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A lot of queer or transgender people, drug addicts or sex workers are victims of inhumane and ill treatment when they visit public healthcare facilities. In the worst cases, some are denied health services and chased away from clinics. 

This scathing finding is revealed in a report that was launched by Ritshidze recently. It is the third and the largest, national report conducted by Ritshidze looking at key population groups. Ritshidze, which means “help us” is a community-led health monitoring system developed by organisations representing people living with HIV, including the Treatment Action Campaign (TAC), the National Association of People Living with HIV, and partners.

The report is part of a clinic monitoring project to improve the quality of healthcare services in the public sector. The data was collected in seven provinces around South Africa, across 24 districts. 13,832 queer or transgender people, sex workers and drug users were interviewed. 

Clinic staff’s bad attitudes

According to the new report, only 35% of transgender people, 33% of gay people, bisexual people and men who have sex with other men (GBMSM), 26% of sex workers, and as few as 17% of people who use drugs said staff were always friendly at the public healthcare facilities they visited. “Clinical staff were the most commonly reported as being unfriendly, followed by security guards. Confidentiality violations are abundant at the facility and privacy violations are alarmingly common. 57% of GBMSM, 61% of trans people, 65% of sex workers, and 74% of people who use drugs did not think privacy was well respected,” the report exposes. 

People often feel unsafe and uncomfortable in health facilities. “The implications of poor treatment, abuse, and violations of confidentiality are that only 7% of GBMSM, 7% of trans people, 5% of sex workers, and 4% of people who use drugs felt very safe at the facility. Similarly only 8% of GBMSM, 7% of trans people, 5% of sex workers, and 3% of people who use drugs felt very comfortable at the facility,” the survey found. It’s common for them to face uncaring, disrespectful, cruel, and even abusive treatment at public health facilities. “Frequently, people are laughed at and judged, and at worst denied services or chased away. It can be unbearable and leave deep scars. Ultimately, it forces some people to stop going to the clinic entirely,” says the report. 

The investigation by Ritshidze found that disgraceful confidentiality violations remain common.

Narrating her own ordeal when trying to access public healthcare, a sex worker who uses the Gompo Clinic in Duncan Village, said, “Due to the continued discrimination at the clinic, I tried to get a transfer letter so I could have a fresh start at another clinic. A nurse who knew that I was a sex worker disclosed to the other nurses what my job was. They refused to give me the transfer letter. I reported to the facility manager and he said he would speak to the staff but the abuse continues.”

People denied ARVs or health services entirely

The report says that 8% of GBMSM, 10% of trans people, 11% of sex workers, and as many as 31% of people who use drugs had been denied services in the last year because of prejudice. 

“10% of people who use drugs also reported having been denied access to their HIV treatment in the last year. This is a violation of people’s constitutional right to health,” states the report. The less formal health services like drop-in centres and mobile clinics, were notably found to be safer and more friendly than public healthcare facilities. 

Violations of confidentiality

The report notes that nearly two-thirds of GBMSM, trans people, and sex workers, and 74% of people who use drugs, did not think privacy was respected, “resulting in only a handful of people feeling truly safe and comfortable when trying to access healthcare.”

Those who are not deterred by these indignities and turn to public healthcare, may still find the services they need unavailable. Approximately 40% of new HIV infections in South Africa are among the key populations sampled in the report and their partners. “Yet basic HIV prevention tools are not always available.”

A visit to the clinic can be an ordeal for trans and gender diverse people. “Health services are not often gender affirming… Only 32% of trans and gender diverse people told us that facility staff were always respectful of their gender identity. 39% of trans women had even gone through the indignity of being told to use a service point just catering to men,” reads the report.

Ritshidze surveyed nearly 14,000 people using drugs, sex workers, and LGBTQIA+ community members in exposing a crisis in the public health system. Pic from SWEAT facebook page

Tamara, from Kraaifontein in Western Cape, identifies herself as transgender. She suffered abuse at the hands of healthcare workers while visiting a government clinic. “I once went to a clinic to seek help after I contracted an infection through intercourse. The security officers started by mocking me, because I am  transgender. I went inside to open a folder, as I walked in the nurses insulted me, whispering, “Does he think he will eventually become a woman?” I felt hurt, because nurses should be educating the public about these things, and not judging us,” Tamara told Elitsha. 

Doctors also didn’t know what was wrong with her and just gave her painkillers. Following a friend’s advice, she turned to a private clinic in Observatory where she found help. “Doctors there diagnosed me well, and treatment was properly given to me. I will never go to a government clinic ever again. I have had awful experiences there. I have been embarrassed, disrespected and felt very unsafe. I think the government should start doing something about this,” she said. 

According to Ritshidze, harm reduction services are life saving but are almost entirely unavailable in most public health facilities. “Even getting information can be a challenge. Only 9% of people who use drugs told us they could get information on where to get new needles despite the benefits on HIV and hepatitis transmission and reducing the risk of wounds and endocarditis. Not to mention the reduction in syringe litter in public places when people can safely dispose of used injecting equipment,” says the report. 

Not everyone reported being able to access the contraceptives they wanted: 32% were denied them because they were sex workers, 34% because they are trans, and 46% because they use drugs. “Safe and caring post violence services are essential, especially in the context of an epidemic of gender-based violence, abuse faced by sex workers, and attacks on queer and trans,” says the report.