Ritshidze survey of nearly six thousand people reveals major crisis in health system for key populations

Mamelodi, 27 January 2022 — Today Ritshidze is launching a new 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. Based on the results of thousands of interviews with KPs, the report will be presented to the Department of Health and other duty bearers at a community meeting in Mamelodi.

“The report confirms the persistent and unaddressed crisis KPs face in accessing healthcare in South Africa. Often clinic staff are unfriendly, openly hostile, and especially abusive to KPs. At times people are even chased away from using facilities altogether. Together with shameful privacy violations, this ill-treatment drives KPs away from using our clinics,” said Nkhensani Mavasa, a KP Organiser from Ritshidze. 

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. Poor staff attitudes, lack of safety and lack of privacy were the main complaints reducing overall satisfaction — just 42% of MSM thought clinic staff are always friendly and professional; 41% of PWUD; 42% of sex workers; and 46% of trans* people. 

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. This is a complete violation of the Constitutional rights to equality and access to health care services.

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. Those who did know about them, report not being able to afford the taxi fare or overnight accommodation needed to get to them. 

Where KPs do continue to suffer the daily indignities associated with 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. 

Ritshidze data reveals that only 5% of trans* people have access to hormone therapy at drop-in centres and only 7% at facilities. For Millicent Sebotsa, a Ritshidze KP data collector, the roundtrip to collect her hormone therapy costs R150 as the services are not available in her province in the North West. She says that many people who approach the clinic nurses for help or information about hormone treatment are just dismissed.

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.” 

“KPs must be treated with dignity and respect to protect their own health and lives. It is also vital to ensure that those most at risk of getting HIV can access the treatment and prevention tools needed to meet the UNAIDS 95-95-95 targets and move South Africa towards epidemic control,” said Sibongile Tshabalala, from the Treatment Action Campaign (TAC).

To follow proceedings virtually please join at: https://vimeo.com/670591756/ee8dc5c3ca

The full State of Healthcare for Key Populations report is available here.

A summary presentation is available here.

A recording will be available after the event on the Ritshidze websiteFacebook and YouTube channels.

For more information and interviews contact:

Ngqabutho Mpofu | +27 72 225 9675 | ngqabutho.mpofu@tac.org.za 

Lotti Rutter | +27 82 065 5842 | lotti@healthgap.org 

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

Ritshidze is a programme of the PLHIV Sector made up of the National Association of People Living with HIV (NAPWA), Positive Action Campaign, Positive Women’s Network, the South African Network of Religious Leaders Living with HIV (SANERELA+), and the Treatment Action Campaign (TAC).


In order to document the challenges facing KPs, last year Ritshidze began a large-scale quantitative and qualitative data collection effort. KPs who took part were identified through snowball sampling, where initial participants were asked to refer those they know, who in turn refer those they know, to participate in the survey. Compared to a facility-based sample, this methodology allowed us to find more “hidden” KPs who may not use the facility and those more regularly accessing services. A team of more than 50 KP data collectors were recruited to support the data collection effort, including mobilisation, implementation of tools, analysis, and reporting. 

A total of 5,979 surveys were taken, combining 1,476 MSM, 2,397 PWUD, 1,344 sex workers, and 762 trans* people. Some individuals with multiple identities (e.g. a trans sex worker or a sex worker who also uses drugs) engaged in more than one survey to reflect their differing identities. 

The quantitative data collection took place between August and October 2021. Data collection took place across 18 PEPFAR supported districts in 7 provinces. Qualitative data collection took place from March 2021 to November 2021.


“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.