1. The role of Community Health Worker in prevention is crucial:  In Haiti “The CHWs are facilitating the uptake of primary health care services, including the most vulnerable households” (Mukherjee, J., & Eustache, F., 2007 )  In Sub-Sahara Africa, “Community health workers as a community-based extension of health services are essential for antiretroviral treatment scale-up and comprehensive primary health care” (Hermann, K., 2009)  In Uganda “Data provide evidence that traditional healers in a rural area of Uganda can successfully adapt HIV prevention messages and family planning information into their clinical practices” (Ssali, A., Butler, et. all, 2005) Cervical Cancer needs attention in the Developing World & South Africa #1 cause of cancer related deaths; attributed to over 3400 deaths of South African women Will affect 1 in 26 South African women Strong association between HIV and HPV Women with limited access to routine PAP tests are at risk Pap tests and early detection are the KEY to prevention Key findings from empirical research on HPV, cervical cancer, and vaccine acceptance in Sub-Sahara Africa Adult women had limited knowledge of HPV and cervical cancer Women had limited access to care Countries lacked cervical cancer prevention programs There is growing interest in vaccine uptake; however, numerous challenges exist Gaps in the literature In developing countries: There are a limited number of empirical studies assessing HPV and cervical related issues Previous studies found women had limited understanding/knowledge of HPV and cervical cancer related issues Lack of studies assessing maternal/parental attitudes. Methods Approximately 15 Sangomas that worked in Alexandria Township were asked to participate in a focus group regarding HPV Ages ranged from 26 - 55 and included men and women One participant (Sangoma) served as a translator for those who could not understand English Participants were asked a series of questions relating to their role in health care, understanding of cervical cancer and HPV, and future involvement in cervical cancer prevention The focus group was then transcribed and triangulated between the researchers to discover common trends and themes Strengths Explores an understudied area Provides a better understanding of issues around knowledge and attitudes about HPV, cervical cancer, and vaccine acceptance Assesses Sangomas’ attitudes, beliefs,and knowledge Uses mixed analytical methods Limitations Descriptive study Generalizable to Alexandra community Small sample size Jennifer A. Nelson, MPH, Shelley A. Francis, DrPH, MPH, CHES; Joan Liverpool, EdD, CHES; Roland H. Thorpe, PhD, MS; Soji Shogun, MBBS, FACHE; Nokuthula Mofammere Background Specific Aims Future Recommendations Strengths and Limitations The South Africa Women’s Health study is supported by an investigator initiated award from Merck Pharmaceuticals, Inc. The contents of this presentation are solely the responsibility of the authors and do not necessarily represent the official views of Merck Inc. The role of Sangomas vaccine acceptance is important in HPV/Cervical Cancer prevention. Therefore, for a successful vaccine or educational campaign recommendations include: Developing educational program for Sangomas for HPV, Cervical Cancer and other diseases of interest Continuing to value and support the exchange of ideas between traditional and western medicine Utilizing the understanding and comfort people have with Sangomas, realizing they are often the first people patients turn to, to share information and encourage treatment Further explore the role of Sangomas in vaccine delivery and population education The following section contains the common themes found in each study area: Role of Sangomas in Health Care People seek them because they are comfortable talking with them about health problems Problem seen include STDS, mental problems, chronic illness and HIV/AIDS Provide education to their patients and refer them to doctors “Before they go to any doctor or clinic, they usually come to see us” Understanding of HPV Lack of knowledge Confusion with HIV Understanding of Cervical Cancer Understanding that pap smears can prevent cervical cancer Associated with the womb, cervix and excessive bleeding Educating the public about HPV/Cervical Cancer Workshops are important and useful, especially when educating parents Speaking openly with children about sex and STDs is important HPV/Cervical Cancer Prevention Stressed importance of condom use in prevention, like in HIV Education about HPV and cervical cancer is necessary for prevention Interested in female condoms, but didn’t know how to acquire them Vaccine Acceptance No prior knowledge of vaccine to prevent cervical cancer Excited about the possibility of a vaccine that could prevent this disease, especially for those that are raped Stressed educating parents, including fathers; no parent would want their child to suffer if it could be prevented Thought age 9 is a good age to talk to girls about the vaccine, and at the same time talk to them about sex “We can save a lot of people, a lot of lives” Sangoma’s future role in HPV and Cervical Cancer Prevention Sangomas are the liaison between doctors/western medicine and the people they serve “So I think it’s better for us to accumulate all this knowledge from you so we will know how to pass it on to them” “For us to work with the western doctors would be a very nice thing. We are going to exchange ideas and at the same time…we can learn the symptoms of the diseases...she will have the knowledge” Results 1.Analyze and describe the role of Sangomas community health workers in Johannesburg, South Africa. 2.Evaluate Sangoma’s knowledge of HPV, cervical cancer, and sexually transmitted diseases. 3.Assess the role of Sangomas as community health workers working in cooperation with western medicine A Focus Group Analysis of Sangoma’s Knowledge, Attitudes, and Beliefs about the Human Papillomavirus, cervical cancer, and vaccine acceptance in Johannesburg, South Africa “What is the best way to keep girls safe from cervical cancer?” “…I would say this vaccine…”