Ritshidze data reveal improved services for people living with HIV in KwaZulu-Natal clinics but key populations are being left far behind

  • 2nd edition of State of Health report compares data over the last year of community-led monitoring in KwaZulu-Natal.
  • The data, together with stories from people living with HIV, key populations and other public healthcare users, will be presented at a community meeting today.
  • The meeting will be live streamed on vimeo, facebook and YouTube.

Umlazi, 10 November 2022 — Being a sex worker, using drugs, or belonging to the LGBTQIA+ community should not mean you are rejected by the very healthcare system that should support you. Yet for communities of key populations in KwaZulu-Natal, unfriendly, and even openly hostile staff, can be unbearable to put up with.

“The clinic staff should not discriminate against us because sometimes we come dirty,” a community member who uses drugs told us. “Most guys die on the road while there is a clinic next to them because they know they will not get help.” 

Ritshidze data reveal that only 28% of people said facility staff are always friendly and professional towards gay, bisexual, and other men who have sex with men, only 19% towards people who use drugs; only 16% towards sex workers; and only 34% towards trans* people. This poor treatment can be off putting enough for people to stop going to the clinic altogether.

As one sex worker put it: “They treat us badly, they judge us…Some of the people that I work with have stopped going for their HIV medication because of the type of attitude that they get when you get there. They should treat us like human beings”.

Poor treatment of key populations is among eleven key issues outlined in the second edition of a new Ritshidze State of Health report. The report will be launched at a community meeting in Umlazi, Durban today. The report reveals that the province is performing worst in providing dignified and specific services to key populations — yet has improved performance in several other areas including reducing waiting times, confidentiality, and providing longer ARV refills. 

Waiting times have reduced from 3:20 hours to 2:39 hours waiting after the facility opens. 30 facilities even had average waiting times under 2 hours — the only province to do so. Ritshidze data show that KwaZulu-Natal continues to have the shortest waiting times of all provinces monitored this year. Yet more must be done. Of 7,857 public healthcare users interviewed, 48% still thought that waiting times are long. 

As one community member explained: “You wake up in the morning and roam around the house because you have anxiety, but then you have to go to the clinic. You know that when you leave home at 5am you’ll be back at 8pm at night… Every time I had to go I’d feel discouraged. I stopped taking treatment last year”.

38% of people who identified long waiting times blamed staff shortages for the long hours waiting.There has been no improvement in staffing levels since last year’s report with 81% of facilities still reporting shortages and 449 vacancies still open (up from 400 last year). The report calls for all at least 70% of vacancies to be filled by March 2023.

Other community members called for the length of ARV refills to be extended so that people living with HIV can make fewer trips to the clinic, easing the burden on overstretched facilities and supporting people to stay on treatment. As one community member put it: “When you arrive in the morning you sit the whole day at the clinic. It is hard… If it were possible to get 3 or 6 months refill, maybe it would be better.”

Positively many more people living with HIV reported 3 to 6 month refills this year, up from 31% to 49%. However, while progress is being made, this still remains low in comparison to other PEPFAR supported countries where 80% of people living with HIV received 3 to 6 month ART refills in 2021. The report calls for the health department and PEPFAR implementing partners — Broadreach and Health Systems Trust — to ensure that all eligible people get 3 month supplies by May 2023. 

Providing friendly and welcoming services is another way to support long-term retention. Positively 82% of people thought that the staff were always friendly and professional, up from 75% last year — and 95% of people living with HIV say that facilities keep their HIV status confidential. KwaZulu-Natal is performing best out of all provinces monitored by Ritshidze on these indicators. 

However, it is important to note that Ritshidze interviews take place at the facility, so people who have already stopped going to the clinic are not at the facility to interview. Our interviews in the community continue to reveal poor treatment:

“If you miss an appointment they scold us in public instead of engaging us as adults…. They use harsh words, calling us stupid, asking if we want to live or die. I lost hope… If you appear to be a “defaulter” on the system, the nurse will line you up and force you to walk around the clinic, singing that you are a “defaulter”.”

“We salute where the KwaZulu-Natal health department and health facilities in the province have made clear improvements and are out-performing other provinces. However, for people who use drugs, sex workers and LGBTQIA+ communities the province needs to urgently sensitise staff and actually hold them accountable to provide dignified and welcoming services,” says Anele Yawa, from the Treatment Action Campaign (TAC).

“Where other challenges remain, the health department should continue to take rapid action to fix our clinics, so that everyone can access the HIV, TB and other health services they need. The department must also get out into our communities to rebuild trust, to encourage those who have stopped going to the clinic before these improvements took place to return.” 

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 second edition of the KwaZulu-Natal State of Health report; the first was published in September 2021. Like the earlier edition, the second edition of the KwaZulu-Natal State of Health report outlines key challenges people living with HIV, key populations and other public healthcare users face in the province. The report focuses on the following critical themes: staffing; waiting times; ART collection; ART continuity; treatment and viral load literacy; accessibility of health services for key populations; specific services for men; the implementation of index testing to find people living with HIV; infrastructure and clinic conditions; TB infection control, and stockouts and shortages of medicines and other health products.

Today, Ritshidze is providing a platform for community members to raise their concerns directly to the KwaZulu-Natal health department, district and national health departments, and PEPFAR partners working in the province, Broadreach, and Health Systems Trust. To follow proceedings virtually please join at: https://vimeo.com/768918874 

The full KwaZulu-Natal State of Health report is available here

The full presentation is available here

A summary report is available here

A summary of recommendations is available here

The media alert is available here

A recording will be available after the event on the Ritshidze website, Facebook, and YouTube channels.

About Ritshidze: 

With the establishment of 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+) — we are more systematically documenting the failures in quality HIV, TB and other health service delivery at 131 facilities in KwaZulu-Natal: 67 in eThekwini, 1 in iLembe, 13 in King Cetshwayo, 15 in uMgungundlovu, 11 in Ugu, 15 in uThukela, 9 in Zululand.

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 July 2022 and August 2022 (Q4 2022):

  • Interviews took place with 128 Facility Managers
  • Observations took place at 130 facilities 
  • Interviews took place with 7,973 public healthcare users
  • 52% (4,173) identified as people living with HIV
  • 68% (5,491) identified as women
  • 22% (1,713) identified as young people under 25 years of age

Additional quantitative data related to key populations was collected between August and October 2021. Data collection took place across three districts: eThekwini, Ugu, and uMgungundlovu. A total of 878 surveys were taken, combining 171 gay men, bisexual men, and other men who have sex with men (GBMSM), 284 people who use drugs, 221 sex workers, and 202 trans* people.
Follow Ritshidze on twitter, facebook and instagram for regular updates or go to www.ritshidze.org.za 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.