Traditional healers join war on HIV

Since he began practising as a traditional healer nine years ago, Shadrack Mashabane has become well-regarded in his community for his ability to tackle ills, including witchcraft-related conditions, mental health disorders and physical ailments.

But recently, Mashabane, from Bushbuckridge in Mpumalanga, has been able to diagnose HIV, a disease he previously knew little about. This is thanks to a Wits University initiative that empowers traditional healers to conduct HIV testing and refer HIVpositive patients for treatment, thereby curbing new infections.

The traditional healers’ project, known as Ntirhisano (Tsonga for “working together”), is considered groundbreaking because it provides a rare opportunity for such practitioners to work closely with health-care workers.

The project is the brainchild of the MRC/Wits Agincourt Research Unit, in collaboration with the department of health and the NGO Right to Care.

After attending “open-house” stakeholder sessions at the Rolle Clinic and Thulamahashe Community Health Centre in Bushbuckridge, Mashabane has not looked back.

“My practice has become a lot busier since I started testing for HIV. I even get people who don’t necessarily want to consult, but who just want to test. My patients say they prefer to come here rather than go to the clinic as my space offers them privacy. They say when they go to the clinic there are too many prying eyes, long queues and a lack of privacy.”

Apart from offering HIV testing using finger-prick kits, Mashabane “walks the journey with them” when patients who test positive are reluctant to go to a clinic.

“Through this work I’m finding a lot of men are reluctant to seek treatment after they test positive. Because of the relationship I’ve already established with my clients, I always offer to come to the clinic with them to offer support. Through counselling, I always pick up when someone is likely not to go to the clinic, so I always follow up to see how they are coping. It’s not an easy journey to go through, but with patience people always persevere.”

About 400 people have been tested since the project began in March with 15 traditional healers.

Dr Ryan Wagner, senior research fellow at the MRC/Wits Agincourt Research Unit, who leads the programme, said one of the objectives of the collaboration is to “strengthen the referral system”.

“To expand coverage and increase uptake of HIV testing, and thereby contribute to ending new HIV cases, we need to embrace innovative approaches, such as traditional healer-initiated HIV counselling and testing.”

The initiative forms part of research that began almost a decade ago. It focuses on the role of traditional healers in health-care delivery to determine whether they can conduct HIV counselling and testing, and work with biomedical health-care workers to help link patients to HIV/Aids diagnosis and care.

Wagner said those who have tested positive have been referred to health facilities for treatment and several “are now initiated on antiretroviral therapy”.

The healers’ training also focuses on patient confidentiality, as a perceived lack thereof is among reasons people are reluctant to test.

“We see this work as the beginning ... showing what might be possible when traditional healers, the department of health and researchers work together. The potential impact of this work is huge. In the long term, we would be thrilled to see [it] expanded to other areas,” said Wagner.

“The next step for us and the work in Bushbuckridge is about expanding to more healers and understanding the impact [they] can have. Our work has shown it is possible and acceptable.”

Wagner said Ugandan researchers are also exploring the role of traditional healers in the fight against HIV.

A pilot project by US-based Weill Cornell Medicine and Uganda’s Mbarara University to deliver point-of-care HIV tests to people in rural Uganda quadrupled testing rates, showing a 100% increase among study participants compared with standard referrals to HIV clinics, which increased by only 23%.

Researchers said the healer-delivered HIV testing model has the potential to “significantly improve the uptake of HIV testing among hard-to-reach populations ... as well as improve rates of linkage to HIV care”.

Wonderful Mabuza, project manager at the MRC/Wits Agincourt Research Unit, who oversees community engagements between healers and health-care workers, said the collaboration has “far surpassed expectations”.

“It’s groundbreaking to have traditional healers trained to provide HIV counselling and testing, and amazing to see community members respond, with some never having tested previously.”

Health department spokesperson Foster Mohale said that based on the results of the pilot study the department will consider replicating or expanding it in other areas.

“In countries across the world, traditional medicine is the first port of call to treat diseases. Today about 60%-80% of the world’s population, mainly from developing countries, depend primarily on traditional medicines,” he said.