In South Africa, traditional healers join the fight against HIV. Stigma remains high in rural areas

The walls of Shadrack Mashabane’s hut in the rural South African town of Bushbuckridge are covered with traditional fabrics, with a small window the only source of light. What stands out among the herbs and medicines in glass bottles is a white box containing an HIV testing kit.

Donald G. McNeil Jr., right, being handed a ladle of Zulu beer by Mama Mtshali, a traditional healer in South Africa

Mashabane is one of at least 15 traditional healers in the town who, in a pilot study, have been trained by University of Witwatersrand researchers to conduct HIV testing and counseling in an effort to ensure as many South Africans as possible know their status.

It’s part of the largest known effort in the country to involve traditional healers in a public health goal and study the results. Later this year, at least 325 other healers will undergo the training and become certified HIV counselors. Researchers will compare rates of HIV testing by healers and clinics.

The researchers say most traditional healers already knew about HIV, some from personal experience, and were eager to get involved. 

South Africa has one of the highest HIV infection rates in the world. In many communities, the disease and its treatment remain stigmatized, despite HIV antiretroviral drugs and pre-exposure prophylaxis being free. Privacy concerns in clinics also prevent people from seeking help.

Many people in rural areas see traditional healers as their first port of call for illness, and the project hopes to help them change their attitudes.

South Africa's young population is a particular problem. A government survey released in December found that while the HIV rate fell from 14% in 2017 to 12.7% in 2022, HIV infections are on the rise among girls aged 15 to 19, a phenomenon that is largely due to older men co-sleeping with them.

In the town of Bushbuckridge in Mpumalanga, home to about 750,000 people, about 2,000 traditional healers are active, providing traditional and spiritual services.

Mashabane said his patients initially found it hard to believe he was offering HIV testing -- a service long expected to be available only at clinics.

"A lot of them weren't convinced. I had to show them my certificate to prove I was qualified to do this," he said.

The process includes signing consent forms for the test and a follow-up visit in Mashabane to ensure patients who test positive receive treatment at local clinics. 

Breaking the news to HIV-positive patients is not that difficult, he said, because the disease can be treated with readily available medicines. But often he has to accompany his patients to clinics "to ease their burden." 

Florence Khoza is also a traditional healer trained to administer HIV tests. She says risky sexual practices are common. She often prescribes traditional herbs and medicines to treat gonorrhea, but now she goes a step further and advises her patients to get HIV tested. 

"I tell them it's in their best interest," she says. 

Khoza says many patients are afraid to go to clinics or hospitals, or to have other community members see them getting HIV treatment.

 

"In many cases, I have them prescribing HIV medication for them," she says. 

Ryan Wagner, a senior researcher on the study, said testing and treatment by traditional medicine practitioners "could ultimately lead to an end to new HIV infections in areas like Mpumalanga, which has the highest HIV infection rates in the world." 

The researchers hope their findings will encourage the South African government to roll out such training across the country.

Certainly! Here are some references on the involvement of traditional healers in the fight against HIV in South Africa:

1. Peltzer, K., & Mngqundaniso, N. (2008). Patients consulting traditional health practitioners in the context of HIV/AIDS in urban areas in KwaZulu-Natal, South Africa. African Journal of Traditional, Complementary, and Alternative Medicines, 5(4), 370-379.
2. Green, E. C., Zokwe, B., & Dupree, J. D. (1995). The experience of an AIDS prevention program focused on South African traditional healers. Social Science & Medicine, 40(4), 503-515.
3. Moshabela, M., Bukenya, D., Darong, G., Wamoyi, J., McLean, E., Skovdal, M., ... & Seeley, J. (2017). Traditional healers, faith healers and medical practitioners: The contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in eastern and southern Africa. Sexually Transmitted Infections, 93(Suppl 3), e052974.
4. Kale, R. (1995). South Africa's health: Traditional healers in South Africa: a parallel health care system. BMJ: British Medical Journal, 310(6988), 1182-1185.
5. Puckree, T., Mkhize, M., Mgobhozi, Z., & Lin, J. (2002). African traditional healers: what health care professionals need to know. International Journal of Rehabilitation Research, 25(4), 247-251.

These references provide a comprehensive view of the role traditional healers play in addressing HIV/AIDS in South Africa, especially in rural areas where stigma remains a significant barrier.

Keywords: traditional healers, South Africa, HIV, stigma, rural areas, HIV treatment, HIV awareness, healthcare, traditional medicine, rural healthcare.