Mar. 08 2022

Healers Provide Bridge to Biomedical Health Care, Reshape Sexual Health in Uganda

There is much to learn from healers’ holistic approach, the authors of a new study write

Young people in the Rakai region of south-central Uganda are turning to healers because of their holistic approach to providing sexual and reproductive health care, according to a new study by researchers at Columbia University Mailman School of Public Health. The researchers describe three reasons young people seek healers over the biomedical community. The findings are published in the journal Social Science and Medicine.

First, young people reported that the high costs, inconsistency of supply, and experience of stigma in biomedical clinics and pharmacies influenced their preferences to visit healers instead of biomedical sexual and reproductive healthcare (SRH) providers.  Second, young people described fears of being subject to stigma or receiving poor-quality care in biomedical settings and the expense of travel costs for treatments. Third, they said healers provide a sex-positive approach to SRH and counsel focused on pleasurable and economically motivated sex. These therapies diverge from international and national HIV prevention messaging that frames non-marital and transactional sex in terms of danger and disease.

Healers have a long history of African healing practices that root “health” in the social body. The healers described in this study represent several types of practitioners who are socially and legally recognized in Uganda.

“Healers have long demonstrated a willingness to collaborate with the biomedical community for HIV/AIDS care. Our findings indicate that healers are and should be engaged as allies in HIV prevention and other biomedical sexual and reproductive health care efforts,” said Erin V. Moore, lead author and Carl F. Asseff Assistant Professor of Anthropology and the History of Medicine at the Ohio State University, and formerly a postdoctoral student at Columbia Mailman School. “From a health efficacy perspective, many healers act as connection points to biomedical systems, where they frequently refer clients for testing and treatment.”

Data was collected in six different communities in the Rakai district of south-central Uganda, The researchers also conducted a sub-study mapping young people’s access to and utilization of SRH to investigate where and how young people sought and attained contraceptives, HIV testing and treatment, and sex education.

“Healers provide a destigmatized, holistic SRH experience by embracing the fact that young people are sexual citizens. Global public health practitioners stand to benefit from taking healers’ conceptualization of sexual health seriously as it takes into account physical, emotional, social, and especially economic well-being,” said Moore. “There is much to learn from the holistic vision of sexual health and healing we have documented among healers and their patients in Rakai, Uganda.”

Uganda has a 35-year experience with HIV/AIDS.  The Rakai region has had considerable success in reducing rates of HIV incidence.  

“Our research shows how healers’ SRH therapies offer a systems-level way to acknowledge young people’s sexual lives and citizenship, which have been so frequently denied by biomedicine and public health,” observed John Santelli, senior author and professor of Population and Family Health and Pediatrics at Columbia Mailman School.

Co-authors are William Ddaaki and Fred Nalugoda, Rakai Health Sciences Program, Kalisizo, Uganda; Jennifer S. Hirsch, Columbia Mailman School of Public Health; and Larry Chang, Johns Hopkins University School of Medicine.

The research was supported by the National Institutes of Health (SSTAR 5R01HD091003) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD058486).