

TB/DD/ 12

Rutaceae

Agathosma apiculata E.Mey. ex Bartl. and H.L. Wendl. Urtica dioica L.

TB/DD/7

Bark Rooistinkhout (Afr.), Inyazangomaelimnyama (Zulu); uMkakase (Xhosa) meaning red stink wood. Umbhucu (Zulu) Leaves

TB/DD/3

Umbabazane (Zulu)

Urticaceae Verbenaceae

Lippia javanica (Burm.f.) Spreng. Xanthorrhoeaceae Aloe ferox Mill.

TB/DD/11 Uvevane (Zulu) TB/DD/ 16

Bulbine alooides (L.) TB/DD/ Willd. 15

Leaves and roots Leaves

Ikhalana, Ikhala, Intelezi (Zulu)

Leaves

Rooiwater (red water)

Sap

product is used, along with incantations, as a means of communication with the ancestors. Many illnesses are thought to be by reason of one falling out of favour with ancestors because of some offence (Munthali, 2006). Foeniculum vulgare Mill. is used for cough, one of the symptoms of TB, as well as for indigestion (Philander, 2010). The former use has been verified by reports of its in vitro activity against Mycobacterium tuberculosis (Camacho-Corona Mdel et al., 2008). Leonotus leonurus (L.) R.Br. is employed for the treatment of a wide variety of ailments: worm infestations and constipation

Purpose

Used to treat pain and fever, stomach ‘complaints’, worms and chest complaints associated with TB. For respiratory problems (such as TB) the roots are pulverised, boiled and used in a mixture. Highly regarded plant among the THPs for HIV. The dried root is grated and added to a remedy for HIV symptoms. Also used to treat TB, internal cancers, malaria, and heart diseases. Used in a remedy to combat abdominal pains and as a purgative. The oily leaves are mashed into pulp and applied to the skin for shingles and herpes zoster Used in a remedy for chest complaints associated with TB. The leaves are used in a remedy to treat HIV as well as for HIVTB co-infection. A blood-purifier, an all-purpose tonic, antidepressant and for respiratory conditions associated with TB such as asthma, bronchitis, influenza, wasting and bronchitis. The bark is ground and used in a powdered form in a remedy to treat HIV and TB co-infection and chest complaints. Used externally to treat shingles and other skin infections, such as sores around the mouth and genitals.

Eradicates “poison” in the body as part of remedy to treat HIV and TB co-infection. A tea (approximately 50 g added to a cup of boiling water) for the treatment of coughs, colds and bronchial problems. Used for HIV and TB. The leaves are cut into cubes and dried. They form black crystals which are consumed as a purgative and immune booster. The sap of Aloe is applied to skin for shingles and thrush. Eradicates “poison” in the body as part of remedy to treat HIV and TB co-infection. Used as a calmative and as a purgative. The sap is applied directly to the skin, to treat shingles and thrush.

(Omoruyi et al., 2012), severe headache (Semenya et al., 2013), skin problems and lung infections (Philander, 2010). The utilisation of this plant as a dressing for septic ulcers and sores in HIV patients may be associated with reports of significant inhibition of HIV-1 protease (Klos et al., 2009). Hypoxis hemerocallidea is used for tumours, as an emetic and antiinfective (Reid et al., 2006). Among the Khoi-San and early Dutch inhabitants at the Cape, the plant, Lessertia frutescens, was popularly used for internal cancers. There are also documented reports of its use as a blood purifier and all-purpose tonic for HIV infection

Please cite this article as: Gail, H., et al., An ethnobotanical survey of medicinal plants used by traditional health practitioners to manage HIV and its related opportunistic.... Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.05.029i

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Table 3 Documentation of specific illness or symptoms treated with THM. Illness/symptoms

Medicinal plants used for treatment

Shingles and sores

Agathosma apiculata Bulbine alooides Mentha longifolia Cussonia paniculata Cussonia spicata Merwilla plumbea Leonotis leonorus Aloe ferox Alepidea capensis Bulbine alooides Cussonia paniculata Hypoxis hemerocallidea Lessertia frutescens Merwilla plumbea Asparagus densiflorus Bulbine alooides Foeniculum vulgare Asparagus densiflorus Aloe ferox Alepidea capensis Helichrysum herbaceum Leonotus leonorus Hypoxis hemerocallidea Lessertia frutescens Prunus africana Lessertia frutescens Urtica dioica Aloe ferox Cussonia spicata Cussonia paniculata Foeniculum vulgare Alepidea capensis Lessertia frutescens Lippia javanica Prunus africana

HIV

Thrush

TB

HIV-TB co-infection

Immune booster

Respiratory problems (cough, chest pain, asthma, bronchitis)

(thought to be because of its canavanine content) in northern Sesotho and many other geographic regions. (Street & Prinsloo, 2013; Philander, 2010; Harnett et al., 2005; Mills et al., 2005). In other regions across South Africa, Lippia javanica (Burm.f.) Spreng., Prunus Africana (Hook.f.) Kalkman, Merwilla plumbea (Lindl.) Speta and Urtica dioica (L.) are used for TB and chestrelated complaints such as cough, bronchitis and flu (Semenya et al., 2013; Street & Prinsloo, 2013; Philander, 2010; Verschaeve & van Staden, 2008). McGaw et al. (2008) conducted a study in which almost 180 South African plants, which were used to treat TB symptoms, were documented. Only three of the plants listed in Table 1 feature in their study, suggesting that all the plants used by THPs in the management of HIV and related OIs still remain unknown and undocumented. Insufficient literature was found linking Agathosma apiculata E. Mey. ex Bartl. and H.L.Wendl., Alepidea capensis (P.J.Bergius) R.A. Dyer and Asparagus densiflorus (Kunth) Jessop to HIV; however, these genera are known to be used for HIV and related OIs. For instance, Agathosma betulina and Agathosma crenulata are reportedly used as cough remedies in the Western Cape and throughout South Africa (Moolla and Viljoen, 2008). Alepidea amatymbica is also utilised for the treatment of colds and chest complaints as well as for abdominal cramps (Louvel et al., 2013; Otang et al., 2012). The moderate anti-HIV activity of Alepidea amatymbica has been attributed to one of its constituents, rosmarinic acid (Louvel et al., 2013). Although no literature was found for the use of Asparagus densiflorus in HIV, Asparagus capensis and Asparagus falcatus are reportedly used for TB treatment and blood cleansing (Philander, 2010).

3.4. Preparation and administration The study found that the plants were used in combinations; multiple extracts involving more than one species has been reported (Otieno et al., 2008; Qui, 2007). The preparation and administration of these plants are dependent on the severity of the illness. Herbal remedies used by the THPs to treat the symptoms of HIV and suspected OIs may consist of up to five plants. At every consultation, the administration of each plant is different according to the client's symptoms. The plants are collected at specific times of the year, with the THPs indicating preference to plant collection during the winter, as this season provides more potent extracts. Most of the plant preparations were taken orally, usually prepared as decoctions or infusions. In addition, mixtures for topical use or inhalation were also prepared. Topical applications were used to treat shingles, thrush (candidiasis or herpes zoster) or other skin infections of a suspected HIV person. Inhalation of burnt plants was used to treat opportunistic respiratory infections associated with HIV. Other preparations, such as decoctions of dried roots, were used as a treatment for abdominal and chest pain associated with TB. Often the dry stem and roots are smoked, or powdered and taken as snuff. Decoctions and infusions were the main methods of preparation, and the resulting tea taken by patients, with the dose depending on the severity of the condition. According to the THPs, the healing process involves the expulsion of “poisons” related to witchcraft, or environmental or spiritual pollution within the body as a result of the virus or OIs. Many of the THPs understood the healing process as a systematic

Please cite this article as: Gail, H., et al., An ethnobotanical survey of medicinal plants used by traditional health practitioners to manage HIV and its related opportunistic.... Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.05.029i

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support of the body's own ability to heal itself as opposed to relieving immediate symptoms. In this study, all of the medically diagnosed HIV patients used their ARVs in conjunction with THM, and at no point were they discouraged from using their prescription medications. Moreover, the THPs had no report of adverse drug interactions between the THM and prescription medications.

Vulnerable 5.9 %

Not evaluated 11.8 % Declining 5.9 %

3.5. Plant part used Least concern 76.5 %

For the plant species reportedly used by THPs for the management of HIV and symptoms of common related OIs, the leaves were the part of the plant most frequently used (43.5%) in medicinal preparations, followed by roots (21.7%). The appreciable use of these plant parts in traditional medicinal preparations has been attributed to the long-held belief that more healing power resides in these parts compared to the other parts of the plant (Semenya et al., 2013). Other parts of the plant, such as the stems, barks and fruits, were also used but to a lesser extent (Fig. 2). 3.6. Conservation Plant conservation refers to assurance of the protection, preservation and judicious management of plants and their resources. Sustainable conservation approaches should be applied to medicinal plants, and is of utmost importance to protect these plant species and to avoid extinction (Mavundza et al., 2011; Fay, 1992). The use of different plant species to treat the same condition is in itself a conservation endeavour, and ensures that the treatment of one condition is not borne by a single plant species (Semenya et al., 2013). From this study, the use of the roots and barks of these plants was approximately 26%, and potentially in future may pose a challenge to conservation of these medicinal plants for the management of HIV and related OIs. All the plant species listed in Table 2 with the exception of Foeniculum vulgare and Urtica dioica are featured in the South African National Red Data List of Plants (SANBI, 2013). These two plants were not evaluated because they were ‘naturalised exotics’ and did not qualify for inclusion in the national list of South African plants. Approximately 76.5% of the remaining plants were categorised as of ‘least concern’ on the South African National Red Data List of Plants. Species in this category have been evaluated against internationally approved conservation criteria and have not been found to be critically endangered, and vulnerable or near threatened (Fig. 3). Widespread and abundant species are included in this category. However, plants such as Hypoxis hemerocallidea (plant part used: root) was categorised as ‘declining’ because of threatening processes (high demand, unsustainable harvesting, land transformation and habitat loss), resulting in a steady decline

Fig. 3. Percentage of plants used for HIV and related OIs in Mpoza village, according to their conservation categories.

of the species. Prunus africana (plant part used: bark) was classified as ‘vulnerable’: facing a high risk of extinction because of harvesting and habitat degradation. Sustainable conservation approach should be taken into consideration, to prevent conservation threat and ultimately extinction to local plant populations (Mavundza et al., 2011). To address this, sustainable harvesting of the affected plants as well as enlightening programmes to educate the people in affected areas on medicinal plant conservation is advocated. Zschocke et al. (2000) have proposed the concept of plant substitution where the bark or underground part of the plant used for medicinal purposes is substituted with leaves of the same plant. This is a viable measure towards ensuring effective plant conservation.

4. Conclusions South Africa is plagued with the burden of HIV and its OIs. The utilisation of medicinal plants to treat the OIs associated with HIV can make significant contribution to reducing the burden of this infection in the country. The present study documents the practice of the management of HIV and treatment of the commonly associated OIs in Mpoza village, South Africa, with the use of medicinal plants. Plants were commonly used because they were affordable and usually more accessible than the nearest health centre. Knowledge of traditional medicine use is in danger of being lost as there is usually insufficient documentation about its use. We envisage that this document/paper will provide some background for further research validating the use of these plants for the indicated conditions.

Uncited references Baab et al., 2007.

Acknowledgement

Fig. 2. Percentage of plant parts used for the management of HIV and symptoms of commonly related OIs.

This study was funded by the EU sponsored (MUTHI) project (FP7AFRICA-2010 266005) and National Research Foundation (Thuthuka). The study was also supported by the South African Herbal Science and Medicine institute (SAHSMI), UWC. The authors would like to acknowledge THPs from Mpoza and Strand for their contribution to this study. We also would like to acknowledge the editorial contributions of Jean Fourie.

Please cite this article as: Gail, H., et al., An ethnobotanical survey of medicinal plants used by traditional health practitioners to manage HIV and its related opportunistic.... Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.05.029i

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Please cite this article as: Gail, H., et al., An ethnobotanical survey of medicinal plants used by traditional health practitioners to manage HIV and its related opportunistic.... Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.05.029i