Gains made in the HIV response in South Africa cannot be undermined by a continued breakdown in access to treatment for public healthcare users. It’s a collapse that has damaging consequences of fuelling outdated but dogged AIDS denialism. 

Speaking at the launch of the second Free State State of Health Report in Bloemfontein at the end of September, Anele Yawa, General Secretary of the Treatment Action Campaign (TAC) who chaired the community report back meeting, said AIDS denialism continues to push back the gains made in the past nearly 18 years of lifesaving ARVs being made available in public sector health facilities.

“We cannot have it that somebody cannot access their ARVs when we are working to have three month and six month supply of ARVs. When someone goes some number of days without getting treatment it will mean when they do start to take their medicines again it will not work. And then we will have someone like Thabo Mbeki saying ‘yes we have won’,” he said responding to a community member’s personal story of being sent away from his clinic without his medication. 

Yawa added: “Thabo Mbeki continues to ridicule the progress we have made as a country and we must challenge this denialism – more than 300,000 people died of AIDS under his watch.” 

The meeting held in the province’s capital city was also a call from Yawa for the provincial department authorities to make sure that TAC and Ritshidze representatives can sit on clinic committees and also that new channels of communications be opened to ensure that complaints are dealt with as they arise, not left for quarterly meetings with Ritshidze. 

Yawa added: “We cannot have it that appointments are disappointments for people who are needing services.”

The second edition of the Ritshidze State of Health Report showed that barriers in access to treatment is reflected in the likes of 56% of people living with HIV at 25 facilities being sent to the back of the queue if they miss an appointment; 20% of people living with HIV interviewed at 19 facilities saying that they were shouted at for missing an appointment, and 181 interviewed at 23 facilities had been refused services for not having a transfer letter. 

The report also highlighted data that reflects the reality of deteriorating clinic infrastructure in the province. Ritshidze found a dramatic decline in the general conditions in clinics in the province. In this reporting period only 42% of facilities monitored were considered by Ritshidze Community Monitors to be in a good condition. It represents an overall slide from last year’s report data. It also makes the Free State rank as the worst performing province in this regard for province’s monitored by Ritshidze in the country. 

Complaints raised include that clinics have no lights or no working lights, and more than half the facilities monitored had broken or cracked roofs, and or, walls and floors. There were also reports of broken furniture at about a third of the sites monitored. 

The report also highlighted bad filing systems, inadequate storage space and poor management of patients’ files. 

Public healthcare users who spoke at the launch of the second edition of the report, said they are often told their files are lost and at each clinic visit new files have to be opened. 

Ritshidze observations reported filing systems to be in a good condition in 50% at 13 sites. This has worsened since last year when 65% of filing systems at 15 sites were observed in a good condition. Not only does this kind of administrative bungle add to long waiting times but it also compromises the accuracy of patients’ medical histories. 

Added to this, an increased number of public healthcare users interviewed in this reporting period noted worsening state of staff shortages. Up to 80% of people said there was never enough staff at a facility. Last year the number of people reporting this was lower at 62%. This matches to other data in the report of only 21% of Facility Managers reporting that they have enough staff. 

The 2022 report for the province also found that even with a marginal improvement in filling vacancies that there are still 50 vacancies at 10 facilities. These include positions for nurses, pharmacy assistants as well as support staff of security guards and cleaners. 

Staff shortages also impact on adequate communication with people living with HIV on understanding viral load test results. In this survey period Ritshidze found a dip in the number of people living with HIV reporting that a healthcare provider explained this to them. The percentages went down from 83% last year to 78% this year. 

Falling further through the cracks of care are key populations, which include sex workers, people who use drugs, and the LGBTQIA+ community. 

Ritshidze data gathered in 26 facilities in the province showed that lubricants were only available in 23% of sites in this reporting period. Data collection among key populations also found low availability with only 50% of gay, bisexual, and other men who have sex with men, 34% of people who use drugs, 40% of sex workers, and 41% of trans* people using public healthcare facilities reporting that they could access lubricants. Condoms and lubricants should be available at all facilities and can easily be placed in the toilets or other areas of the clinic where people could take them without the fear of being seen by others.

As one gay man using Bophelong Clinic said to Ritshidze monitors in August 2022: “Lubricants are not always available but they have them in the store room and do not keep them outside. In addition… there is a stigma attached to lubricants.”

Ritshidze community-led monitoring in this second year offers the means of year-on-year tracking of indicators that can show progress and decline and flag areas for intervention. This reporting period took between July and August 2022; 29 Facility Managers were interviewed and Ritshidze Community Monitors interviewed 1,349 public healthcare users across the Free State.

The full report outlines recommendations across the indicators tracked by Ritshidze and also measures the year-on-year progress (or lack thereof) at the clinics monitored. 

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