# The Risk of HIV Acquisition among Traditional Healers in South Africa: Implementing Novel Strategies to improve protective Behaviors

> **NIH NIH R21** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2021 · $201,291

## Abstract

Project Summary: In South Africa there are an estimated 200,000 traditional healers providing health services.
Like allopathic health care workers (HCW), traditional healers are exposed to bloodborne pathogens through the
widespread practice of traditional “injections”, where healers perform dozens of subcutaneous incisions to rub
herbs directly into the bloodied skin. Ninety-eight percent of healers perform these treatments; they experience
an average of 1,500 blood exposures over the course of their lifetime. This high frequency of blood exposure,
coupled with treating high risk patients, can result in increased risk of patient-to-healer disease transmission if
personal protective equipment (PPE) are not used. Healers in South Africa who reported patient blood
touched their skin had 2.59 times higher risk of being HIV-positive than those with no exposure (59% vs.
25%); overall healers have a substantially higher HIV prevalence (30%) than the general population (19%).
Free PPE are made available at local health facilities, but most healers have low levels of literacy, limited ability
to assess blood exposure risk, and have no PPE training. Given these limitations, use of PPE during treatments
is inconsistent. A small proportion of healers employ PPE appropriately during each treatment; these
“early adopter” healers suggest PPE use is sustainable in rural sub-Saharan Africa if a healer has the
necessary skills, risk assessment training, and encouragement. Our proposal compares two implementation
strategies to increase PPE use during procedures and decrease the number of injections performed: (1) HCW
led education on risk of blood exposure and development of PPE donning, use and doffing skills though a week-
long training followed by 3 educational outreach visits at the healer's place of practice vs. (2) “Early adopter”
healer and HCW co-led week-long training followed by 3 educational outreach visits. We hypothesize that the
strategy of engaging “early adopter” healers as trainers will lead to more accurate participant risk assessments,
increase participant self-efficacy, and lead to more consistent use of PPE during treatments.
The Specific Aims of this study are to:
(1) Adapt PPE training using the ADAPT-ITT model;
(2) Compare fidelity of PPE training between the HCW-only team versus the healer + HCW team;
(3) Compare the effects of our two implementation strategies on healer exposure to patient blood.
This potentially high-impact intervention is well-suited to the R21 mechanism. While some allopathic providers
may recommend an outright ban on the procedure, patients and healers have strongly believed in the efficacy
of these treatments for hundreds of years- they are not likely to stop at our recommendation. It is up us to
overcome our own biases to develop an effective strategy to prevent HIV seroconversion. Our team of South
African and U.S. investigators has a proven record of HIV research success and specific experience successfully
engagi...

## Key facts

- **NIH application ID:** 10135011
- **Project number:** 5R21AI150302-02
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Carolyn Audet
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $201,291
- **Award type:** 5
- **Project period:** 2020-04-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10135011

## Citation

> US National Institutes of Health, RePORTER application 10135011, The Risk of HIV Acquisition among Traditional Healers in South Africa: Implementing Novel Strategies to improve protective Behaviors (5R21AI150302-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10135011. Licensed CC0.

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