title: HIV/AIDS-related attitudes and practices among traditional healers in Zambézia Province, Mozambique.
abstract: OBJECTIVE
  To document HIV knowledge, treatment practices, and the willingness of traditional healers to engage with the health system in Zambézia Province, Mozambique.
  
  
  METHODS
  Traditional healers offer culturally acceptable services and are more numerous in Mozambique than are allopathic providers. Late presentation of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) is reported among persons who have first sought care from traditional healers.
  
  
  METHODS
  One hundred and thirty-nine (139) traditional healers were interviewed in their native languages (Chuabo or Lomwe) in Zambézia Province. Furthermore, 24 traditional healers were observed during patient encounters. Healers answered a semistructured questionnaire regarding their knowledge of HIV/AIDS, general treatment practices, attitudes toward the allopathic health system, and their beliefs in their abilities to cure AIDS.
  
  
  RESULTS
  Traditional healers were older and had less formal education than the general population. Razor cutting in order to rub herbs into blooded skin was observed, and healers reported razor cutting as a routine practice. Healers stated that they did not refer HIV patients to clinics for two principal reasons: (1) patient symptoms/signs of HIV were unrecognized, and (2) practitioners believed they could treat the illness effectively themselves. Traditional healers were far more likely to believe in a spiritual than an infectious origin of HIV disease. Prior HIV/AIDS training was not associated with better knowledge or referral practices, though 81% of healers were interested in engaging allopathic providers.
  
  
  CONCLUSIONS
  It was found that the HIV-related practices of traditional healers probably increase risk for both HIV-infected and uninfected persons through delayed care and reuse of razors. Mozambican traditional healers attribute HIV pathogenesis to spiritual, not infectious, etiologies. Healers who had received prior HIV training were no more knowledgeable, nor did they have better practices. The willingness expressed by 4 in 5 healers to engage local formal health providers in HIV/AIDS care suggests a productive way forward, though educational efforts must be effective and income concerns considered.
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN 37203, USA. carolyn.m.audet@vanderbilt.edu
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Audet
authors.forename: Meridith
authors.initials: M
authors.lastname: Blevins
authors.forename: Troy D
authors.initials: TD
authors.lastname: Moon
authors.forename: Mohsin
authors.initials: M
authors.lastname: Sidat
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Paulo
authors.initials: P
authors.lastname: Pires
authors.forename: Alfredo
authors.initials: A
authors.lastname: Vergara
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy; D000328:Adult; D001291:Attitude of Health Personnel; D003469:Culture; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016488:Medicine, African Traditional; D008875:Middle Aged; D009073:Mozambique; D012017:Referral and Consultation; D029181:Spirituality