Third edition Ritshidze report reveal short waits & improved HIV services in KwaZulu-Natal — but key populations continue to face hostile treatment

  • 3rd edition of State of Health report compares data over the last three years 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 three district community meetings — in King Cetshwayo (14 November), eThekwini (15 November), and uMgungundlovu (16 November) this week
  • The meetings will be live streamed on vimeo/vimeo/vimeo, facebook and YouTube/YouTube/YouTube.

Nseleni, 14 November 2023 — “I know that I use drugs but that doesn’t mean that they have to mistreat me. One staff member swore at me and said: “Get out you “para” you’re wasting seats for the patients who really need help”.

For people who use drugs, sex workers, and LGBTQIA+ community members, a trip to the clinic in KwaZulu-Natal can be a traumatising experience. “Instead of helping me, they started mocking me, making fun of me, and calling me all sorts of names,” explained one sex worker. A trans woman who had been two days late for an appointment told us: “The nurse came out and said, “Magosha, why are you late? I cried and she continued stigmatising me… I waited until they closed. I ended up not getting my ARVs. I don’t want to go back to a public health facility.

While 82% of public healthcare users said staff are always friendly — in contrast only 25% of gay, bisexual, and other men who have sex with men, only 22% of people who use drugs, only 37% of sex workers, and only 32% of trans people thought they were. The majority of key populations interviewed did not feel safe or comfortable at the facility — with many reporting major privacy violations.

Poor treatment of key populations is among ten key issues outlined in the third edition of a new Ritshidze State of Health report in KwaZulu-Natal. The report will be launched at three district community meetings this week — in Nseleni today (King Cetshwayo), Umlazi tomorrow (eThekwini), and Mpophomeni on Thursday (uMgungundlovu)

Other key issues include scaling up pick-up points where people can collect ARVs — 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: At Medipost you don’t wait. You arrive and produce your identity or appointment card, get your treatment, sign for it, and you are done. It is quicker compared to the clinic”.

Despite benefits for the health system and people living with HIV, 35% of people living with HIV said they had never even been offered one of these options — and 37% wish they could collect their ARVs closer to home. Of those using facility pick-up points, 63% 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 last longer than needed.

On a more positive note, more people living with HIV reported getting a 3-month refill this year, up to 61%. While this is a welcome improvement, compared to 71% in Mpumalanga, and 80% in other PEPFAR supported countries, progress can still be made. 

Waiting times have continued to reduce over the last year, from 2:39 hours to 2:18 hours waiting after the facility opens. The province continues to have the shortest waiting times out of all provinces monitored by Ritshidze. However, 34% of people still reported long waiting times, with 32% blaming disorganised filing systems. 

One community member told us: “In May I went to collect my refill. I arrived and they couldn’t find my file. It happened again in July”. He called on clinics to pre-retrieve files the day before scheduled appointments. 

Another person explained the impact of lost files: “They’ll keep on looking for the files until they give you a piece of paper. When I consult the doctor he can’t use the paper because he doesn’t know my medical history.” Another explained how he and his mother are now sharing ARVs, “because she now can’t get hers due to the file not being found.”

Overall it is clear that KwaZulu-Natal is outperforming other provinces across several Ritshidze indicators — however there is still room for improvement in scaling up 3 month supply of ARVs, getting more people into pick-up points, improving filing systems, and critically, in improving the quality of services provided to members of key populations.

One man who uses drugs summed it up, pleading: “We all have rights to healthcare and I think we should be treated in the same way. Please do something.

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 KwaZulu-Natal State of Health report; the first was published in November 2021, and the second in November 2022.

This week, Ritshidze is providing a platform for community members to raise their concerns directly to the King Cetshwayo, eThekwini, and uMgungundlovu health departments, the KwaZulu-Natal health department and national health departments, and PEPFAR partners working in the province, BroadReach and Health Systems Trust. Duty bearers are afforded the right to respond. 

To follow proceedings virtually please join at: 

King Cetshwayo: Tuesday 14 November: 

Vimeo | YouTube | facebook

eThekwini: Wednesday 15 November: 

Vimeo | YouTube | facebook

uMgungundlovu: Thursday 16 November: 

Vimeo | YouTube | facebook

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

The full KwaZulu-Natal presentation is available here

The King Cetshwayo presentation is available here

The eThekwini presentation is available here

The uMgungundlovu 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 126 facilities across KwaZulu-Natal: 66 in eThekwini, 18 in King Cetshwayo, 14 in uMgungundlovu, 11 in Ugu, 15 in uThukela, 10 in Zululand. 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 126 Facility Managers
  • Observations took place at 129 facilities 
  • Interviews took place with 7,231 public healthcare users
  • 51% (3,677) identified as people living with HIV
  • 22% (1,565) 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: eThekwini, King Cetshwayo, Ugu, and uMgungundlovu. A total of 1,302 surveys were taken, combining 200 gay, bisexual, and other men who have sex with men (GBMSM), 555 people who use drugs, 380 sex workers, and 167 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.