Turning the Tide on HIV with Traditional Healers

Years ago in southern India, when Dr. Radhika Sundararajan conducted fieldwork for her Ph.D. in anthropology, her young translator fell critically ill. His family and village pooled their limited resources to send him to a clinic five hours away.

He had malaria, which would have been quickly diagnosed had he lived closer to a clinic for testing. This experience was a key reason Dr. Sundararajan decided to go to medical school and led to her current role as an emergency physician, anthropologist and global health researcher at Weill Cornell Medicine. She focuses on bridging gaps in health-care access for people living in low-resource settings.

Many people in the rural areas of India and Uganda — where Dr. Sundararajan has worked — don’t have the means to visit hospitals or clinics. They also may have had poor interactions with institutional health systems or experienced stigma when seeking care at a clinic. As a result, informal health providers, such as traditional healers, are often the first line of care.

Dr. Sundararajan and her colleagues theorized that working with traditional healers could help address HIV in Uganda.

“Since there are these two parallel health systems, the best way to support patients with HIV is to have the two providers (institutional and traditional healers) cooperating to provide the best care,” she says.

The Ugandan Ministry of Health recommends annual HIV testing for all sexually active people, but in early conversations with traditional healers, the team learned that many patients had not been tested for HIV in years, if at all. The team developed an intervention in which traditional healers were trained to recommend and administer HIV tests to those patients.

Supported by an NIH K23 grant between 2019 and 2020, the team found this approach significantly increased testing uptake. They reported that patients seeing the 17 traditional healers who participated in the study were 4.4 times more likely to accept an HIV test compared to patients who were referred to local clinics for testing.

“Healers can provide more emotional and psychosocial support, deliver testing in confidential settings and reach folks who are reticent to go to formal clinics,” Dr. Sundararajan explains.

Clinical care is essential, though, for patients who are HIV-positive. But according to some estimates, nearly one in five HIV-positive patients in sub-Saharan Africa leaves treatment programs within a year. The Sundararajan team’s 2023 study — supported by an NIH R01 grant — showed that traditional healers were successful in reconnecting their patients with clinical HIV care.

Recently, Dr. Sundararajan’s team launched a study to improve HIV testing among children. Many pregnant women in rural Uganda don’t deliver their babies or receive prenatal care in clinics or hospitals where HIV testing is standard. The team’s intervention enlists traditional healers to offer HIV screening for children under 5 years old.

“This ultimately leads to the idea of something very holistic, where traditional healers can be seeing and helping people with HIV from childhood all the way to adulthood,” she says.