- 4th edition of State of Health report compares data over the last four years of community-led monitoring in Mpumalanga
- The data, together with stories from people living with HIV, members of key populations and other public healthcare users, will be presented at two district community meetings — in Gert Sibande (30 July) and Ehlanzeni (1 August) this week
- The meetings will be live streamed on vimeo/vimeo, facebook/facebook and YouTube/YouTube.
Ermelo, 30 July 2024 — “I was turned away. I walked out crying. I could not get contraceptives. When I came back I discovered I was pregnant. I was shouted at. They said that treatment is not free, that I should not have come from Mozambique. We are not attended to if we do not have IDs. They are chasing us out and shouting at us. They even wanted to call the police.”
In the last year 230 people interviewed by Ritshidze across Mpumalanga had been denied services because they did not have an identity document. A further 185 people had been denied health services for not having a transfer letter — something that is not required in national ART guidelines to start or restart your ARVs.
Shockingly 131 of these reports came from Nkangala alone — where 15% of respondents told us they had been denied services without a transfer letter.
Members of key populations we interviewed had also been refused access to health services. An astounding 8% of gay, bisexual, and other men who have sex with men (GBMSM), 18% of trans people, 20% of sex workers, and 40% of people who use drugs we interviewed had been denied services in the last year — worsening from data collected the previous year.
One person who uses drugs described how “they chase you out without any medication. It is all the staff that treat us this way. They support each other in chasing us away from the clinic”. 14% of people who use drugs we spoke to also reported having been denied access to their lifesaving HIV treatment in the last year.
Being denied services is a humiliating, painful, and unjust experience to go through — and a violation of the Constitutional right to health, equality, and human dignity. While some people may suffer the indignity of trying to get services another time, others can be pushed out of care altogether.
Denial of health services are among ten key issues outlined in the fourth edition of a new Ritshidze State of Health report in Mpumalanga. The report will be launched at two district community meetings this week — in Ermelo today (Gert Sibande) and Kabokweni on Thursday (Ehlanzeni).
Another issue in the report is about the lack of friendliness at clinics. This year 42% of people thought staff were never friendly, or only sometimes friendly.
“They have a bad attitude. They are nurses but they don’t want to even explain one or two things to us. I’m not asking for anything special, just that they help us patients,” one community member explained to us.
When people living with HIV disengage from treatment for any reason, clinicians should meet them with support when they return. However when they return, instead of being asked how treatment collection could be made easier, too many are shouted at or made to wait all day.
“The Facility Manager insulted me and asked why I didn’t come on my date,” one sex worker remembered. “He said that I would have to wait until all the people who came on their date would be served”. 18% told us that staff still send them to the back of the queue if they miss or are late for their appointment — yet national ART guidelines say this must not happen.
Commonly people who are queer or trans, use drugs, or engage in sex work, face uncaring and even abusive treatment in our clinics. One person who uses drugs told us: “they would say things like ‘you are smelling, why don’t you bathe yourself’. You cannot even stand in the queue with the other people. I’ve stopped my HIV treatment since January…. When it finished I did not want to go back…. I’m scared”.
Only 39% of trans people, 37% of GBMSM, 27% of sex workers, and 14% of people who use drugs said that facility staff were actually nice to them. Many also reported that staff treated them worse after they found out they were a member of a key population. “They are just homophobic at that clinic. The nurses will laugh at me, gossip about me and just discriminate. The service was bad to begin with but it just got worse ever since they found out that I’m gay,” one man explained.
The availability of lubricant is another challenge. Despite being a basic HIV prevention tool only 29% of clinics monitored had lubricant available. “I do get condoms there, but no lubricants. I gave up asking for lubes and just buy them. When you ask, they will tell you it is unavailable,” one gay man told us.
For those who did ask for lubricants, too often staff were disrespectful. One sex worker recounted how “the Facility Manager threw me out like a dog… I told her that I didn’t have money to buy lubricant and pleaded with her, explaining that I was a sex worker. She told me she would not give me the lubricant because we apply it on our faces… I walked out embarrassed… I will never go back to that clinic”.
Another challenge outlined in the report is that not all people taking ARVs understand the benefits of taking their pills every day. Only 84% of those interviewed understood that having an undetectable viral load means treatment is working well — and just 70% understood that having an undetectable viral load means a person cannot transmit HIV.
One person told us that: “when they do a viral load test they don’t tell you the results. Ever since I have taken treatment I don’t know what my viral load is”. Mpumalanga scored the worst across all provinces monitored by Ritshidze in ensuring people understood the importance of an undetectable viral load.
For those with an elevated viral load, quality counselling and support is critical. Instead though, too often people can be dismissed out of hand and left confused and frustrated. “They informed me that my CD4 count dropped and that they would put me back on the evening pill and monitor me… I am confused and don’t know what’s happening,” one person told us.
This year’s report continues to call for urgent action and reform to improve health services across health facilities in Mpumalanga. We simply cannot get everyone on HIV treatment while denying people entry to clinics or access to services, or by making conditions intolerable. These failures of the healthcare system are only perpetuating the spread of HIV. Keeping people on treatment, regardless of who they are, or where they come from (infectious diseases do not know boundaries), is essential to stopping the spread of HIV. Public healthcare users should be provided services and treated with dignity, respect, and compassion in our clinics. It is a key principle of health service provision. In the words of one community member: “I wish they could change the staff at the clinic to those who understand us… and show us some love and care”.
For more information or to arrange interviews contact:
Ngqabutho Mpofu | +27 72 225 9675 | ngqabutho.mpofu@tac.org.za
Lotti Rutter | +27 82 065 5842 | lotti@healthgap.org
Note to editors:
This is the fourth edition of the Mpumalanga State of Health report; the first was published in May 2021, the second in June 2022, and the third in June 2023.
Today, Ritshidze is providing a platform for community members to raise their concerns directly to the Mpumalanga health department, the Gert Sibande and Ehlanzeni district health departments, the national health department, and PEPFAR partners working in the province, BroadReach and Right to Care. Duty bearers are afforded the right to respond.
To follow proceedings virtually please join at:
Gert Sibande: Tuesday 30 July:
Ehlanzeni: Thursday 1 August:
The full Mpumalanga State of Health report is available here
The full Mpumalanga presentation is available here
The Gert Sibande presentation is available here
The Ehlanzeni presentation is available here
A summary report is available here
A summary of recommendations is available here
About the report:
The report has been developed using data from Ritshidze — a community-led monitoring system developed by organisations representing people living with HIV, including the Treatment Action Campaign (TAC), the National Association of People Living with HIV (NAPWA), Positive Action Campaign, Positive Women’s Network (PWN), and the South African Network of Religious Leaders Living with and affected by HIV/AIDS (SANERELA+).
Ritshidze monitoring takes place on a quarterly basis at more than 400 clinics and community healthcare centres across 29 districts in 8 provinces in South Africa — including 45 facilities across Mpumalanga: 23 in Ehlanzeni, 18 in Gert Sibande, and 4 in Nkangala. Ritshidze collects data through observations, as well as through interviews with healthcare users and healthcare providers. All monitoring tools are available here: https://ritshidze.org.za/category/tools/
Data in this report were collected between April 2024 and May 2024 (Q3 2024).
- 45 facilities were assessed
- Interviews took place with 45 Facility Managers
- Observations took place at 45 facilities
- Interviews took place with 2,389 public healthcare users
- 52% (1,253) identified as people living with HIV
- 13% (313) identified as young people under 25 years of age
Additional quantitative and qualitative data were collected within the community specific to the quality and friendliness of health services provided for people who use drugs, sex workers, and the LGBTQIA+ community. Data collection took place between July and September 2023 across three districts: Ehlanzeni, Gert Sibande, and Nkangala. A total of 1,489 surveys were taken, combining 217 gay, bisexual, and other men who have sex with men (GBMSM), 805 people who use drugs, 326 sex workers, and 141 trans people.
Follow Ritshidze on twitter, facebook and instagram for regular updates or go to www.ritshidze.org.za for more information.
