Traditional Healer-initiated HIV Counseling and Testing in Rural South Africa

In South Africa, HIV testing has been undermined by HIV stigma, distrust in the allopathic health system, a preference for traditional medicine, and distance to the health facility. South Africa has made progress towards their 90-90-90 goals, yet a substantial proportion of the population do not test regularly; only 33.9% of adults in rural Mpumalanga (our study site) underwent HIV testing in the past year. In South Africa, people of low socioeconomic status (SES), men, immigrants, and those who distrust the health system have higher rates of HIV stigma, are more likely to seek care from traditional healers, and are less likely to receive an HIV test. The demographic and sociological characteristics of healers closely mirror this population, making them an ideal group to bridge the health care utilization divide. Development of a Healer-Clinician HIV Prevention Collaborative will facilitate testing and preventive service linkage among those who have traditionally avoided/refused testing via three synergistic strategies: (1) Healer-Initiated Counseling and Testing (HICT) to reinforce the value of HIV testing and teach HIV stigma reduction and coping strategies; (2) Establishing a path for patients to navigate between traditional and allopathic systems to encourage repeat HIV testing (or treatment, if HIV-positive); and (3) Improving the environment at the health facility via a stigma reduction training and “open house” sessions where healers and providers work together to provide patients an opportunity to better understand health services (and increase the likelihood that patients return). We propose to pilot this novel intervention with patients seeking treatment from a select group of trained traditional healers. We hypothesize that patient's seeking traditional treatment will find the offer of testing acceptable, will uptake HIV testing despite high levels of stigma and mistrust of the health system, and will engage in treatment at the health facility after linkage by their traditional healer. The Specific Aims of this study are to: (1) Conduct qualitative interviews with “non-testers” from varied SES and demographic groups to understand the interface of HIV stigma, mistrust in the health system, and HIV testing to create the most acceptable model of healer-based testing; (2) Adapt a successful South African community-based HIV prevention project to create a Healer-Clinician HIV Testing and Prevention Collaborative; and (3) Pilot our Healer-Clinician Collaborative and assess uptake of HIV testing as well as linkage to treatment and prevention services among participants offered healer-initiated counseling and testing. Our team has a proven record of engaging traditional healers to improve patient outcomes, conducting research to evaluate and address mistrust in the health system, HIV stigma, and developing interventions to increase HIV testing uptake.