In South Africa, traditional healers join the fight against HIV; stigma remains high

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

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

It is part of the largest known effort in the country to engage traditional healers in a public health goal and study the results. By the end of this year, at least another 325 healers will receive the training and become certified HIV counselors. The researchers will compare rates of HIV testing by quacks and clinics.

Most traditional healers already knew about HIV (some from personal experience) and were eager to participate, the researchers said.

South Africa has one of the highest HIV rates in the world. Stigma around the disease and its treatment persists in many communities, even though HIV antiretroviral medications and pre-exposure prophylaxis are free. Privacy concerns at clinics also prevent people from seeking help.

Many people in rural areas see traditional healers as their first point of contact for illness, and the project hopes they can help change attitudes.

South Africa’s large young population is a particular concern. A government study published in December showed that people living with HIV had decreased from 14% in 2017 to 12.7% in 2022, but HIV prevalence increased among girls between 15 and 19 years old, a phenomenon attributed in largely because older men sleep with them.

Around 2,000 traditional healers operate in the town of Bushbuckridge in Mpumalanga province, home to about 750,000 people, providing traditional and spiritual services.

Mashabane said patients initially found it difficult to believe that he was offering them HIV testing, a service they had long expected to be available only at health clinics.

“Many were not convinced. I had to show them my certificate to prove that I was qualified to do this,” she said.

The process includes signing consent forms to be tested, along with following up with Mashabane to ensure that patients who test positive receive their treatment at the local clinic.

He said breaking the news to a patient who has tested positive for HIV is not that difficult because the disease can be treated with readily available medications. But in many cases he has to accompany the patient to the clinic “to make it easier for them.”

Florence Khoza is another traditional healer who has been trained in HIV testing. She said risky sexual behavior is common. She often dispenses herbs and traditional medications to treat gonorrhea, but now she goes further and advises patients to get tested for HIV.

“I tell them it’s best for them,” he said.

Khoza said many patients fear going to the clinic or hospital and being seen by other community members receiving HIV treatment.

“In many cases I pick up HIV medications on their behalf,” he said.

Ryan Wagner, lead researcher on the study, said testing and treatment through traditional medicine practitioners could “ultimately lead to the end of new HIV cases in communities like rural Mpumalanga, which has one of the highest HIV burdens worldwide.

The researchers hope their findings will inspire the South African government to implement this type of training throughout the country.

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