Ritshidze’s second edition of the State of Healthcare for Key Populations report shows little has changed for people at high risk for HIV. Privacy violations, denial of healthcare services, and treatment persist among key populations.
Nine thousand people took part in the survey used to compile the report. Released on Monday, it laid bare the abuse key populations face at the hands of the country’s healthcare workers. The first report was released in January 2022 and involved 6,000 people.
The report shows that 42% of gay, bisexual and men who have sex with men (gbMSM), 45% of people who use drugs, 38% of sex workers, and 35% of trans* people experienced privacy violations at clinics.
UNAIDS defines key populations as groups at high risk of HIV infection, stigmatised by society because of their identities or behaviours, and less likely than other groups to be reached by interventions. These include sex workers, gay men and other men who have sex with men, transgender people, people who inject drugs, and people in prisons and other enclosed settings.
Londiwe Khuzwayo, key population organiser at Ritshidze says it is worrying that clinic staff continue to violate patients’ privacy.
“Clinic staff are known to disclose people’s HIV status or the fact that they are queer, trans*, a sex worker, or someone who uses drugs, in front of other healthcare users, or to invite other clinicians into private consultations to laugh at or judge people’s symptoms,” says Khuzwayo.
Key populations refused access to healthcare
According to the report, significant numbers of key populations were refused access to services in the last year. This includes 5% of gbMSM, 19% of people who use drugs, 12% of sex workers, and 9% of trans* people. This goes against Section 27 of the constitution, that says everyone has the right to access health care services.
Both clinical and non-clinical staff, like security guards, continue to be unfriendly and discriminatory, be it at the clinic gate, waiting areas or even during medical consultations.
“Just 37% of respondents reported facility staff are always friendly towards gay, bisexual, and other men who have sex with men(gbMSM). Only 24% of those surveyed say clinic staff are friendly towards drug users. 46% say clinic staff are friendly towards sex workers, and just 41% towards trans* people. Where the attitude of clinic staff becomes unbearable, some people have stopped going to the facility altogether,” the report states.
A sex worker who accesses healthcare services at Lusikisiki village clinic in the Eastern Cape, who was interviewed by Ritshidze describes how she was treated when she went to seek help at the clinic after a client attacked her.
“In June 2022, I was attacked by my client and went to open a case at the police station. They said I should go ask for J88 from the facility when I got there because the staff knew my condition and my day-to-day job. The nurse refused to give me J88.” ( J88 is a key document recording medical evidence that may be needed in order to obtain a conviction in an assault case.)
She went on: “I also asked for PrEP, and they said there was nothing I was going to do with it because I am a sex worker, and I deserve to be attacked by my client. The ill-treatment started from the gate with a security guard pointing fingers at me and informing people that I use drugs and do sex work”.
Another sex worker who uses Empangeni community health centre said, “They treat us badly, they judge us, and I think that is why they don’t give us good services. Some of the people that I work with have stopped going for their HIV medication because of the type of attitude that they get when they get there. They should treat us like human beings, the same way they treat others.”
Support Key populations
Deputy Minister of Health, Dr Sibongiseni Dhlomo, says key populations such as sex workers should be commended for seeking services.
“We need to say this sex worker is responsible for coming and asking for condoms. What I learned when I was in India is sex workers are saying, ‘I wake up every day, and I support my children, and some of them are at university. And I do not want to die very young as I want to be there when my children graduate. So the only thing I do is to protect myself while I do my service. And I commend that. That is very responsible,” says Dhlomo.
Some of the key findings from the report:
- There is limited availability of key populations specific services
- Services like contraceptives, STI treatment, and post-sexual violence services are also hard to reach
- Key populations often struggle to access basic prevention tools
- Lubricants were only freely available in 27% of facilities
The report also states that more key populations were offered PrEP at a drop-in centre compared to a public health facility. despite this, numbers remain low, with only 43% of gbMSM, 51% of people who use drugs, 24% of sex workers, and 63% of trans* people saying the drop-in centre offered them PrEP. – Health-e News