If you're a native of rural Mozambique who contracts a disease and becomes symptomatic, you'll likely consult a traditional healer before getting medical advice.

It's easy to dismiss that thinking as primitive but an alarming number of residents in California, Washington and Oregon believe the same way - they don't trust science, they think nature can cure them, and that is why supplements, alternative cures, homeopathy and even specific foods are a booming business.

They believe they are cursed, just like someone in Mozambique might. But rather than it being placed by a neighbor or the spirit of an ancestor, some Americans believe the curse is modern living.

Both have healers - in Africa it may be cutting the skin with a razor blade and rubbing herbs in it, in San Francisco it may be cutting gluten and ingesting the herbs to detoxify. 

When it comes to HIV, the situation is a little more serious. A recent survey of symptomatic HIV-positive people in rural Mozambique, led by Carolyn Audet, Ph.D., M.A., assistant professor of Health Policy, found that individuals who initially consulted traditional healers had a 2.4 times longer delay between the onset of symptoms and diagnosis of HIV than those who did not consult healers.

Among a total of 517 study respondents newly diagnosed with HIV, 62 percent saw a healer before seeking clinical care.

For study respondents who did not visit a healer, the median time from first symptoms to a clinical visit was two months, while it was three months for those who saw a single healer and nine months for those who saw two or more healers.

The study respondents were asked about diagnoses and treatment provided by healers, and the most commonly reported diagnoses were curses (56 percent), biological causes (15 percent) and angered spirits (10 percent). Among respondents who saw a single healer, 55 percent were administered herbs subcutaneously, using razor blades and rubbing the herbs into the cuts.

Sten Vermund, M.D., the Amos Christie Professor of Global Health and director of the Vanderbilt Institute for Global Health, was among the study's co-authors.

"Carolyn's findings give a sense of urgency to the need to engage traditional healers both to encourage referrals of sick patients and to support, rather than undermine, the lifelong antiretroviral therapy regimen," Vermund said.

In Mozambique as elsewhere in sub-Saharan Africa, university-trained doctors are in very short supply but traditional healers are numerous. Compared to doctors, healers also may be more in step with African consumers' beliefs about the spiritual causes of illness and preferences for treatment.

Religion pervades the outlook and practices of these healers. To effect cures, they routinely supplement herbalism with incantation, divination and various forms of "magic."

The prevalence of HIV/AIDS among Mozambicans age 15 to 49 is estimated to be at least 11 percent (in the United States it's 0.6 percent).

Some African countries recently have sought to integrate Western medicine and traditional healers.

The study authors outline recent health system efforts to facilitate referral of HIV/AIDS patients by traditional healers.

"Educating traditional healers to recognize and refer people with AIDS has had limited success," Vermund said. "We need to develop and test new models to incentivize these referrals, and we need to ensure that health care workers welcome such referrals and follow through with testing."