Healers provide bridge to biomedical healthcare while reshaping sexual health in contemporary Uganda

Young people in the Rakai region of southcentral Uganda are turning to healers  because of their holistic approach to providing sexual and reproductive health, according to a new study at Columbia University Mailman School of Public Health. The researchers describe three reasons for young people to 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 in lieu of biomedical sexual and reproductive healthcare (SRH) providers. Second, young people also described fears of being subject to stigma or receiving poor-quality care in biomedical settings and the expense of travel costs for treatments. Third, 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 different 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 healthcare 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 were collected in six different communities in the Rakai district of southcentral 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 University Mailman School of Public Health.