Traditional healers can help facilitate HIV serostatus disclosure: results from a qualitative study in rural Uganda

Introduction

In Uganda, HIV-related stigma and discrimination remain major barriers to HIV care engagement and serostatus disclosure. While serostatus disclosure can improve access to, engagement with and retention in HIV care, many people living with HIV (PLWH) hesitate to disclose due to fear of negative consequences. Traditional healers (THs) are trusted community members offering accessible and confidential psychosocial support. This study explores the role of THs in facilitating HIV status disclosure among PLWH disengaged from clinical care in southwestern Uganda.

Methods

This qualitative sub-study was nested within a cluster-randomized trial evaluating the effectiveness of THs supporting PLWH to engage with HIV care in southwestern Uganda. In-depth semi-structured individual interviews were conducted with 22 healers (14 female) and 16 PLWH (10 female) from August 2023 to June 2024. Interviews explored experiences with HIV care and healer-facilitated support to engage with and remain in HIV care. Data was analysed thematically, with particular attention to serostatus disclosure practices.

Results

Four key themes emerged: (1) PLWH, who receive care from TH practices, preferred THs over healthcare workers to disclose their HIV serostatus due to perceived trust, confidentiality and personalized care; (2) HIV-related stigma and fear of domestic violence hindered disclosure within families, but disclosure to healers offered a safer alternative; (3) in some cases, THs were the first individuals to whom PLWH disclosed their status; and (4) THs actively encouraged and facilitated serostatus disclosure by PLWH to family members, offering guidance and mediating difficult conversations. These findings highlight the critical role of THs in reducing barriers to disclosure and fostering supportive networks to improve the quality of life for PLWH.

Conclusions

THs provide a culturally sensitive and trusted avenue for HIV status disclosure in rural Uganda. Their unique position within the community allows them to address stigma, build trust and facilitate safe disclosure practices. Integrating healers into HIV care through training and collaboration with formal healthcare systems could enhance linkage, adherence, retention and overall care outcomes for PLWH. Future research should explore scalable models to leverage the positive influence and potential of THs to improve HIV care delivery.