The role of traditional healers in community-based HIV care in rural Lesotho.

Traditional healers provide a substantial proportion of health care in resource-poor settings, including countries with high burdens of HIV in sub-Saharan Africa. Traditional healers have played many roles in HIV care, but some biomedical providers view them as obstacles in providing HIV treatment. This is a qualitative study exploring the roles played by traditional healers in a community-based program rolling out antiretroviral therapy (ART) in two rural communities in Lesotho. Seventeen traditional healers took part in interviews focus groups, and participant observation sessions over a 2 years period. Data showed they provided a wide range of HIV services prior to the ART rollout. Baseline knowledge regarding HIV was high, but healers reported mixed emotions about the planned ART rollout. Joint meetings were held between biomedical providers and traditional healers, and a collaborative model of care resulted. Traditional healers took on a variety of roles in the ART rollout, including HIV prevention activities, HIV testing, monitoring patients, and participating in joint learning sessions. All of the traditional healers underwent HIV testing and 7/17 (41.2%) tested positive for the disease, of whom four were eligible for and enrolled in ART. Healers expressed an appreciation for the collaboration with biomedical providers and being paid for their referrals. However, some expressed concern about the biomedical providers' lack of understanding of HIV in the local context. This research shows that traditional healers can provide a variety of community-based HIV services and are not obstacles for advancing care in the communities they serve.