Third edition Ritshidze report reveals friendlier services for some & denial of services for others in Eastern Cape clinics

  • 3rd edition of State of Health report compares data over the last three years of community-led monitoring in the Eastern Cape
  • The data, together with stories from people living with HIV, key populations and other public healthcare users, will be presented at two district community meetings — in Buffalo City (19 September) and OR Tambo (21 September) this week
  • The meetings will be live streamed on vimeo/vimeo, facebook and YouTube/YouTube.

East London, 19 September 2023 — “I asked for ARVs and explained why I don’t have a transfer letter. The clinic made it difficult… I spent the whole year without treatment.”

For some people who move to a new place or relocate for work, getting access to lifesaving ARVs becomes a challenge. In the last year, a staggering 503 people interviewed in the Eastern Cape 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*. 

One community member explained: “I have not taken my treatment in a few months because the facility requires a transfer letter. I suggested that they test and reinitiate me… but they said that would be difficult. I gave up and stopped trying.Another told us that he had not gotten treatment for eight months because the clinic “refused to email the transfer letter”.

Members of key populations we interviewed had also been denied services: including 4% of gay, bisexual, and other men who have sex with men, 20% of people who use drugs, 25% of sex workers, and 21% of trans people. 

“I was chased away by the security guard, who told me the clinic is not a place for “addicts” and I should go get cleaned up first”, one person told us. Another recounted how after going to one clinic and being “told to go away”, he went to a second only to be refused again: “they told me it is useless for me to get medication because I will go back to drugs… After I tried these places, I lost all hope”.

A further 294 people had been denied services because they did not have an identity document. 

Being refused health services is among ten key issues outlined in the third edition of a new Ritshidze State of Health report in the Eastern Cape. The report will be launched at two district community meetings this week — in Braelyn today (Buffalo City), and Ikwezi on Thursday (OR Tambo)

Other key issues include challenges to people collecting ARVs at pick-up points — either at the facility or in the community. This can reduce the burden on facilities — and should make it quicker and easier for people living with HIV.

One community member summed up how much better it was to collect at an external pick-up point: “I arrive at any time with no queues. I just collect my medication and leave. When you come to the clinic, you cancel all your appointments for the day and devote your time to waiting at the clinic”.

Despite benefits for the health system and people living with HIV, more than half of people living with HIV (59%) said they had never even been offered one of these options — and almost half (49%) wish they could collect their ARVs closer to home. Of those using facility pick-up points, 70% of people using facility pick-up points told us that they must still collect files, take vitals, and see a clinician before getting their parcel — making clinic visits drag on for hours. 

“I have to be up at 4am and queue with other patients. Usually, our treatment is not pre-packed or ready for collection,” one person using a facility pick-up point explained.

Another said: “We spend the whole day there until 3pm just to submit prescriptions to the dispensary. This caused me to stop taking treatment.”

On a more positive note, 74% of public healthcare users thought that clinic staff were always friendly and professional, a major improvement from only 55% last year. However, members of key populations reported a different story. One trans woman explained being forced to use a “men’s corner” for clinic services out of malice by staff. “It was very horrible for me what they did — just traumatising.

There also continue to be reports of 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 will attend to you after all other patients have left the facility if you miss your appointment regardless of waking up at 3am or 4am,” one person told us. Another explained how the nurse chased her away after she lost her clinic card saying “I don’t have time for defaulters, there are serious people that seek my help”. 

Overall, these shortcomings contribute to slow progress towards getting everyone to start and stay on HIV treatment. One woman summed it up saying it can also feel like healthcare isn’t the priority at the clinic — rather, the priority is simply  just putting people through a system. She says: “That can’t be right.” 

* DMOC Standard Operating Procedures 2023: “While referral letters are helpful, a patient cannot be required to leave the facility without treatment to first obtain a referral/transfer letter”.

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 Eastern Cape State of Health report; the first was published in September 2021, and the second in September 2022

This week, Ritshidze is providing a platform for community members to raise their concerns directly to the Buffalo City and OR Tambo health departments, the Eastern Cape health department and national health departments, and PEPFAR partners working in the province, MatCH and TB HIV Care. Duty bearers are afforded the right to respond. 

To follow proceedings virtually please join at: 

Buffalo City: Tuesday 19 September: 

Vimeo | YouTube

OR Tambo: Thursday 21 September: 

Vimeo | YouTube

The full Eastern Cape State of Health report is available here

The full Eastern Cape presentation is available here

The Buffalo City presentation is available here

The OR Tambo 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 46 facilities across the Eastern Cape: 9 in Alfred Nzo, 6 in Amathole, 11 in Buffalo City, 6 in Chris Hani and 14 in OR Tambo. 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 46 Facility Managers
  • Observations took place at 46 facilities 
  • Interviews took place with 2,514 public healthcare users
  • 55% (1,388) identified as people living with HIV
  • 17% (426) 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 four districts: Amathole, Buffalo City, Nelson Mandela Metro, and OR Tambo. A total of 1,607 surveys were taken, combining 682 gay, bisexual, and other men who have sex with men (GBMSM), 549 people who use drugs, 156 sex workers, and 220 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.