The latest Ritshidze report has unveiled severe shortcomings in the Free State’s public healthcare system, revealing that only 17% of people living with HIV (PLHIV) receive a three-month supply of antiretroviral (ARV) medication. The report highlights a range of systemic issues, including long wait times, staff unfriendliness, denial of services, poor treatment literacy, and unsanitary conditions in healthcare facilities. Ritshidze, a community-led monitoring system developed by organisations like the Treatment Action Campaign and the National Association of People Living with HIV, aims to improve healthcare quality. The data, collected from 2,659 public healthcare users between April and May 2024, paints a grim picture of the healthcare landscape in the Free State.
 Alarming Wait Times and Staff Shortages
Long wait times are a significant source of frustration for public healthcare users, with 81% reporting excessive delays. The average wait time exceeded three hours at 46 facilities, with some patients waiting over six hours. These prolonged waits increase the risk of treatment interruptions, particularly for PLHIV collecting ARVs. The report also points to severe staff shortages, with only 24% of respondents saying there are enough staff to meet their needs. A transgender individual from Lejweleputswa described arriving at the clinic early in the morning and leaving without being attended to by 4 PM due to the lack of healthcare workers. The report lists 143 vacancies across 23 facilities, with chaotic paper filing systems exacerbating delays.
 Unfriendly Staff and Denial of Services
The report reveals a worrying trend of unfriendly and punitive behaviour from healthcare staff. Only 50% of respondents thought staff were always friendly, and 49% felt that staff were only sometimes or never friendly. This unfriendly environment is particularly harmful to PLHIV, with some patients reporting that they were denied ARVs after missing appointments. Moreover, the report highlights the ongoing mistreatment of vulnerable groups, including people who use drugs, sex workers, and LGBTQIA+ individuals. A transgender man expressed that the lack of understanding and support at the clinic made it impossible to feel safe or respected, sometimes leading him to leave the facility without receiving the necessary care.
 Failure to Implement National ART Guidelines
Despite the 2023 National ART Guidelines recommending longer ARV refills and the establishment of pick-up points to simplify treatment collection, only 17% of respondents reported receiving a 3-6 month supply of ARVs. The Free State has made the least progress in this area, with only 11% in Thabo Mofutsanyana and 25% in Lejweleputswa receiving a three-month supply, compared to 98% in Mopani (Limpopo) and 97% in Bojanala (North West).
Call to Action
The Ritshidze report concludes with an urgent call for the Free State government to address these critical issues. The failures in the healthcare system are cited as core reasons why people struggle to stay on ARVs or access HIV prevention. The report stresses the need for clinics to become safe spaces that provide empathy and support to everyone, regardless of their background. The Ritshidze team has submitted a list of recommendations to the Free State government and requested a response by 30 September 2024.