Third edition Ritshidze report reveals only 3% of people living with HIV got an ARV refill of 3 months or more in Free State

  • 3rd edition of State of Health report compares data over the last three years of community-led monitoring in the Free State
  • 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 Thabo Mofutsanyana (30 August) and Lejweleputswa (31 August) this week
  • The meetings will be live streamed on vimeo/vimeo, facebook and YouTube/YouTube.

Bethlehem, 30 August 2023 — “You arrive at 6am and leave at 4pm. Going there monthly is exhausting. Sometimes they don’t have your tablets and ask you to come back the following day.”

Waiting all day at the clinic is a frustrating reality for people living with HIV in the Free State. Yet a simple solution exists — for people who are collecting ARVs to simply get a longer supply of medication. However, only 3% of people living with HIV interviewed by Ritshidze reported receiving a 3 or 6 month refill in the province — as recommended in National ART Guidelines.

I am on ARVs. I am not satisfied with the 2 month refill that I get. I would like to get 4 or 3 months refill. That way, I will only go to the clinic 3 or 4 times a year,” one person living with HIV told us. 

Not only would “multi-month dispensing” mean fewer trips back to the clinic — making medicine collection easier for people living with HIV — but it would also reduce the burden on congested and overstretched facilities. Another person said: “People like me should be given a longer refill… that would decrease the influx at the clinic.”

In comparison to the Free State, 64% of people living with HIV interviewed by Ritshidze reported a 3-6 month refill in Mpumalanga. Outside of South Africa, other PEPFAR supported countries report more than 80% of people getting a 3 to 6 month supply.

Multi-month dispensing is among ten key issues outlined in the third edition of a new Ritshidze State of Health report in the Free State. The report will be launched at two district community meetings this week — in Bethlehem today (Thabo Mofutsanyana), and Thabong tomorrow (Lejweleputswa)

Other issues include long waiting times — where the Free State performed worst across all provinces monitored. While average waiting times reduced in the last year, from 6:03 hours down to an average of 5:27 hours waiting, this remains an extremely long time for people to wait for health services. 

One community member told us: “I collect HIV treatment monthly. At times I encounter challenges… they go on tea breaks for hours… We wait for them and keep hearing that they are not yet back from their lunch break. That causes the clinic to be flooded with people and you’ll leave… after 4pm. You can’t go eat or do anything else but wait. That’s our problem.”

Some public healthcare users have resorted to paying people to stand in queues for them on their medication collection days or for them to hold a spot for them because the long waiting times have become unbearable. 

“But the person, or even if it’s you, can get there to the clinic, and come to the front of the queue and is then told that there are no nurses on duty that day and then you are turned away and told to return the next day only for the same thing to happen again,” one community member told us. 

In addition to longer ARV refills, another strategy to reduce waiting times is to allow people living with HIV to collect their treatment at pick-up points either at the facility or externally in the community. This can reduce the burden on facilities — and should make it quicker and easier to collect ARVs. However, 63% of people living with HIV said they had never even been offered one of these options — and 55% still wish they could collect their ARVs closer to home. 

“One community member told me that her waiting time just to collect ARVs is around three hours. She’s still on a monthly script, even though she is stable on her medication. She’s been told that arranging her external pick-up is still stuck in paperwork,” said Mary Nyathi, a Ritshidze Project Officer from the Treatment Action Campaign (TAC).

Overall, these shortcomings contribute to slow progress towards getting everyone to start and stay on HIV treatment. One woman summed it up, saying that it’s just a lot of things all adding up to bad service and a lack of quality care. “You must come there and see — after spending one day there you’ll understand that it’s very bad. It’s so discouraging… it makes you want to disengage from care,” she says. 

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 Free State 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 Thabo Mofutsanyana and Lejweleputswa health departments, the Mpumalanga health department and national health departments, and PEPFAR partners working in the province, Right to Care and Wits RHI. Duty bearers are afforded the right to respond. 

To follow proceedings virtually please join at: 

Thabo Mofutsanyana: Wednesday 30 August: 

Vimeo | YouTube

Lejweleputswa: Thursday 31 August: 

Vimeo | YouTube

The full Free State — State of Health report is available here

The Thabo Mofutsanyana presentation is available here

The Lejweleputswa 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 21 facilities across Free State: 11 in Thabo Mofutsanyana and 10 in Lejweleputswa. 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 April and May 2023 (Q3 2023).

  • Interviews took place with 21 Facility Managers
  • Observations took place at 21 facilities 
  • Interviews took place with 1,095 public healthcare users
  • 47% (516) identified as people living with HIV
  • 16% (180) identified as young people under 25 years of age

Additional quantitative data related to HIV prevention were collected in June 2023. Data collection took place at 84 sites across four districts: 20 sites in Fezile Dabi, 19 sites in Lejweleputswa, 25 sites in Mangaung, and 20 sites in Thabo Mofutsanyana. Data were collected by talking to Facility Managers and carrying out observations. All data are available at 

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: Lejweleputswa, Thabo Mofutsanyana and Mangaung. A total of 1,010 surveys were taken, combining 281 gay, bisexual, and other men who have sex with men (GBMSM), 399 people who use drugs, 189 sex workers, and 151 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.