Women living on streets struggle to get basic health services

nurse dressing a patient's wound.
Sister Philani dressing a patient's wound at the Denis Hurley Centre clinic in Durban.

“Most of the times when I, or a friend, went to a clinic the healthcare workers didn’t want to help us because of the way we smelled or how we looked,” Chantel Sampson recalls.

In 2018, the 42-year-old lived on the streets of Cape Town. As an unhoused person, Sampson was conscious of how she looked. She tried to make sure that she always “dressed up” so that she could be treated like a human being. 

“I would mostly go there [to the clinic] for HIV tests and contraceptives. I was not turned away but always ignored. Everyone else would get help except me,” she tells Health-e. 

Research shows that people living on the street face multiple health problems. This population is disproportionately affected by substance abuse, violence, malnutrition and illness. At the same time, use of healthcare services is particularly low among this group. 

Stigma and harsh judgements are a challenge to our clients when accessing services at public facilities,” says Sister Carla Horwood, nursing manager at the Bellhaven Harm Reduction Centre in Durban. The centre provides a host of free harm reduction services to the homeless and people from low-income communities who use drugs.

“They tell us that they’d rather not go to a hospital or clinic because of the way they are treated, based on the fact that they are experiencing homelessness, work as sex workers, or because they use drugs.”

Pads and tampons are scarce

A cocial worker at the Bellhaven Harm Reduction Centre, Torres Luna, adds that women living on the streets are not given adequate support when it comes to their health. 

“Most women living on the street don’t know the health services they are entitled to. They don’t have information on the health services that they need. When they go there, they should be informed. But by the time our clients come from public facilities, they don’t know the basics about their health and it’s because they were not treated fairly,” she says.

Many of the women coming into Bellhaven are often seeking contraceptives, which they can’t easily get at government health facilities where, they say, healthcare workers judge them for having sex. 

“Even those who are pregnant come here for checkups because they are scolded for having babies while living in the street by the healthcare workers. They also come with a lot of different sexually transmitted infections because of judgments when they want to access condoms.” 

Horwood says it is most surprising when she sees women in their 40s and 50s coming into the centre for their first ever pap smear. The World Health Organisation (WHO) recommends that women should have their first pap smear around the age of 21 years old

“They come and even ask for sanitary pads and tampons, because these are a scarce resource for them. A pap smear is a basic health assessment needed for women. Condoms are basic contraceptives that are a need. It’s not okay that women experiencing homelessness don’t have access to these basics.” 

Sexual reproductive health hygiene 

Streetscapes is a non-profit organisation in Cape Town that provides free well-being and healthcare services to people living on the streets. 

Vivien Pluddämen-Hobbs is a social worker with the organisation. She’s seen many clients scour for money to buy pads or tampons. This makes them less likely to buy disposable products. They rely on cloths and other items that they can clean and reuse.  

“It’s difficult for them because they don’t have easy access to public bathrooms, they don’t have consistent access to running water. It’s almost not possible to have a dignified bleed every month,” she says. 

“Some of my other clients have stopped menstruating because maybe they are not eating enough and the body is under constant stress.”

Menstrual cycles are irregular or stop completely for a period of time under environments of stress, poor diet, weak immune system, and multiple other reasons. 

Recognise them as a key population group

Raymond Perrier, director of the Denis Hurley Centre, says the organisation has observed that one of the factors keeping women who are homeless out of government clinics is that they are often mistreated by healthcare providers.

To help avert this, the Denis Hurley Centre established a clinic that has been running for ten years. Located in Durban, the facility serves people who are homeless, refugees, and people part of key population groups at increased risk of HIV infection such as sex workers and injecting substance users. The clinic also has a mobile unit that goes out into the streets where they find patients who need services. 

“We know that homeless women and men are not able to access healthcare, even though they are a vulnerable population, because of the conditions in which they’re living.”

The basic primary healthcare services offered at the centre are all free and include wound dressing, vaccinations, HIV and TB medication, and a medication adherence programme to ensure that people stay on track.

Perrier argues that people who are homeless should be recognised as a part of the key population groups that need to be attended to, and that healthcare workers need to be sensitised and educated about.

“People living in the streets are much more susceptible to being infected with HIV, TB, and other contagious diseases. They’re less likely to get healthcare when they ask for it, and they’re less likely to ask for healthcare because they’ve been socially excluded.” 

Advocating for the homeless

Following her COVID-19 diagnosis in 2020 while staying at a camp for people who are homeless in Strandfontein, Sampson made the decision to change her life and be sober. At the time, she was using crystal meth and mandrax. With the help of Streetscapes, she joined their rehabilitation programme. 

“I made a deal with God – that if I recovered from COVID-19 I would stop taking drugs. I recovered and my journey to sobriety began,” says Sampson.

Today, she is sober, reunited with her family, and able to be present for all six of her children. Sampson is now employed as a peer support specialist at the organisation.

“When I accompany some of our clients who are living on the street, I have to advocate for them at health facilities when healthcare providers ignore them or don’t provide services to them. This still happens a lot of the time,” she says. – Health-e News. 


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