Fourth edition Ritshidze report reveals unwelcoming services and long delays at Gauteng clinics

  • 4th edition of State of Health report compares data over the last four years of community-led monitoring in Gauteng.
  • The data, together with stories from people living with HIV, key populations and other public healthcare users, will be presented at three district community meetings — in Ekurhuleni (21 November), City of Tshwane (22 November), and Johannesburg (23 November) this week
  • The meetings will be live streamed on vimeo/vimeo/vimeo, facebook and YouTube/YouTube/YouTube.

Tembisa, 21 November 2023 — “We fear the staff attitude. We get shouted at and are spoken to like children. You become scared to go to the clinic and can stop going altogether.” 

Reports of unwelcoming clinics in Gauteng are common. People feel afraid to go, and find staff unapproachable when they are there. Ritshidze data reveal that only 65% of people thought that clinic staff were always friendly. 

While not everywhere, in certain facilities there remains a culture of bullying and belittling people. This can make people want to give up on getting health services. “The nurses scold you when you ask questions. That place brings us no joy at all… I even stopped collecting my treatment”, one person living with HIV told us

Unfriendly services are among ten key issues outlined in the fourth edition of a new Ritshidze State of Health report in Gauteng. The report will be launched at three district community meetings this week — in Tembisa today (Ekurhuleni), Mabopane tomorrow (City of Tshwane), and Diepkloof on Thursday (Johannesburg)

Other issues include people living with HIV being shouted at or sent to the back of the queue if they are late for an appointment — which goes against ART guidelines that clearly say that no punitive action is allowed for a late or missed appointment. 

They ignore you and make you wait a very long time if you miss your appointment by a day,” someone told us. Another said I missed my appointment yesterday. When I arrived today I was told I would be assisted last. I was not happy because I arrived early just like everyone else”. 21% of people we interviewed said that staff sent them to the back of the queue for a late/missed appointment.

Those who go back to the clinic after a treatment interruption can also be met with hostility. “The social worker told me how useless I was and that hurt me… She spoke to me as if I was a piece of rubbish,” one community member told us.  

For members of key populations, the situation can be even more cruel. After testing positive for HIV, one sex worker told us how humiliated and distraught she felt when the nurse said “why should the government waste money treating people like you? You disgust me”. 

Similarly, a man we spoke to who uses drugs described how hurt and embarrassed he felt when the nurse openly gave him his ARVs in the waiting area saying, “we are really tired of you… why can’t you just die because you’ve already killed yourself with drugs. You don’t even bathe and don’t like yourself” — this while other people in the waiting area were staring and taking pictures.

Many members of key populations blame this poor treatment for why they had stopped going to the clinic altogether — including 13% of gay, bisexual, and other men who have sex with men, 21% of people who use drugs, 10% of sex workers, and 11% of trans people. As one person who uses drugs summed up: “I am scared to go to the clinic. I would rather die than go”.

On a more positive note, average waiting times have reduced in the province over the last year, from 3:54 hours down to 3:20 hours. However, 45% of public healthcare users interviewed still think waiting times are long — and waiting all day at the clinic remains a frustrating reality. 

“I wake up at 3am to try and get there early… but I come back home at 4pm. It doesn’t matter how early you get there,” one person told us. Another referred to the long queues as a “disaster” saying, “if you arrive in the morning, you will leave around 5pm or 6pm. They don’t care. Sometimes you’ll be told to go and buy medication.

Waiting times are only worsened when people’s medical files go missing — and at times people are forced to open new files, losing their patient history, or are denied health services altogether. 

Ritshidze monitors reported that filing systems were in a bad condition at 27% of sites in the province. “They can search for your file for an hour and come back to tell you that your file is lost… sometimes we leave the clinic without help”, one person explained to us. 

Another challenge identified is people struggling to get ARVs when they move to a new place or relocate for work. In the last year, 338 people interviewed in Gauteng had been denied services because they did not have a transfer letter — something that is not required by ART guidelines to start or restart your ARVs. Alarmingly 878 people also told us they had been denied services without an identity document. 

I didn’t have a transfer letter because I lost my belongings… They said I should go and get a transfer letter where I come from. I told the woman that I couldn’t go back… I’ve defaulted now,” one person explained. Another said “I told them I had lost my transfer letter, but my ARVs had run out… they didn’t even give me a chance to explain my situation, they just wouldn’t help me.” 

Overall, these failings in the health system contribute to slow progress towards getting everyone to start and stay on HIV treatment. This year’s report continues to call for urgent action and reform. Gains made in the HIV response in South Africa cannot be undermined by poor quality healthcare services.

For more information or to arrange interviews contact:

Ngqabutho Mpofu | +27 72 225 9675 | 

Lotti Rutter | +27 82 065 5842 |

Note to editors:

This is the third edition of the Gauteng State of Health report; the first was published in December 2020, the second in November 2021, and the third in January 2023.

This week, Ritshidze is providing a platform for community members to raise their concerns directly to the Ekurhuleni, City of Tshwane, and Johannesburg health departments, the Gauteng health department and national health departments, and PEPFAR partners working in the province, Anova and Wits RHI. Duty bearers are afforded the right to respond. 

To follow proceedings virtually please join at: 

Ekurhuleni: Tuesday 21 November: 

Vimeo | YouTube | facebook

City of Tshwane: Wednesday 22 November: 

Vimeo | YouTube | facebook

Johannesburg: Thursday 23 November: 

Vimeo | YouTube | facebook

The full Gauteng State of Health report is available here

The full Gauteng presentation is available here

The Ekurhuleni presentation is available here

The City of Tshwane presentation is available here

The Johannesburg 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 129 facilities across Gauteng: 29 in the City of Tshwane, 40 in Ekurhuleni, 46 in Johannesburg, 13 in Sedibeng. Ritshidze collects data through observations, as well as through interviews with healthcare users and healthcare providers. All monitoring tools are available here: 

Data in this report were collected between July and August 2023 (Q4 2023).

  • Interviews took place with 129 Facility Managers
  • Observations took place at 129 facilities 
  • Interviews took place with 6,679 public healthcare users
    • 51% (3,426) identified as people living with HIV
    • 12% (786) 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 2022 across three districts: Ekurhuleni, Johannesburg, and Sedibeng. A total of 1,651 surveys were taken, combining 234 gay, bisexual, and other men who have sex with men (GBMSM), 775 people who use drugs, 494 sex workers, and 148 trans people.

Follow Ritshidze on twitter, facebook and instagram for regular updates or go to for more information.


“Ritshidze” — meaning “Saving Our Lives” in TshiVenda — has been developed by people living with HIV and activists to hold the South African government and aid agencies accountable to improve overall HIV and TB service delivery.

Partner organisations include 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+)—in alliance with Health Global Access Project (Health GAP), the Foundation for AIDS Research (amfAR), and Georgetown University’s O’Neill Institute for National and Global Health Law.

CLICK HERE to read more and see where we work.