Public health facilities in KwaZulu-Natal (KZN) face a shortage of health workers; there are limited pick-up points for HIV treatment; and key populations continue to face hostile attitudes from healthcare workers and a lack of privacy. 

These are just some of the findings of a new report compiled by Ritshidze, a coalition of non-profit HIV advocacy organisations. The report was launched on Tuesday. 

There is also a lack of information about access to harm reduction services. These services include the provision of methadone treatment to help people who are dependent on heroin, and the supply of clean needles for injecting drug users. Key populations who are most vulnerable to HIV acquisition are denied health services. And there is a lack of essentials such as lubricants in most facilities.

Ritshidze monitoring is conducted on a quarterly basis at about 400 clinics and community healthcare centres in eight South African provinces, and 126 of these facilities are in KZN. 

Data in this report was collected between July and August 2023 and over 7,231 public healthcare users were interviewed.

Key populations bear the brunt

Key populations include gay men, other men who have sex with men, sex workers, transgender people, and people who inject drugs. 

The report states that, in the last year, many people were turned away from health facilities for simply being lesbian, gay, bisexual, transgender, intersex, queer/questioning asexual (LGBTQIA+). Sex workers and drug users were also refused access to health services. 

“The issues outlined in this report give us the reasons why, despite clear and positive progress, not everyone is on HIV treatment yet, and why other people do not access HIV prevention options,” reads the report.

The report also indicates that receiving ARVs through pick-up points remains a challenge in the province. Patients who use these services have to jump many hurdles. 

“Sixty three percent of people using facility pick-up points told us that they must still collect files, take vitals and see a clinician before getting their parcel, adding unnecessary delays. Of those still using the facility, 35% report that they had never been offered the option to collect from a pick-up point and 37% wish they could collect their ARVs closer to home,” reads the report.

Patients’ stories

The report also found that lubricants were only available at 26% of the facilities  that were monitored by Ritshidze.

“I hardly get lubricants as they are always out of stock.  But condoms are outside so you can just take as many you want,” says Pretty* Zulu, a sex worker, using Pennington Municipal Clinic in Ugu for health services. She was interviewed by Ritshidze in August 2023.

Mpho Diamonds*, a non-binary person who uses drugs and relies on Addington Hospital in eThekwini for health services. They say that the attitude of staff towards LGBTQIA+ individuals is very bad at the facility.

“They behave like they are seeing something that they are not used to and when the nurse was drawing blood, she was rushing and I still have the scar. It was like she just wanted to get away from me,” says Diamonds*. Diamonds was interviewed by Ritshidze in September 2023.

Mavis Buthelezi* a transgender woman, access healthcare services at Marburg clinic in Ugu. She says that she is stigmatised because of her sexuality. She was interviewed by Ritshidze in August 2023.

“Overall experience is fine but regarding my sexuality, it is not fine because I believe there is a lot of stigma. It is a clinic that has a wide range of nurses from different races, and due to religious reasons, some nurses don’t take it well if you need services that consider your sexual health or need you to disclose your sexuality. Those are the challenges I can say I am facing,” says Buthelezi. 

Patrick Ntuli* a transgender man, who uses Mbunde clinic in Ugu for health services, says that key populations are discriminated against at the facility. He was interviewed by Ritshidze in August 2023.

“They do not ask all the normal questions or do any examinations. It is like our sexuality is going to jump on them like we are contagious. If I, who is a known activist in the community, still face all these challenges, I wonder how bad the rest of the LGBTQI members in the community gets treated. Especially those who are in the rural and semi-rural clinics where they have staff that are older and are stuck in their ways,” says Ntuli.

Notable improvements

But it is not all doom and gloom in KZN. The report states that there have been some improvements. These include shorter waiting times, more people getting three months’ supply of ARVs, and friendlier staff in some of the facilities.

“Average waiting times have reduced from 2:39 hours to 2:18 hours. KZN continues to have the shortest waiting times out of all the provinces which are monitored by Ritshidze,” reads the report.

According to the report 83% of public healthcare users thought that clinic staff were always friendly and professional. But only 25% of gay, bisexual and other men who have sex with men reported that staff are always friendly. And only 22% of people who use drugs and 37% of sex workers and only 32% of transgender people.

“The majority did not feel safe or comfortable at the facility and major privacy violations still occur,” reads the report.-Health-e News.

*Indicates a name change.