Perceptions | Perspectives The Situational Analysis exercise illustrated that the various components of the system for health – service providers and service users; health facilities and communities – agree on the standards that should constitute “good” public health service. Focus group discussions with each group, however – with gay and bisexual men (GBT), with lesbian and bisexual women (and trans men; LBT), with transgendered men and women (predominantly a trans-women constituency; T), with facility management and clinical staff – reveal that: • These groups have significantly varied perspectives on the extent to which these standards are met. • Direct personal experience of health services strongly shapes perception of those services by users, as does second-hand reported experience transmitted across the community. • Experience is, at least in part, a function of identity. Service providers generally perceive their services to be significantly more acceptable than do service users. Gay and bisexual men generally have a more favourable experience than do lesbian and bisexual women. • Perception is subjective, and not necessarily based in fact. Nevertheless, it is strong enough to inform opinion and perspective by individual service users, and to be either an incentive or deterrent to continuing in care, both for those users and for peers in the community to whom that perspective might be transferred. Amongst members of key populations, sustained demand for services that translates into consistent utilisation is predicated on positive perception: that services are deemed appropriate and acceptable. For the situational analysis process, groups reflected on their experience with at least one of the three partner health facilities, with reference to five standards: AVAILABILITY, ACCESSIBILTY, AFFORDABILITY, ACCEPTABILITY and ACCOUNTABILITY. Discussion around QUALITY, including the extent to which services were sexuality and gender AFFIRMING, was implicit. Each facility reflected similarly on itself. Using the Mixing Desk tool to guide discussion, respondents graded each standard by setting a level from 0 – 10, and discussing the perception that informed that score. PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 20