Carolyn M Audet1,2, Sizzy Ngobeni3, Mevian Mkansi3, Floidy Wafawanaka3, Muktar H Aliyu1,2, Sten H Vermund4, Ryan G Wagner3,5. 1. Department of Health Policy. 2. Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 3. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 4. School of Public Health, Yale University, New Haven, Connecticut, USA. 5. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
Abstract
OBJECTIVE: To understand the risk of HIV acquisition through occupational exposure among rural South African traditional healers, notably via the practice of traditional skin incisions with razors. DESIGN: A random sample of traditional healers living in South Africa participated in a cross-sectional survey that included a rapid HIV test. SETTING: Rural Bushbuckridge district of Mpumalanga, South Africa. PARTICIPANTS: Traditional healers. INTERVENTION: Pretest counseling, posttest counseling, and referral to care if HIV seropositive. MAIN OUTCOME MEASURE(S): HIV infection. RESULTS: Among healers who reported a previous positive test result or accepted an HIV test (96%), HIV prevalence was 30% (95% confidence interval: 23-37%). During their careers, 98% of healers reported conducting at least one 'vaccination' (as traditional incisions are called), 32% reported always using gloves when conducting these procedures, 29 (14%) reported patient blood touching their bare skin. Healers who reported exposure to patient blood had a higher HIV prevalence than their nonexposed colleagues (adjusted risk ratio: 2.35, 95% confidence interval: 1.55-3.56, P = 0.001). CONCLUSION: Nearly all traditional healers are routinely performing minimally invasive skin incisions that could expose them to patient blood. The lack of training and access to personal protective equipment increase their risk of acquisition of blood-borne pathogens, including HIV. Given the widespread practice of traditional skin incisions across southern Africa, and the higher levels of HIV among traditional healers exposed to patient blood, it is likely that traditional healers are a hitherto unrecognized key population at disproportionate risk of acquiring HIV.
OBJECTIVE: To understand the risk of HIV acquisition through occupational exposure among rural South African traditional healers, notably via the practice of traditional skin incisions with razors. DESIGN: A random sample of traditional healers living in South Africa participated in a cross-sectional survey that included a rapid HIV test. SETTING: Rural Bushbuckridge district of Mpumalanga, South Africa. PARTICIPANTS: Traditional healers. INTERVENTION: Pretest counseling, posttest counseling, and referral to care if HIV seropositive. MAIN OUTCOME MEASURE(S): HIV infection. RESULTS: Among healers who reported a previous positive test result or accepted an HIV test (96%), HIV prevalence was 30% (95% confidence interval: 23-37%). During their careers, 98% of healers reported conducting at least one 'vaccination' (as traditional incisions are called), 32% reported always using gloves when conducting these procedures, 29 (14%) reported patient blood touching their bare skin. Healers who reported exposure to patient blood had a higher HIV prevalence than their nonexposed colleagues (adjusted risk ratio: 2.35, 95% confidence interval: 1.55-3.56, P = 0.001). CONCLUSION: Nearly all traditional healers are routinely performing minimally invasive skin incisions that could expose them to patient blood. The lack of training and access to personal protective equipment increase their risk of acquisition of blood-borne pathogens, including HIV. Given the widespread practice of traditional skin incisions across southern Africa, and the higher levels of HIV among traditional healers exposed to patient blood, it is likely that traditional healers are a hitherto unrecognized key population at disproportionate risk of acquiring HIV.
Authors: R Jewkes; K Dunkle; M Nduna; J Levin; N Jama; N Khuzwayo; M Koss; A Puren; N Duvvury Journal: Int J Epidemiol Date: 2006-09-28 Impact factor: 7.196
Authors: Carolyn M Audet; José Salato; Meridith Blevins; Wilson Silva; Lázaro González-Calvo; Sten H Vermund; Felisbela Gaspar Journal: Trop Med Int Health Date: 2016-09-16 Impact factor: 2.622
Authors: Molly S Rosenberg; Francesc X Gómez-Olivé; Julia K Rohr; Brian C Houle; Chodziwadziwa W Kabudula; Ryan G Wagner; Joshua A Salomon; Kathleen Kahn; Lisa F Berkman; Stephen M Tollman; Till Bärnighausen Journal: J Acquir Immune Defic Syndr Date: 2017-01-01 Impact factor: 3.731