MAKALAH TERAPI KOMPLEMENTER PADA PASIEN

HIV DENGAN EBP

Diajukan untuk memenuhi salah satu tugas Mata Kuliah Keperawatan HIV/ AIDS

Dosen Pembimbing :

Ahmad Saripudin. S.Kep., Ners., MM

Disusun Oleh :

1. Elida Modiana M ( 218.C.0046 )

2. Fega Nurpuji Khairiyah ( 218.C.0054 )
3. Haris Susanto ( 218.C.0047 )
4. Nadiah ( 218.C.0068 )
5. Nursari ( 218.C.0050 )
6. Rizki Martin ( 218.C.0057 )

PROGRAM STUDI S1 ILMU KEPERAWATAN

SEKOLAH TINGGI ILMU KESEHATAN ( STIKes) MAHARDIKA

CIREBON

2020 / 2021
 KATA PENGANTAR

Assalamu’alaikum wr.wb
Puji syukur kami panjatkan kehadirat Allah SWT, yang telah memberikan rahmat dan hidayah-
Nya, sehingga kami dapat menyelesaikan Makalah yang berjudul “ Terapi Komplementer Pada Pasien
HIV Dengan EBP ". Makalah ini disusun untuk memenuhi salah satu tugas Mata Kuliah Keperawatan
HIV/AIDS pada Program Studi Ilmu Keperawatan Sekolah Tinggi Ilmu Kesehatan (STIKes) Mahardika
Cirebon. Selama proses penyusunan makalah ini kami tidak lepas dari bantuan berbagai pihak yang
berupa bimbingan, saran dan petunjuk baik berupa moril, spiritual maupun materi yang berharga dalam
mengatasi hambatan yang ditemukan. Oleh karena itu, sebagai rasa syukur dengan kerendahan hati,
kami mengucapkan terima kasih yang sebesar-besarnya kepada yang terhorm
1. Ahmad Saripudin.S.Kep., Ners., MM yang telah memberikan bimbingan dan dorongan dalam
meyusun makalah ini sekaligus Dosen Pengampuh Mata Kuliah Keperawatan HIV/AIDS
2. Orangtua kami yang tercinta serta saudara dan keluarga besar kami yang telah memberikan
motivasi/dorongan dan semangat, baik berupa moril maupun materinya.
Kami menyadari bahwa makalah ini jauh dari sempurna, untuk itu kami mengharapkan kritik
serta saran yang bersifat membangun untuk perbaikan penyusunan selanjutnya. Kami berharap, semoga
makalah ini dapat bermanfaat bagi kita semua. Aamiin...
Wassalamu’alaikum wr.wb.

Cirebon, 10 Juni 2020

Penulis

DAFTAR ISI
HALAMAN JUDUL ......................................................................................
KATA PENGANTAR....................................................................................
DAFTAR ISI................................................................................................... iii

BAB I PENDAHULUAN..................................................................................

1.1 LATAR BELAKANG......................................................................

1.2 RUMUSAN MASALAH..................................................................

1.3 TUJUAN............................................................................................

BAB II TINJAUAN TEORI.......................................................................

2.1 PENGERTIAN TERAPI KOMPLEMENTER.....................

2.2 TUJUAN TERAPI KOMPLEMENTER...............................

2.3 JENIS – JENIS TERAPI KOMPLEMENTER.....................

2.4 TERAPI KOMPLEMENTER PADA PASIEN HIV/AIDS..

2.5 PENGERTIAN EBP................................................................

2.6 LAMPIRAN JURNAL.............................................................

2.7 ANALISIS JURNAL................................................................

BAB III PENUTUP.......................................................................................

3.1 KESIMPULAN.........................................................................

3.2 SARAAN...................................................................................

DAFTAR PUSTAKA......................................................................................

BAB I

PENDAHULUAN
1.1 LATAR BELAKANG

Terapi komplementer dan alternatif saat ini digencarkan di berbagai negara. Di Indonesia upaya
ini juga terus mendapatkan dorongan dari berbagai lini baik pemerintah maupun nonpemerintah.
Penggunaan terapi komplementer diharapkan semakin mendekatkan jangkauan kemampuan masyarakat
terhadap upaya pengobatan tanpa mengurangi peran terapi modern. Penyakit infeksi hingga kini masih
merupakan masalah kesehatan global, terutama di daerah tropis. Proses terjadinya penyakit infeksi
akibat interaksi antara trias penyebab, yaitu inang atau host, agen, dan faktor lingkungan. Beberapa
faktor host memengaruhi kejadian penyakit infeksi, yaitu umur, imunisasi, penyakit yang diderita
sebelumnya, status nutrisi, kehamilan, status emosi. Mekanisme pertahanan tubuh individu, baik spesifik
maupun nonspesifik sangat menentukan dampak paparan mikroorganisme patogen menimbulkan,
menentukan perjalanan penyakit infeksi. Beberapa tindakan medis juga dapat meningkatkan potensi
terjadinya infeksi, termasuk pemberian obat-obatan imunosupresan. Terapi komplementer dapat
dimanfaatkan sebagai alternatif semata, hingga terapi konvensional, sebagai terapi penyerta terapi
konvensional menyertai terapi medis. Saat ini di Indonesia pemanfaatan terapi komplementer pada
berbagai penyakit infeksi akut maupun kronis ( Nasronudin, 2011).

Menurut data WHO pada akhir tahun 2017,terdapat 36,9 juta orang hidup dengan HIV dengan
1,8 juta infeksi baru di tahun yang sama di dunia dan meningkat pada tahun 2018 tercatat sebanyak 37,9
juta orang, 21% penderita HIV tidak mengetahui tentang penyakit yang diderita (Kemenkes, 2017).
Kementerian Kesehatan Indonesia tahun 2018 mengatakan jumlah kumulatif infeksi HIV yang
dilaporkan sampai dengan Juni 2018 sebanyak 301.959 orang dari estimasi orang dengan HIV/AIDS
(ODHA) jumlahnya pada tahun 2018 sebanyak 640.443 orang. Acquired Immunodeficiency Syndrome
(AIDS) merupakan suatu kumpulan dari gejala atau sindrom yang timbul akibat rusaknya system
kekebalan tubuh manusia yang disebabkan oleh infeksi Human Immunodefiency Virus (HIV)
(UNAIDS,2019). 
Menurut Kemenkes 2018 penyebab kejadian HIV/AIDS untuk faktor resikonya yang paling
tertinggi yaitu 73,4% heteroseksual, 16,5% homoseksual, 5% dari ibu yang terinfeksi ke anak, 2,49%
perinatal dan 0,3% melalui transfusi. Jumlah CD4 pada pasien HIV yang mengivasi sel CD4 dan
membuat mereka memproduksi lebih banyak virus. Seseorang yang terinfeksi HIV mungkin merasa
baik dan tidak menunjukan gejala, sedangkan setiap hari jutaan sel CD4 yang terinfeksi dihancurkan
oleh virus tersebut. Secara klinis, jika jumlah CD4 kurang dari 200/ml dibutuhkan obat anti- HIV yang
dibutuhkan agar kekebalan tubuh tetap tejaga dan tidak sampai pada AIDS Mekanisme molekular dari
berbagai agen antiretrovirus menghambat berbagai protein fungsional dari HIV yang penting untuk
mesin replikasi virus HIV terbukti mampu membuat virus HIV tersupresi, menurunkan viral load,
meningkatkan CD4 T Lymphocyte count dan meningkatkan kekebalan tubuh pasien (Broder,2009.,
Montaner et.al, 1999).

Evidence based practice (EBP) adalah  sebuah proses yang akan membantu tenaga kesehatan
agar mampu uptodate atau cara agar mampu memperoleh informasi terbaru yang dapat menjadi bahan
untuk membuat keputusan klinis yang efektif dan efisien sehingga dapat memberikan perawatan terbaik
kepada pasien (Macnee, 2011). Sedangkan menurut (Bostwick, 2013) .
evidence based practice adalah starategi untuk memperolah pengetahuan dan skill untuk bisa
meningkatkan tingkah laku yang positif sehingga bisa menerapakan EBP didalam praktik. Dari kedua
pengertian EBP tersebut dapat dipahami bahwa evidance based practicemerupakan suatu strategi untuk
mendapatkan knowledge atau pengetahuan terbaru berdasarkan evidence atau bukti yang jelas dan
relevan untuk membuat keputusan klinis yang efektif dan meningkatkan skill dalam praktik klinis
gunameningkatkan kualitas kesehatan pasien.Oleh karena itu berdasarkan definisi tersebut, Komponen
utama dalam institusi pendidikan kesehatan yang bisa dijadikan prinsip adalah membuat keputusan
berdasarkan evidence based serta mengintegrasikan EBP kedalam kurikulum merupakan hal yang sangat
penting.
1.2 RUMUSAN MASALAH

1. Pengertian Terapi Komplementer

2. Tujuan Terapi Komplementer
3. Jenis – jenis Terapi Komplementer
4. Terapi Komolementer pada Pasien HIV dan AIDS
5. Pengertian EBP

1.1 TUJUAN
1. Tujuan umum

Agar mahasiswa mengetahui lebih dalam tentang terapi komplementer pada pasien HIV.

2. Tujuan Khusus
Agar mahasiswa mampu mengetahui lebih tentang terapi komplementer pada pasien HIV dengan
EBP.
 BAB II

TINJAUAN TEORI

2.1 Pengertian Terapi Komplementer

Menurut Kamus Besar Bahasa Indonesia (KBBI), terapi adalah usaha untuk memulihkan kesehatan
orang yang sedang sakit, pengobatan penyakit, perawatan penyakit. Komplementer adalah bersifat
melengkapi, bersifat menyempurnakan. Pengobatan komplementer dilakukan dengan tujuan melengkapi
pengobatan medis konvensional dan bersifat rasional yang tidak bertentangan dengan nilai dan hukum
kesehatan di Indonesia. Standar praktek pengobatan komplementer telah diatur dalam Peraturan Menteri
Kesehatan Republik Indonesia.

Terapi komplementer adalah sebuah kelompok dari macam - macam sistem pengobatan dan perawatan
kesehatan, praktik dan produk yang secara umum tidak menjadi bagian dari pengobatan konvensional.

Menurut WHO (World Health Organization), pengobatan komplementer adalah pengobatan non-
konvensional yang bukan berasal dari negara yang bersangkutan. Jadi untuk Indonesia, jamu misalnya,
bukan termasuk pengobatan komplementer tetapi merupakan pengobatan tradisional. Pengobatan
tradisional yang dimaksud adalah pengobatan yang sudah dari zaman dahulu digunakan dan diturunkan
secara turun – temurun pada suatu negara. Tapi di Philipina misalnya, jamu Indonesia bisa dikategorikan
sebagai pengobatan komplementer.Terapi komplementer adalah cara Penanggulangan Penyakit yang
dilakukan sebagai pendukung kepada Pengobatan Medis Konvensional atau sebagai Pengobatan Pilihan
lain diluar Pengobatan Medis yang Konvensional. Berdasarkan data yang bersumber dari Badan
Kesehatan Dunia pada tahun 2005, terdapat 75 – 80% dari seluruh penduduk dunia pernah menjalani
pengobatan non-konvensional. Di Indonesia sendiri, kepopuleran pengobatan non-konvensional,
termasuk pengobatan komplementer ini, bisa diperkirakan dari mulai menjamurnya iklan-iklan terapi
non-konvensional di berbagai media.

Terapi komplementer dikenal dengan terapi tradisional yang digabungkan dalam pengobatan modern.
Komplementer adalah penggunaan terapi tradisional ke dalam pengobatan modern. Terminologi ini
dikenal sebagai terapi modalitas atau aktivitas yang menambahkan pendekatan ortodoks dalam
pelayanan kesehatan. Terapi komplementer juga ada yang menyebutnya dengan pengobatan holistik.
Pendapat ini didasari oleh bentuk terapi yang mempengaruhi individu secara menyeluruh yaitu sebuah
keharmonisan individu untuk mengintegrasikan pikiran, badan, dan jiwa dalam kesatuan fungsi.

Pendapat lain menyebutkan terapi komplementer dan alternatif sebagai sebuah domain luas dalam
sumber daya pengobatan yang meliputi sistem kesehatan, modalitas, praktik dan ditandai dengan teori
dan keyakinan, dengan cara berbeda dari sistem pelayanan kesehatan yang umum di masyarakat atau
budaya yang ada (Complementary and alternative medicine/CAM Research Methodology Conference,
1997 dalam Snyder & Lindquis, 2002). Terapi komplementer dan alternatif termasuk didalamnya
seluruh praktik dan ide yang didefinisikan oleh pengguna sebagai pencegahan atau pengobatan penyakit
atau promosi kesehatan dan kesejahteraan.
Definisi tersebut menunjukkan terapi komplemeter sebagai pengembangan terapi tradisional dan ada
yang diintegrasikan dengan terapi modern yang mempengaruhi keharmonisan individu dari aspek
biologis, psikologis, dan spiritual. Hasil terapi yang telah terintegrasi tersebut ada yang telah lulus uji
klinis sehingga sudah disamakan dengan obat modern. Kondisi ini sesuai dengan prinsip keperawatan
yang memandang manusia sebagai makhluk yang holistik (bio, psiko, sosial, dan spiritual).

2.2 TUJUAN TERAPI KOMPLEMENTER

Tujuan Terapi Komplementer :

1. Sebagai pengobatan pilihan lain diluar pengobatan medis

2. Untuk memperbaiki fungsidari sistem tubuh, terutama sistem kekebalan dan pertahanan tubuh
3. Lebih berserah diri dan ikhlas menerima keadaan

2.3 JENIS – JENIS TERAPI KOMPLEMENTER

Jenis-Jenis Terapi Komplementer
Jenis pelayanan pengobatan komplementer-alternatif berdasarkan permenkes RI Nomor:
1109/Menkes/2007 adalah:
1. Intervensi tubuh dan pikiran : hipnoterapi, mediasi, penyembuhan spiritual, dao dan yoga.

2. Pengobatan farmaklogi dan biologi : jamu, herbal

3. Diet dan nutrisi untuk pencegahan dan pengobatan : diet makro nutrient dan diet mikro nutrient.

4. Akuputur : suatu metode tradisional china yang menghasilkan analgesia atau perubahan fungsi
sistem tubuh dengan cara memasukan jarm tipis di sepanjang rangkaian garis atau jalur yang
 disebut meridian. Manipulasi jarum langsung pada meridian energy akan mempengaruhi organ
interna dalam dengan pengalihan qi (shi).
5. Akupresur : sebuah ilmu penyembuhan dengan menekan, memijat, mengurut bagian dari tubuh
untuk mengurangi rasa nyeri, menghasikan analgesia, atau mengatur fungsi tubuh.

6. Meditasi : praktik yang ditujukan pada diri untuk merelaksas tubuh dan menekankan pikiran
menggunakan ritme pernapasan yang berfokus.

7. Psikoterapi : pengobatan kelainan mental dan emosional dengan teknik psikologi.

8. Yoga : teknik yang berfokus pada susunan otot, postur, mekanisme pernapasan, dan kesadaran
tubuh. Tujuan yoga adalah memperoleh kesejahteraan mental dan fisik melalui pencapaian
kesempurnaan tubuh dengan olahraga, mempertahankan postur tubuh, pernapasan yang benar,
dan meditasi.

9. Terapi relaksasi : tehnik terapi relaksasi meliputi meditasi, hipnotis dan relaksasi otot.
Walaupun tehinik-tehnik ini bisa mengurangi stress dan membuat tubuh lebih bugar, tetapi
masih belum jelas efektifitas tekhnik terapi relakasasi terhadap penyakit asma.(Nasronudin
2011).

2.4 TERAPI KOMPLEMENTER PADA PADA PASIEN HIV DAN AIDS

A. TERAPI SPIRITUAL
Terapi Spiritual SEFT merupakan salah satu terapi komplementer yang dapat digunakan
untuk menurunkan tingkat depresi. Keefektifan SEFT terletak pada pengabungan antara
Spiritual Power dengan Energy Psychology. Spiritual Power memiliki lima prinsip utama
yaitu ikhlas, yakin, syukur, sabar dan khusyu. Energy Psychology merupakan seperangkat
prinsip dan teknik memanfaatkan sistem energi tubuh untuk memerbaiki kondisi pikiran,
emosi dan perilaku (Freinstein dalam Zainudin, 2012 ).
Selain itu SEFT efektif, mudah, cepat, murah, efeknya dapat permanen, tidak terdapat
efek samping, bersifat universal, memberdayakan individu (tidak tergantung pada pemberi
terapi), dapat dijelaskan secara ilmiah (Zainudin, 2012).
Menurut Beck (2009) seseorang yang mengalami depresi mengalami juga disfungsi
keyakinan terhadap masa depan dan kehidupan yang akan datang, hal ini dapat koreksi
dengan sikap pasrah.
B. TERAPI FISIK
 Fisioterapi ( terapi fisik ) adalah terapi yang menggunakan berbagai prosedur, seperti
gerakan badan , pijat, mandi dengan air panas, kompres, semburan air, yang dipakai sebagai
perawatan untuk menenangkan saraf ( dulu disebut hidroterapi,dan sekarang jarang
digunakan sebagai program terapi dikebanyakan rumah sakit ) ( Kanisius, 2006).
2.5 PENGERTIAN EBP
Evidence-Based Practice adalah pendekatan sistematis untuk meningkatkan kualitas praktik
keperawatan dengan mengumpulkan bukti terbaik, Almaskari (2017). Evidence adalah kumpulan
fakta yang diyakini kebenarannya. Ada dua bukti yang dihasilkan oleh evidence yaitu bukti
eksternal dan internal. Evidence-Based Practice in Nursing adalah penggunaan bukti ekternal dan
bukti internal (clinical expertise), serta manfaat dan keinginan pasien untuk mendukung
pengambilan keputusan di pelayanan kesehatan, ( Chang, Jones, &
Russell 2013).
 2.6 LAMPIRAN JURNAL

AIDS PATIENT CARE and STDs

Volume 27, Number 9, 2013

ª Mary Ann Liebert, Inc.

DOI: 10.1089/apc.2013.0175

A Review of the Use of Complementary

and Alternative Medicine and HIV:
Issues for Patient Care

Ava Lorenc, PhD, and Nicola Robinson, PhD

Abstract

HIV/AIDS is a chronic illness, with a range of physical symptoms and psychosocial issues. The
complex health and social issues associated with living with HIV mean that people living with
HIV/AIDS (PLWHA) have historically often turned to complementary and alternative medicine (CAM).
This article provides an overview of the literature on HIV and CAM. Databases were searched using
keywords for CAM and HIV from inception to December 2012. Articles in English and in Western
countries were included; letters, commentaries, news articles, articles on specific therapies and basic
science studies were excluded. Of the 282 articles identified, 94 were included. Over half reported
prevalence and determinants of CAM use. Lifetime use of CAM by PLWHA ranged from 30% to 90%,
with national studies suggesting CAM is used by around 55% of PLWHA, practitioner- based CAM by
15%. Vitamins, herbs, and supplements were most common, followed by prayer, meditation, and
spiritual approaches. CAM use was predicted by length of time since HIV diagnosis, and a greater
number of medications/symptoms, with CAM often used to address limitations or problems with
antiretroviral therapy. CAM users rarely rejected conventional medicine, but a number of CAM can
have potentially serious side effects or interactions with ART. CAM was used as a self-management
approach, providing PLWHA with an active role in their healthcare and sense of control. Clinicians,
particularly nurses, should consider discussing CAM with patients as part of patient-centered care, to
encourage valuable self-management and ensure patient safety.

Introduction homeopathy, or massage. CAM has been historically

(CAM) is
C OMPLEMENTARY AND ALTERNATIVE MEDICINE
defined as ‘‘a group of diverse medical and health care
systems, practices, and products that are not generally con-
sidered part of conventional medicine,’’1 for example
acu- puncture, herbal medicine, osteopathy,
popular among people living with HIV/AIDS (PLWHA), as
before the development of antiretroviral therapy (ART) in
the mid-1990s, PLWHA experienced frustration and despair
due to the lack of and slow progress of treatment options.2
Since this initial uptake of CAM by the HIV/AIDS
community, the experience of living with HIV has changed
radically, mainly due to the development and widespread
effective use of highly active ART (HAART). PLWHA
have, in general, demonstrated adaptability to the
changing treatments available, including
CAM.3
HIV is now a manageable chronic illness, 4–6 with life ex-
pectancy in the developed world similar to that of people
without HIV.7 PLWHA experience a range of physical
London South Bank University, London, United Kingdom.
503
symptoms and psychosocial issues, some in common with
other chronic diseases, some unique. These include
abnormal psychology, mood and related disorders,
personal and social uncertainty, identity issues, stigma,
social isolation, poor quality of life, and unemployment,5
and a range of side effects from ART such as
gastrointestinal and dermatological effects, cardiac and
liver problems, and bone loss.8 The impact of HIV on
physical and emotional health may be worse than for many
other chronic diseases.9 CAM is still often used to address
these complex health and social issues associated with
living with HIV/AIDS,10 including stress reduction,
relieving side- effects and symptoms, and boosting the
immune system.11
It is important that conventional clinicians are aware of
CAM use and, where appropriate, discuss its use with their
patients, both to improve the practitioner-patient
relationship and adherence to ART, and to identify potential
safety is- sues.12,13 Practitioners therefore need to have up-to-
date knowledge regarding CAM use. Previous reviews
have often focused only on the prevalence and
determinants of CAM use, often with a methodological
rather than clinical focus;14,15 this review aims to provide a
broader overview of the current
literature on the use of CAM for PLWHA to identify issues
which may have implications for patient care.
Methods
The following databases were systematically searched
in December 2012 with no date limits: Medline, Cinahl,
PsycArticles, AMED, Sciencedirect, Cochrane library.
Search terms were for HIV and complementary
therapy/medicine (Table 1).
In order to identify studies with relevance for patient
care in the UK and other Western countries, inclusion
criteria were: about complementary or alternative medicine
and HIV; in English; based in a Western country. Exclusion
criteria were: studies on a specific CAM therapy; letters,
commentaries, news articles; basic science studies (animal
or lab-based).
America,16,19–56,64 five in Europe,57–61 and two in Aus-
tralia.62,63 Three studies used national samples.52,63,64
Prevalence figures for lifetime use of CAM varied from
30% to 90%; use over the past 6–12 months ranged from
15.4% to 100%. Variations in prevalence figures are partly
due to dif- fering definitions of CAM, for example, when
restricted to practitioner-based CAM, prevalence was only
15–16%.32,35 The three national studies35,63,64 and two
multistate studies32,34 give the most externally valid results.
They suggest that CAM is used by around 55–60% of
PLWHA;63,64 15–16% practitioner-based CAM.32,35
Vitamins, herbs, and supplements were the most
common approaches used, followed by prayer, meditation
and spiri- tual approaches, massage, and acupuncture.
Higher levels of education and being female were the most
common predictors of CAM use (reported as significant in

1316,20,22–24,28,30,32,36,57,59,62,63 and seven 19,23,31,59,62,63,66

Results
A total of 282 articles were identified, 119 were excluded
from reviewing the titles, and a further 71 from screening
abstracts, leaving a total of 91 articles for review. See Fig. 1
for details. Many of the studies were conducted in the USA.
The 91 articles were published between 1989 and 2012 and
were grouped as below:
● Studies of the prevalence and determinants of CAM
use for PLWH—54 articles14–68
● Studies of PLWHA attitudes to CAM, reasons for use
and decision-making process—15 articles10,69–81
● Overviews of the evidence for CAM—nine reviews 82–
90
and one two-part overview of the use of CAM in
HIV91,92
● Guidance for clinicians—six articles 12,13,93–96
● Articles on safety—four articles 97–100
Prevalence
Of the 54 articles identified on the prevalence of CAM
use, one was a systematic review15 and there were three
other reviews.14,45,46 Thirty-five were carried out in North
studies, respectively). Other determinants were Cauca-
sian,23,28 higher income,20,35 gay/lesbian,24,35 younger,20,63 and
having depression.25,35 HIV-specific predictors included
longer disease duration/time on ART (5 studies16,21,36,57,62),
and using a higher number of medications (2), 19,60 more
symptoms/infections (3),25,36,57 and ART side effects (2). 16,59
CAM use was associated with having an HIV diagnosis;43
and Carwein and Sabo27 found that 100% of participants
with HIV used CAM, compared to 16% before HIV
diagnosis. Other predictors suggest an association with
having a more active role in healthcare, for example,
reading more information or having more health promoting
behaviours.25,26,35,63
Reasons for use varied, from reducing symptoms and im-
proving well-being to improving immunity. Five studies re-
ported the use of CAM for people with specific symptoms
(depression,51,65 anxiety,56 peripheral neuropathy,55 and
pain52). In these studies, prayer and meditation were pre-
ferred options and use varied from 18% to 52% of respon-
dents. CAM use was associated with less illicit drug use in
one study.48 Four prevalence studies specifically focused on
ad- herence to HAART therapy,47–49,61 but results were
equivocal,

TABLE 1. SEARCH STRATEGY AND RESULTS

HIV CAM Results

Medline HIV (mesh) OR HIV

Infection (mesh) Complementary therapies (mesh) 189
Cinahl MH human
immunodeficiency MH alternative therapies 4
virus
PsycArticles HIV OR ‘‘human ‘‘Complementary therapies’’ OR 3
immunodeficiency ‘‘complementary medicine’’
virus’’ OR ‘‘alternative therapies’’ OR
‘‘alternative medicine’’ OR
‘‘complementary and alternative medicine’’
AMED SH HIV 8
Sciencedirect HIV (abs/title/key) ‘‘Complementary therapies’’ OR 61
‘‘complementary medicine’’
OR ‘‘alternative therapies’’ OR
‘‘alternative medicine’’ OR ‘‘
complementary and alternative
medicine’’ (abs/title/key)
Cochrane HIV 17
library
282
FIG. 1. Flowchart of study selection.
with no firm pattern suggested as to whether adherence
was improved as a result of CAM use.
Given the strong influence of the introduction of
HAART, particularly the latest one-pill-once-daily
regimens, on the behaviour, treatment, and lifestyle of
PLWHA,101 we com- pared prevalence articles published
pre- and post-modern HAART regimens (i.e., before/after
2005 when single dose regimens became widely available
and recommended).4,102–104 However, there were no
differences in prevalence figures, determinants, or reasons
for use, suggesting that ART does not have a strong
influence on CAM use by PLWHA, dis- cussed further
below.
Attitudes to CAM, reasons for use
and decision-making
Fifteen studies were identified regarding patients’
attitudes to CAM, reasons for use and decision-making. Ten
were north American,67,69,71–74,77–79,81 four from
Australia, 10,70,76,80
and one from Switzerland.
75
One of the key reasons for using CAM was to provide a
method to self-manage health or to give a sense of con-
trol,10,71,77,80 to cope with uncertainty,71 manage symptoms,71
give freedom from and additional choice to medical regi-
mens,10,71,76,80 and attempt to normalize health status, main-
tain health, or find wellness.71,77,78 CAM was also used for
personal growth or fulfilment77,78 with different CAM used
along a journey, from those focusing on the physical self to
those facilitating inner awareness, such as meditation. 77
Another key reason was to address the limitations or
problems with conventional ART.70,80,81 However, most
studies found that CAM users did not reject conventional
medicine;78 only one study found that a preference for CAM
predicted non-use of ART.74 In fact, one study found that
patients used conventional parameters such as CD4 counts
to make their decisions about CAM.79
One study described the decision-making process of se-
lecting a CAM, often based on friends and family, judging
which approaches work and are safe, from subjective
personal experience, attempting to combine conventional
medicine and CAM.73 Cultural values appear likely to
influence the
decision to use CAM.69,78 One study found that psychologi-
cally needier people were more likely to seek CAM.75
Barriers to CAM use include cost, access,
time/discipline/ energy needed, overwhelming choice, and
the need for evidence.72,73
Guidance for clinicians
Six articles were identified giving guidance for clinicians,
looking at the issues of combining CAM with HIV conven-
tional medication.12,13,93–96
Four articles provided guidance for nurses to make deci-
sions regarding CAM, advising that nurses discuss CAM
use with their HIV patients. 13,93,95,96 Irish, although this article
is now very outdated, suggests that discussing CAM with
pa- tients is part of nurses’ obligation to provide patient-
centred care, and that nurses should assess whether CAM
are harmful and encourage disclosure by being
nonjudgmental, which can help to maintain health. 13 Palmer
provides an overview for HIV nurses on CAM, CAM use
and reasons, safety issues, and benefits.93 He concludes that
nurses have an ethical obligation to provide patients with
up-to-date information about CAM products so that they
can make an informed choice.93 Haddad presents a clinical
scenario of a patient with HIV who wishes to use CAM
instead of conventional treatment.95 She dis- cusses the need
for nurses in this situation to avoid jumping to the
conclusion that they should dissuade the patient and in-
stead suggests exploring the reasons behind the patient’s
wishes, particularly any concerns about conventional treat-
ment, and ensuring the patient makes an informed
decision. Freeman and MacIntyre also advise that nurses
have an un- derstanding of CAM in order to improve their
relationships with patients.96
The other two articles,12,94 although somewhat outdated,
potentially provide useful HIV-specific guides to a range of
CAM. Steinberg94 also provides some suggestions for how
conventional practitioners, or PLWHA themselves, can inte-
grate CAM and conventional treatment. This includes ‘find-
ing the right balance’, ‘dealing with uncertainty’ regarding
new symptoms and illness progression, ‘anger’ related to
the social/financial impact of HIV, ‘nonexclusivity’ (using
CAM
to complement other treatments), and encouraging patient
responsibility and empowerment. Elion and Cohen 12 em-
phasise the need for discussion and disclosure of CAM use,
for safety reasons, but also issues of cost, fraud and the
evidence-base.
These articles illustrate how a discussion of CAM can
form part of nurses’ holistic and patient-centered care of
PLWHA and emphasize the need for primary care
providers and nurses to engage in dialogue with patients
regarding CAM, and encourage disclosure by being
nonjudgmental.
Reviews of treatments
Nine review articles provided descriptive information on
various treatments82–90 and a two-part review additionally
covered a range of other issues.91,92 Reviews on the effect of
CAM were generally positive and suggest that CAM has a
potential use for a range of health issues, 84,86–89,105 although
many highlighted that the evidence base is still
inconclusive. Massage therapy84,105 and stress
management 86,87
were highlighted as the CAM most likely
to be beneficial treat- ments. Two reviews highlighted the
limitations of the evi- dence base, which was seen as
insufficient to support use of any CAM.85,90
Safety
Only four articles were identified regarding the safety of
CAM and HIV, plus the Spanish study by Vaszquez et al.,
which includes safety information.61 Ernst97 described some
of the risks of CAM, although these were not HIV specific,
and then gave a single case study example of an HIV
patient being exploited by an ‘energy’ therapy. An article by
Gilmour et al.98 is not specifically about HIV; they describe
natural health product–drug interactions in general and the
need to ask patients about CAM use, using the case
example of an HIV - positive patient taking St Johns wort,
which interacts with indinavir. Ladenheim et al.99 provide a
more thorough study of the potential health risks of CAM
for PLWHA, using a survey of the use of herbal medicine
and supplements among PLWHA to identify any potential
risks. They identified 59 patients (20% of those using CAM)
whose CAM use necessi- tated a warning, 29 of whom were
advised to stop their CAM use due to concerns about
serious interaction with ART or adverse effects. The most
common adverse effect was with echinacea (used by 22
patients) which, in theory, could in- crease the number of
infected leucocytes by stimulating the immune system,
resulting in increased HIV viral load. Eight patients were
using garlic, and two were using St Johns wort, which can
both interact with ART, reducing its therapeutic levels. One
patient was using kava, which may cause hepa- totoxicity.
Other CAM being used were not as high a safety risk but
patients were advised to use with caution. These in- cluded
aloe vera, gingko biloba, and vitamin C megadoses, which
can reduce the effectiveness of ART, and cat’s claw, DHEA,
ginseng, liquorice, milk thistle, and red yeast, which can
cause ART-related side effects. Vaszquez et al. (included
above as a prevalence study) 61 additionally documented po-
tential herbal medicine-ART interactions, which also
included echinacea, milk thistle, garlic, ginseng, and cat’s
claw, as well as grapefruit (can reduce concentrations of
indinavir and sa- qyinavir), valerian (can increase
hepatotoxicity), marijuana (reduces Cmax), hypericum
(reduces ART effectiveness). La-
denheim et al. highlighted that the main risk of CAM use in
PLWHA is potential ART–interaction, through the cyto-
chrome pathways, making CAM use with protease
inhibitor and non-nucleoside reverse transcriptase inhibitor
ARTs particularly risky. A focus group study identified that
safety of CAM is important in patients’ decision making,
but that they had limited knowledge, although this study
was nearly 10 years old.100
Discussion
CAM appears to be popular with PLWHA, although
there is a paucity of recent, large-scale, national survey data,
par- ticularly outside of the USA. Prevalence figures vary
widely, though this is known to be a common issue in
studies of CAM.106 Vitamins, herbs, and supplements
emerge as the most common approaches used, followed by
prayer, medi- tation, and spiritual approaches.
Supplements and herbs may be used for a range of
reasons, including cleansing or strengthening the body.88
Their pop- ularity may be related to a generally high
knowledge of nu- trition amongst PLWHA, encouraged by
the community and by healthcare clinicians.107 These oral
CAM can cause po- tential safety issues through interaction
with conventional medication, in particular ART, with
implications for the role of conventional clinicians. 98,99
However, as seen in this re- view, there is a lack of research
on the specific safety impli- cations of CAM use by
PLWHA.3
Prayer, meditation, and spiritual approaches may be
used to provide an approach to understanding and coping
with chronic illness and providing emotional support and a
stabi- lizing force within daily life.108 It is important that
clinicians understand that these approaches may be
important to pa- tients, particularly within the context of
patient-centred and culturally-competent care.
CAM use appears related to having an HIV diagnosis27
and in many of the articles reviewed, CAM use was
predicted by having a longer duration of time since HIV
diagnosis and a greater number of medications and
symptoms. This may re- late in part to ART use, as CAM is
often used to address the limitations of or problems with
ART. This is most likely in a complementary rather than
alternative manner, as most studies found that CAM users
did not reject conventional medicine but used CAM as part
of an integrated approach.80 Thorpe et al.10 explain that
PLWHA did not want CAM to ‘re- medicalize’ health
management but instead used CAM as part of a ‘return to
normality’. As well as coping with the side effects of ART,
CAM may be used for relaxation, to support a positive
attitude and to improve energy levels.108
A strong theme from the literature was the use of CAM
to provide a method of self-management of health or give a
sense of control for PLWHA, as evidenced by the high use
by those who are active in their own healthcare. This theme
has been identified for other chronic illnesses, including
cancer.108,109 Swenderman110 emphasizes that self-management
is as important, and complex, in HIV as in other chronic
conditions, with additional HIV-specific challenges related
to lack of self-monitoring, stigma, disclosure, and
transmission routes. The emphasis on self-management may
be related to the ‘‘AIDS movement’’ and activism in the
HIV/AIDS com- munity.3 Encouraging effective self-
management of health is important in HIV as it is associated
with medication
adherence,111 although this review did not find evidence
that CAM use was associated with adherence.
Although it places the emphasis on the patient,
healthcare clinicians have a key role in self-management,
both providing treatment and advice, as well as
encouragement, motivation, and tools.108,111 Only a quarter
of HIV clinicians report asking patients about CAM use,112
although PLWHA who use CAM still rely on biomedical
knowledge and providers to provide certainty. 10 There is
clearly a need, even an ethical duty, 3 for conventional
healthcare providers to discuss CAM with their patients,
including perhaps making informed decisions on the use of
CAM and being aware of potential safety implications,
particularly interactions between herbal and conventional
medicines.98,113 Although some evidence-based information
is available for clinicians, for example, in a range of articles
identified in this review,14,82,83,91,92 there is a need for educa-
tion of clinicians and perhaps for professional guidance to
stipulate discussion of CAM as part of HIV clinicians’ duty. 3
There is also a need for further research into CAM for HIV/
AIDS,3 perhaps starting with massage and stress manage-
ment which show promising preliminary evidence.
Given the numerous similarities identified between HIV
and other chronic diseases, emphasizing HIV as a chronic
disease may help to encourage self-management, reduce
stigma, and expand access to healthcare.110
In conclusion, CAM is popular with PLWHA,
particularly supplements, herbs, and spiritual approaches,
and appears related to having an HIV diagnosis. The use of
these com- plementary approaches appears to help PLWHA
to cope with symptoms and side effects, but also, perhaps
more impor- tantly, to take control of their own health.
Clinicians should consider discussing CAM with patients as
it may encourage valuable self-management and ensure
patient safety.
Acknowledgments
We are grateful to NHS Brent Primary Care Trust for
funding this work.
Author Disclosure Statement
No competing financial interests exist.
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Address correspondence to:

Dr. Ava Lorenc London South Bank University

103 Borough Road London SE1

0AA United Kingdom

E-mail: lorenca@lsbu.ac.uk
2.7 ANALISIS JURNAL
1. Judul jurnal
A Review of the Use of Complementary and Alternative Medicine and HIV:
Issues for Patient Care
2. Jurnal

AIDS PATIENT CARE and STDs

3. Volume & halaman

Volume 27, Number 9, 2013

4. Doi

DOI: 10.1089/apc.2013.0175

5. Tahun

2013

6. Penulis jurnal

Ava Lorenc, PhD, and Nicola Robinson, PhD

7. Kata Kunci
Complementary and Alternative
8. Metode
Metode basis data adalah metode permintaan data secara informal.permnitaan
data (query) adalah metodologi akses ad boc yang menggunakan perintah
yang mirip dengan bahasa inggris untuk membangun daftar atau informasi
dasar lainnya dari basis data.para pengguna dapat mengakses data melalui
 permintaan langsung,yang tidak memerlukan program pengguna formal.
(rizaluardi Achmad Pratama 2020)

9. Pembahasan
Cam sedang populer namun masih banyak kekurangannya, cam oral
dapat menyebabkan masalah keamanaan potensial melalui interaksi dengan
obat konvensional dan sebagian penelitian menemukan bahwa penggunaan
Cam tidak menolak obat konvensional tetapi menggunakan cam sebagai
bagian dari pendekatan terpadu dan cam bisa digunakan untuk relaksasi dan
meningkatkan energi pasien.

Dalam jurnal ini bertema penggunaan cam untuk menyediakan metode

menejemen kesehatan diri atau ODHA memberikan rasa kontrol untuk odha
tema ini di identifikasi untuk penyakit kronis lainnya namun tidak dijelaskan
secara rinci ataupun per poin dan dalam jurnal tidak menjelaskan pelayanan
kesehatan itu tidak harus berfokus pada dokter dan pasien namun pelayanan
kesehatan perlu juga terlibatnya tenaga kesehatan yang lainnya untuk
kolaborasi. Dalam pemberian Cam harus ada diskusi dengan pasien untuk
membuat suatu keputusan untuk keselamatan pasien.
10. Hasil
 BAB III

PENUTUP

3.1 KESIMPULAN
Terapi komplementer dikenal dengan terapi tradisional yang
digabungkan dalam pengobatan modern. Komplementer adalah penggunaan
terapi tradisional ke dalam pengobatan modern. Terminologi ini dikenal
sebagai terapi modalitas atau aktivitas yang menambahkan pendekatan
ortodoks dalam pelayanan kesehatan. Terapi komplementer juga ada yang
menyebutnya dengan pengobatan holistik. Pendapat ini didasari oleh bentuk
terapi yang mempengaruhi individu secara menyeluruh yaitu sebuah
keharmonisan individu untuk mengintegrasikan pikiran, badan, dan jiwa
dalam kesatuan fungsi.
3.2 SARAN

Demikian yang dapat kami tuliskan, semoga makalah ini dapat

dimanfaatkan secara maksimal sebagai bahan referensi dalam pembelajaran
kami berharap pembaca bersedia memberikan kritik dan saran yang
membangun kepada kami agar makalah ini dapat menjadi lebih baik lagi,
semoga makalah ini dapat bermanfaat bagi penulis maupun pembaca.
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