Patients using public healthcare facilities in Gauteng report being refused access to healthcare services, shortage of healthcare workers, hostile services and punitive action for people on antiretroviral therapy (ART) who miss appointments to collect treatment.

These are some of the findings which have been outlined in a new report by Ritshidze, a coalition of non-profit HIV advocacy organisations, released this week. 

Despite being at a higher risk of HIV infection, key populations such as men who have sex with men and sex workers report being refused access to health services. Those who do access services often face hostility from healthcare workers. Important products in the prevention of HIV and other sexually transmitted infections such as lubricants remain unavailable in most facilities in Gauteng.

Ten percent of gay, bisexual and other men who have sex with men who took part in the report were denied care. The estimate was 23% among people who use drugs; 8% among sex workers, 6% among transgender people.   

The report also indicates that people who use drugs had limited access to harm reduction services such as clean needles and methadone. Only 9% of injecting drug users were given information about where they could get new needles. Only 17% of drug users were given information about where to get methadone.

Patients safety concerns

The report found that 24% of patients who arrive at facilities before 6am felt “very unsafe” when waiting for the clinics to open their gates.

This is the fourth edition of the annual report. Data in this report were collected between July and August 2023. And interviews with healthcare users were collected from March 2023. More than 6, 670 public healthcare users were interviewed. More than half (51%) were living with HIV, and 12% were younger than 25. 

“The issues outlined in the fourth edition of the state of health report put a spotlight on the ongoing reasons why people do not want to go to the clinic. These barriers together with the frequent frustration and hurt people experience, all contribute to us falling short of getting everyone on HIV treatment, or accessing the HIV prevention options,” reads the report.

Only 65% of people reported that staff were always friendly and professional and only 35% of people living with HIV who had missed appointments said staff welcomed them back.

“Twenty-one percent said they were sent to the back of the queue, which goes against ART guidelines that clearly say that no punitive action is allowed for a late or missed appointment,” reads the report.

Patient views

Catherine Khumalo*, a sex worker who accesses health services at Empilisweni clinic in Sedibeng says that she would like to see healthcare workers change their attitude towards sex workers.

“They must treat us well as human beings. The way they are treating us is bad as they would make you join the end of the line even if you came first and if I go to the clinic and ask for pills, they should stop calling me names but treat me with respect as they are there to help us and not to judge us,” says Khumalo*. She was interviewed by Ritshidze in April this year.

Mpho Motau*, who uses drugs says that he was humiliated by healthcare workers at Singobile clinic in Johannesburg. He was interviewed by Ritshidze in March 2023.

“The nurse gave me my pills (ARVs) in front of everyone and said ‘we are really tired of you, who knows maybe you are smoking these pills, why can’t you just die because you have already killed yourself with drugs and you don’t even bathe and don’t like yourself’,” explains Motau*.

Motau* says that he felt offended as everyone at the clinic was staring at him and some were blocking their noses and others were taking pictures.

Mavis Ndlovu*, a sex worker who uses Kingsway Municipal clinic in Ekurhuleni says that a nurse refused to assist her after she tested positive for HIV. She was interviewed by Ritshidze in March 2023.

“The nurse tested me and it came back positive. I cried and asked her to help me with the medication and she said ‘why do you bother us? Why should the government waste money on treating people like you rather than giving the medication to the patients who deserve it?’,” explains Ndlovu.

She says that she felt humiliated and hated herself after the ordeal. “I was crying and begged the nurse to help me and she told me to stop ‘prostitution’ because I will kill people’s children with AIDS and she said that I disgusted her,” says Ndlovu.

Notable Improvements

According to the report, waiting time for patients at the monitored facilities have improved in the last year, from an average of 3:34 hours to 3:04 hours. 

More people are currently receiving 3-6 month ART refills.

Also, there has been an increase in the number of people collecting their ARVs at nearby collection points instead of in the facility, up from 51% to 65%. 

“However, 66% of people using facility pick-up points said they must collect files, take vitals, and see a clinician before getting their parcel, adding to delays at the facility,” reads the report.-Health-e News.

*Indicates a name change. Photos by Rian Horn, Ritshidze