March 8, 2022-- 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.
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 (grant P2CHD058486).
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.
Social Science & Medicine