|POST for traditional health care
|1. Avoid skin-piercing procedures
||(a) Don’t remove body parts. Some traditional health care involves removing things, such as eye-teeth (canine teeth), labia or clitoris from girls, tonsils. Avoid all such operations. This goes also for foreskins, especially for babies – let men decide when they are older if they want to be circumcised (see Circumcision section).(b) For other invasive procedures, if you cannot ensure use of disposables or sterile instruments, avoid.
|2. Use new disposable instruments
||(a) Figure out ahead of time what will happen during the procedure, and ask the provider to use new disposables as much as possible – razors, gloves, porcupine quills, etc.(b) If you receive treatment in a group – such as with your family – consider that blood from any one person may be dangerous for all others. Insist that each member of the group is treated with their own set of razors, gloves, and other disposable instruments.
(c) If the provider applies medicine to sores (such as a razor cut), is there any chance that blood from someone’s cut could get into medicine that is later used on another patient? If so, ask the provider to make new medicine for you. If you are in a group that will receive medicine from the same source, ask the provider to use a sterile instrument each time he or she takes medicine from that source.
|3. You sterilize the instruments
||(a) You can sterilize reused instruments by boiling or by holding them a flame.(b) If quills or thorns or similar items are required, you can kill HIV by dipping them into boiling water – that will kill HIV, but other pathogens may survive.
|4. Ask providers how they sterilize instruments
||If the provider reuses instruments, ask if they have been boiled after the previous patient.
Additional information about traditional health care
What is traditional health care? Traditional health care includes procedures that people believe are good for their health, even though some experts may disagree.
Are traditional and informal providers safe? Let’s focus on one risk – blood-to-blood contact. Some traditional providers are safe, and some aren’t. It’s up to you to find people who will work with you to help you avoid HIV from blood-to-blood contact.
As an aside: Some evidence suggests that many traditional and informal providers have been as safe as – or safer than – many formal providers. Over the last 20 years, HIV has spread faster in relatively wealthy African countries at peace, where formal health care is available, than in countries with long term civil wars.i ii iii For example, as of 2017, UNAIDS estimates 27.4% of adults are HIV-positive in eSwatini (Swaziland), 23.8% in Lesotho, 22.8% in Botswana, and 18.8% in South Africa – all relatively wealthy countries that have been at peace for decades. In contrast, UNAIDS estimates 0.7% HIV prevalence in the Democratic Republic of Congo (DRC) in 2017, after decades of civil war. Similarly, UNAIDS estimates 2.8% of adults were HIV-positive in Mozambique in 1992 after more than a decade of civil war, but with peace this increased to 10.5% by 2001.
The point is: You should be alert in all settings where you may be poked or cut – and not be overly distracted by whether someone is a professional in a white coat or someone in jeans or other informal clothes.
Risk to get HIV from traditional health care
Because many different procedures may be involved, there is no simple answer. You can make your own estimates from the procedures and risks described in the Table on Estimated risks in the section on Blood-borne Risks.
If instruments are sterile or new disposables, if the provider wears new gloves to touch any open wound, and if there is no way that blood from a previous patient might have gotten into medicines applied to a wound or cut, you have no risk to get HIV from traditional health care procedures.
Evidence that traditional health care has infected patients with HIV
Some studies show that men and womeniv circumcised in traditional ceremonies are more likely to have HIV infections than other men and women (see Circumcision section).
A study among Luos in Kenya reports that men who had received saro (a form of traditional blood-letting) were 2.1 times more likely to be HIV-positive than men who had not received saro.v
i Spiegel PB, Bennedsen AR, Claass J, et al. Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan countries. Lancet 2007; 369: 2187-2195.
ii Gisselquist D. Impact of long-term civil disorders and wars on the trajectory of HIV epidemics in sub-Saharan Africa. J Soc Aspects HIV/AIDS 2004; 1: 114-27.
iii Strand RT, Dias LF, Bergstrom S, et al. Unexpected low prevalence of HIV among fertile women in Luanda, Angola. Does war prevent the spread of HIV? Int J STD AIDS 2007; 18: 467-71.
iv Pepin J, Plamondon M, Alves AC, et al. Parenteral transmission during excision and treatment of tuberculosis and trypanosomiasis may be responsible for the HIV-2 epidemic in Guidea-Bissau. AIDS 2006; 20: 1303-1311.
v Mattson CL, Bailey RC, Agot K, et al. A nested case-control study of sexual practices and risk factors for prevalent HIV-1 infection among young men in Kisumu, Kenya. Sex Transm Dis 2007; 34: 731-736.