Last week Ritshidze launched a detailed report into the state of healthcare services provided to key populations (KPs) — including men who have sex with men (MSM), people who use drugs (PWUD), sex workers, and trans* people. The report confirms that clinic staff are unfriendly, openly hostile or even abusive to KPs. Based on the results of interviews with thousands of KPs, the report was presented to the National Department of Health, PEPFAR and the Global Fund at a community accountability meeting in Mamelodi. You can find the presentation here and watch the full recording below.
Of the nearly six thousand KPs interviewed, most use public health facilities to get health services — including 86% of men who have sex with men, 85% of people using drugs, 76% of sex workers, and 75% of trans* people. However, nearly three quarters of those KPs were not “very satisfied” with clinic services.
Shockingly, a significant proportion of KPs even reported being refused access to services because of being a KP — including 14% of men who have sex with men, 12% of people using drugs, 13% of sex workers, and 11% of trans* people. In some provinces this was even more appalling with 38% of people using drugs in Limpopo reporting being denied entry to a health facility.
Ritshidze data reveal significant numbers of KPs do not think that privacy is respected at the clinic. One trans* woman told us that in the past, nurses have made her something of a show, a spectacle. “One time when I asked for lubricants, the nurse asked me why I needed it, and I had to say it’s for one, two, three and then she called other nurses to come and listen like this is something new,” she said of being treated with no respect for her confidentiality.
Where KPs do continue to suffer the daily indignities of using the public health system, specific services remain unavailable for the most part. KPs often struggle to access basic HIV prevention tools. Lubricants are often unavailable at the clinic — only 26% of men who have sex with men, 19% of people who use drugs, 28% of sex workers, and 25% of trans* people reported that lube is available. We heard reports from sex workers told to put condoms back because they had taken too many.
Harm reduction services — like methadone and unused needles, overdose treatment such as naloxone — are critically important to support people who use drugs to take drugs safely, or be supported to stop. Yet only 24% of people using drugs said methadone was available at drop-in centres and only 9% at clinics. One man explained how the clinic staff don’t treat people who use drugs as “human beings” instead “they are so judgemental… calling us names that make us feel offended.”
While drop-in centres often offer better suited and more friendly services, most KPs interviewed had never heard of a drop-in centre. This included 87% (840) of MSM, 81% (1123) of people using drugs, 74% (718) of sex workers, and 83% (419) of trans* people who were unaware of service delivery sites made especially for KPs.
KPs who did know about drop-in centres report not being able to afford the taxi fare or overnight accommodation needed to get to them. Millicent Sebotsa, a Ritshidze KP data collector explained she must pay R150 for a round trip to collect her hormone therapy in Johannesburg. She went on to explain that many people who approach the clinic nurses for help or information about hormone treatment are just dismissed.
This is just a snap shot of the issues discussed in the community accountability meeting. It was a space for KPs to talk directly to those in power, to report challenges and seek rapid interventions by the Department of Health, PEPFAR and the Global Fund. These duty bearers must do better to ensure quality healthcare provision for KPs. Continuous KP-led sensitisation training must be implemented for all clinical and non-clinical cadres with follow-up to assess impact. Clinic staff must be held accountable if they treat KPs poorly or do not protect confidentiality. As a first step, two public health facilities in every district should be identified as sites to provide KP specific services — and at the same time, drop-in centres and mobile clinics should be scaled-up to provide friendly, safe, well communicated, and quality services that KPs need.
Urgent and drastic improvement to the health system is critical to ensure that all KPs are treated with dignity and respect and can protect their own health and lives. Follow Ritshidze on twitter, facebook and instagram for regular updates or go to www.ritshidze.org.za for more.