Perspectives of Traditional Healers, Religious Leaders, and Biomedical Providers on Depression and HIV Care in Rural Uganda.

Access to depression care remains limited in rural Uganda, where individuals, particularly people living with HIV, often seek support from a range of community-based and biomedical providers. Yet little is known about how these providers conceptualize depression in the context of HIV or how their perspectives shape care. This study aimed to explore how biomedical providers, traditional healers, and religious leaders conceptualize depression, perceive one another's roles, and approach depression care for people living with and without HIV. We conducted a qualitative study in Buyende District, Uganda, including 60 in-depth interviews with biomedical providers, traditional healers, and religious leaders (20 per group). Data were analyzed using thematic analysis. Four themes emerged: conceptualizations of depression, perceptions of other providers, strategies for care, and barriers to treatment. Across provider groups, depression was understood as rooted in socioeconomic hardship and frequently linked to the challenges of living with HIV. Material support, livelihood opportunities, and counseling were widely viewed as central components of effective care. While biomedical providers were generally perceived as more legitimate, mistrust toward traditional healers was common. Despite differing explanatory models, participants described overlapping counseling practices and expressed interest in improved communication across provider groups. Participants also expressed concern that reductions in HIV funding could worsen economic insecurity and increase vulnerability to depression. These findings highlight how depression care for people living with HIV unfolds within pluralistic provider systems and underscore the importance of integrating psychosocial care with strategies that address economic vulnerability when designing HIV and mental health interventions in rural settings.