7 February 2023
A new survey has found that drug users, sex workers and LGBTQIA+ people are often treated badly at public health facilities. Graphic: Lisa Nelson
Queer people and sex workers are being treated with hostility at clinics and even denied services, according to a Ritshidze report launched on Monday.
Ritshidze is a project of the Treatment Action Campaign (TAC), the National Association of People Living with HIV, the Positive Action Campaign, the Positive Women’s Network, and the South African Network of Religious Leaders Living with and affected by HIV/AIDS.
The Ritshidze monitors interviewed a total of 9,137 people, including 2,349 gay,bisexual, and other men who have sex with men, 3,353 people who use drugs, 2,290 sex workers, and 1,145 transgender people. They found that sex workers, people who use drugs and LGBTQIA+ community members were often badly treated in public health facilities.
Patients who presented their stories spoke of being mocked, harassed, being treated with open hostility and even being denied services in community health centres.
The report said some people do not feel safe enough to go to the clinic at all, and some stopped taking treatment as a result.
“I went to Stanza Bopape Clinic because I had an abscess on my bum,” one gay patient recounted during the launch of the report. “I know nurses there are rude, but the way this one responded to me was very bad. She said you guys like to sleep with boys and you expect us to help you and perform miracles. I just needed her to give me [medicines] for the abscess, but she just ended up rambling her own thing. I felt very disrespected and judged.”
“Where key populations do continue to suffer the daily indignities of using the public health system, specific services remain unavailable for the most part,” the report says.
Access to services such as methadone (to reduce drug dependency) and unused needles, contraceptives, or hormones, remains unavailable to many people.
“Ritshidze data shows that both clinical and non-clinical staff like security guards continue to be unfriendly and discriminate against key populations be it at the clinic gate, in waiting areas, or even during medical consultations. Disgraceful privacy violations continue to occur that destroy people’s right to privacy and make clinics feel unsafe and uncomfortable to be in,” the report says.
The Ritshidze survey found that 12% of people interviewed were not receiving health services anywhere. “At public health facilities, key populations are often treated very poorly by clinic staff who at times shout or verbally abuse people, questioning people’s sexuality or gender, and how or why they engage in sex work or take drugs.”
One sex worker said she had been sexually harassed by a doctor in a health facility in KwaZulu-Natal. When she asked to see the facility manager, other staff members told her she needed an appointment.
“The doctor said no one would believe a mere sex worker over him. I was violated because of who I am. I don’t think I will ever go to a clinic again, because we are made to feel less human,” she said.
The report has recommended that the Department of Health should issue a circular this month. “It should state that all key populations should be treated in a friendly, dignified and respectful manner; and that privacy violations, ill-treatment, harassment and/or abuse will be met with consequences,” the report recommends.
Deputy Minister of Health Dr Sibongiseni Dhlomo said the department would work on having dedicated clinic staff to assist key populations in each province.
“We need, maybe, that one nurse in each facility be informed on the needs of key populations. That one healthcare worker will be able to influence the whole clinic, from the gate to the dispensary. I will ensure the department considers this approach,” said Dhlomo.
He acknowledged that the department had failed in training some of their staff. “We need to improve. We will work with this Ritshidze data, and it must inform our growth. There are a huge number of health care staff that need training again,” said Dhlomo.
“We need to say this sex worker is so responsible to come and ask for condoms. As government we must say, we have this group of sex workers, some are parents who want to see their kids through school, university and see them achieve their goals. Therefore, let’s support them to live a longer and healthy life,” said Dhlomo.