HIV- and TB-focused activist organisation Ritshidze has been compiling reports on the state of healthcare in South Africa’s provinces. They have so far presented reports on Gauteng, Mpumalanga, North West, Limpopo, Free State, Eastern Cape and now KwaZulu-Natal.

The reports are compiled through community-led monitoring of clinics, with the intention that community organisations use the information to advocate for better access to healthcare services, specifically for TB and HIV patients.

Common themes emerging from the reports are issues of bad attitudes by medical staff, long waiting times averaging up to four hours, a lack of privacy when consulting and pervasive stockouts of medication.

People accessing the public healthcare system in KwaZulu-Natal say they are often shouted at and experience bad attitudes from medical staff, which often lead to them not returning and defaulting on their treatment.

According to the report, this is one of the major reasons why people living with HIV (PLHIV) are not meeting the UNAIDS target whereby 95% of people living with HIV know their status, 95% know their status on HIV treatment and 95% on HIV treatment know their viral load.

Ritshidze has found that in KwaZulu-Natal, 94% of people living with HIV know their status, 85% know their status on HIV treatment and 89% on HIV treatment know their viral load.

The quarterly report is compiled using research conducted between August 2021 and September 2021 — during the third Covid wave — with 136 facility managers at 141 facilities, and with 3,447 patients.

The report highlighted that understaffing often led to clinics being overburdened, with 81% of facility managers reporting being understaffed and patients waiting for extended periods to be attended to — 3.29 hours was reported as the average waiting time for patients. Twenty-four percent of patients noted feeling unsafe when having to get to the clinic very early to start queuing.

The report revealed that people living with HIV often had to unnecessarily go to clinics to pick up their ARV medication, instead of the health department arranging for off-site pick-up points that would be more convenient and also place less strain on already understaffed clinics.

Everyone living with HIV who was interviewed said they would prefer off-site pick-up points and 54% said they would prefer to fetch their ARVs from places closer to their homes. The report says that 15% of people living with HIV reported receiving only one month’s supply of ARVs.

“PLHIV lead complicated lives and many miss appointments and even miss taking some pills. Giving them support when they return to the clinic helps ensure long-term adherence. But PLHIV who return to the clinic and are treated badly, or who fear they will be, will often not come back.” This is in light of PLHIV at 38 clinics saying that they were reprimanded if they missed an appointment.

The Ritshidze report notes that treatment and viral load literacy is particularly important when it comes to people taking and remaining on their medication. The 89% of people on HIV treatment who know their viral load said it had been explained to them by a nurse — however, 9% of them did not agree that not having an undetectable viral load meant that a person was not infectious.

People who are considered key populations — namely gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs, prisoners and other incarcerated people — are particularly vulnerable when it comes to accessing treatment and are said to experience barriers. They therefore need to be afforded safe spaces to disclose their status without fear of discrimination or negative attitudes impinging on their dignity.

Many people regarded as being part of these key population groups reported being ridiculed and having their privacy violated — like Sihle, who went to Gateway Clinic at Addington Hospital: “Right now I can’t get my hormone therapy to transition unless I have money to go to a private doctor. My wish is that we could get therapy and support at all the public clinics. But even if we don’t have that, we just need the nurses not to judge us, or to put this stigma on us… I am a human being like any other human being.”

The report recommends that the health department ensures that staff are sensitised to provide non-discriminatory services to members of key populations by February 2022.

Some of the other key recommendations made by the KZN report are:

• The department of health should increase their nurses by 15% by December 2022;
• Ensure that at least 60% of PLHIV receive their ARVs off-site so as to ease the patient burden on understaffed clinics by May 2022, and ensure that all eligible PLHIV receive at least a three-month supply of ARVs;
• By December 2021 all patients should be consulted in private rooms;
• As of December 2021, all healthcare workers (including CHWs), must provide accurate and easily understandable information on treatment adherence and the importance of an undetectable viral load when talking to PLHIV;
• From March 2022, the KZN health department should implement a provincial strategy to address stockouts and shortages of medicines and other medical tools and supplies. DM/MC

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