Trusting the messengers
- Claire Keeton
People are more receptive to health information and messaging when it is delivered by someone they trust, rather than by someone with authority.
When peer educator Odwa Mbane sits on a bed in a Joburg brothel to talk about HIV prevention, the transgender sex worker next to her listens more attentively than she would in a clinic. The gold in Mbane’s teeth glints as she explains, in a familiar lingo, how to stay safe with clients. The sex worker – among the most vulnerable in society to HIV – trusts Mbane not to judge her.
Photo by Sandra Maytham-Bailey
About 500km east of Joburg, in a hut fragrant with herbs, a traditional healer talks to an elderly man from Bushbuckridge, Mpumalanga, about HIV testing. “Our old fathers don’t like clinics but they come to me,” says Thembisile Makhubele who works with the Ntirhisano project run by the MRC/µÚÒ»³Ô¹ÏÍø Rural Public Health and Health Transitions Research Unit (Agincourt), which trains traditional health practitioners to conduct HIV counselling and rapid testing in partnership with the Department of Health and Vanderbilt University.
“If they hear about testing from people like us who believe in culture and they trust us, it is easier for them to understand and accept what we say about HIV,” says Makhubele.
Ntirhisano Co-Principal Investigator Dr Ryan Wagner, a Senior Research Fellow at Agincourt, says: “Traditional healers are often integral, respected members of the community and from this established position they can give advice. People are more likely to listen to – and act on – advice given by someone whom they trust. Trust is a key component of any relationship.”
Bridging the trust gap
Peer educators and traditional healers, in partnership with µÚÒ»³Ô¹ÏÍø programme implementers, researchers and the Department of Health, are bridging the gap between populations vulnerable to HIV and healthcare providers.
For example, the ’s (µÚÒ»³Ô¹ÏÍø RHI) Key Populations Programme, trains and supports peer educators in promoting safe sexual health behaviours. Amanda*, a 42-year-old sex worker, says: “We feel free talking to them because they know where we are coming from. They give us condoms and pamphlets and will remind us not to forget to go to the clinic to collect our medication.”
The results are in the data that show that 95% of female sex workers who had tested HIV positive and initiated antiretroviral treatment in the µÚÒ»³Ô¹ÏÍø RHI Key Populations Programme achieved 95% suppression of their viral load.
More than 4 500 sex workers and about 1 500 trans and gender diverse people in nine clinics across South Africa were on antiretrovirals before last year’s funding cuts.
Programme lead, Naomi Hill says that trust boosted their high adherence. “Our clients see healthcare workers as the deliverers of technical information, but peer educators share their experiences, which builds rapport,” she says.
Peer educators also use stories and role-play to engage their clients. “This makes it easier for them to address their clients’ fears and the stigma,” says Programme Manager, Nokunceda Mabuza.
Community Liaison Officer, Katlego Serame, says that “coming to a safe space to share with people in the same situation” makes people more receptive to healthcare messages.
“Trusted peers also broadcast their messages on social media platforms like WhatsApp. The messaging is co-created with vulnerable populations to be relevant to the local context,” explains Hill.
Speaking the same language
Traditional healers are often from the community whose members they treat, says Wagner. “They may share cultural beliefs and speak the same language. This is not always the case with doctors or nurses and it can provide an advantage.”
Traditional practitioner Makhubele says: “Our clients feel more comfortable with us compared to with a nurse at a clinic. When I explain HIV counselling and testing, they sometimes tell me, ‘I don’t want to do this’ or ‘We are afraid’. I tell them it is not about dying. You can still live with HIV. Knowing your status by testing means you can get help,” she says.
She adds: “When I told my clients about HIV testing, I thought I might lose them because many people don’t want to hear about it. But the first person I advised about HIV understood. The training also helped me as a traditional healer to do my work safely. Before, we were even doing things (with blood) without gloves.”
Ntirhisano Project Manager Wonderful Mabuza said that 16 out of 17 traditional healers trained in the pilot “were excited to help their clients”.
Traditional practitioners recruited 250 clients, a third of whom had never tested for HIV. All were willing to test for HIV compared to 23% in the control group. However, only 60% presented for treatment.
Community messengers build trust
In March 2026, Dr Ruth Browne, CEO of the Ronald McDonald House children’s charity, spoke at µÚÒ»³Ô¹ÏÍø about how hair stylists and barbers in New York City have become trusted community messengers, connecting formal health systems to communities. µÚÒ»³Ô¹ÏÍø programmes are further proof of this endeavour.
“We have much to learn from trusted peers on how to build relationships and conversations, rather than just delivering health information. We have always had a strong partnership with the Department of Health and now we are working closely with them to ensure that peer-led approaches are embedded in public health clinics,” concludes Browne. “Building trust and understanding people’s experiences bridges the credibility gap between key population groups and health providers.”
* Amanda preferred to use her first name only
- Claire Keeton is a freelance writer.
- This article first appeared in CURIOS.TY, a research magazine produced by  and the .
- Read more in the 21st issue, themed #Trust — the invisible glue binding society, science and technology.