As PLHIV and key populations we must all stand up & fight for our rights — when no one fights, we die

The time has come to name and shame nurses who continue to discriminate against public healthcare users, are unprofessional and abuse their power, and refuse, delay or obstruct access to services. 

This was the call from Anele Yawa, General Secretary of the Treatment Action Campaign (TAC) at the community report-back meeting of the second edition of the Ritshidze Eastern Cape State of the Health report this October. 

“We know it is not all nurses that are bad. And we must be sensitive to these nurses so that they understand the Constitution and understand the Patient’s Rights Charter.

“But where we find nurses who mistreat patients we must take their names, report them to the Facility Managers and we must take their names right up to the Minister of Health, there must be consequences for these nurses,” he said, adding that nurses should focus on delivering a service they are employed to do, not to be engaged in power struggles and games of judgement and gossip at their patients’ expense.  

This was further borne out in the report’s recommendation that “Poor staff attitude, privacy violations, verbal or physical abuse/harassment and/or of services being restricted or refused should be urgently investigated by DoH/PEPFAR and disciplinary action taken where appropriate. Facility Managers should be held responsible for unresolved issues. For facilities we report on here, the DoH/PEPFAR should respond within 3 months with actions that have been taken.”

The overriding theme at the meeting in Mdantsane was that of poor staff attitudes coupled with long waiting times. For public healthcare users they said it makes facility spaces unwelcoming, where people feel afraid and find staff unapproachable. As a result they are unable to speak out about their medical and health concerns.  

People who shared their stories at the meeting and people whose recorded stories were played back at the meeting, said they often felt belittled and bullied by clinic staff. 

One young woman told of going to the clinic to pick up contraceptives and being questioned about “being too young to be sexually active”. She said: “I told them that I didn’t want to get pregnant. They did give me my contraceptives that day but I left there feeling very bad”.

Another woman said in her recorded message that there is no privacy in the consulting room where she has to see the nurses.

“We are four to a room there, so you can’t discuss what you want to because there is no privacy,” she said. Another woman said a nurse walked out on her consultation and called someone to attend to her and called her medical complaint “a ridiculous story”.

Even more devastating for one man who shared his story was that his clinic delivered his ARVs to his home without his knowledge. They also made no effort to keep the contents of his delivery confidential. Because he wasn’t at home at the time of the delivery his sister signed for his ARVs. 

“I was forced to answer my sister’s questions and I had to disclose to her and my mother. The clinic took away my right to disclose only when I was ready — even now my sister insults me because of my HIV status,” he told those in the meeting. 

The situation also continues to be especially trying for key populations living in the province. KPs include sex workers, people who use drugs, and people in the LGBTQIA+ community. The data in this reporting period found that there continues to be a low number of facilities offering KP specific services. And many KPs say not only are services unavailable but they often feel judged and encounter hostile staff at their clinics.

The experiences they shared are matched by data that reflects continued staff shortages in the province. Ritshidze has found that Facility Managers interviewed said that it continues to be difficult to attract and retain staff in a province that has large rural communities. These unfilled vacancies in turn add to a burden of burnout, low morale and poor service delivery, as observed by Ritshidze Community Monitors at 49 facilities that were part of this reporting period of July to August 2022.  

The province has also not fully met a single recommendation that was made to authorities by Ritshidze from a year ago and only partially met some recommendations. Where there was improvement in the likes of better filing systems; some extension in the number of people living with HIV who are eligible and able to access 3-months refills of their ARVs; and there was some improvement in making patient waiting areas safer in terms of limiting the risk of spreading TB, there are still much room for improvement.  

This mixed progress makes the second edition of the report for the Eastern Cape, one that still calls for urgent reform and change.  

Of concern from the data highlighted in the report is that many people still don’t have reliable access to getting their ARVs. Currently in the province 92% of people living with HIV know their HIV status but only 73% of these people are on HIV treatment and of these people, 87% are virally suppressed. This translates to just 67% of all people living HIV in the province receiving ARVs and only 58% of these people living with HIV while being virally suppressed. 

Some community members told of experiences of being sent away from clinics without receiving their ARVs and some said they relied on “bumming” a few tablets from other people living with HIV they knew in their social circles. There were also people who said that if they missed a clinic appointment date they would be shouted at by nurses and sent to the back of the queue to be attended to last. Some told of simply walking away from treatment, unable to put up with how they were treated at facilities. 

Yawa stressed: “Healthcare workers must acknowledge that missed appointments happen and no one should be sent to the back of the queue because they have missed an appointment. This kind of staff attitude is unacceptable and staff must be investigated and be made accountable.”

“We must all stand up and fight for our rights as PLHIV and as KPs, because no one will fight for us and when no one fights then we die.” 

A new set of recommendations have been set out by Ritshidze in the latest report. They are targets meant to help map a way forward that authorities at facility management level right through to province can start to use to target inventions for implementation and ultimately better service delivery for healthcare in the province.

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“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.

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