4. Poor knowledge of and provision for the health needs of women who have sex with women. facility. And it creates stigma. When we arrive at PSI, people literally call out ‘Aunty Mavis, “A lot of our association with Wilkins and PSI is about HIV and TB. But we ourselves as “Maybe the managers at PSI think things are different to the way they really are. They have WSWs don’t have a full understanding of other STIs that might affect us. And then they themselves – the nurses – at the clinic are not well informed about WSW health, and they your people are here’”. a different impression of how effective the sensitisations have been, and how deep that has penetrated the facility. Managers are the ones who go to the LGBT workshops, but I don’t don’t have a lot of information to share either if we’re looking for advice.” think they share with their staff afterwards, like with the receptionists, for instance.” “Protective barriers for lesbian and bisexual women are not accessible at clinics. They don’t “The staff may have been sensitised once, and worked hard to not discriminate. But now cater for that. Condoms are, but male condoms. There is nothing available for women who have sex with women, not even at pharmacies. The assumption is that we are not a health there are new staff members who have come in since then and are not all up to date.” risk for HIV, so they are not catered for.” “In Bulawayo, from the time you walk in the door as a trans person you have to pass many “Basic care – the essentials – should be accessible to women, even without having to go already feel not welcome. Judged. Health workers calling others to come look.” through all the ‘procedures’ they make you go through. Like, we need a police report to prove we’ve been violated or assaulted before we get access to treatment. A friend got drunk one night and woke up in bed with a man. She knew she needed to access PEP and that she wouldn’t be able to do that without a police report. So she went to the police station, but those victim-friendly officers were not around to file a report for PEP. Thy told my friend people – the security, the receptionist, etc. – until you find the person you want to see. You 6. Available services and the way in which they are delivered are not affirming of sexual and gender identities, especially of women who have sex with women and trans people. that the officers had gone to Harare. When she went to Bambanani [PSI Bulawayo] and explained the situation they told her ‘there’s nothing we can do. Go to the public hospital.’ “The services are fine. They’re available. And accessible to you as long as you present as a How can we go to a public hospital when this one that is KP-friendly can’t help us? And then heterosexual.” what? Get cross- questioned? Get arrested? And we needed those pills in less than 72 hours. But if you go as an MSM, you get those pills to protect yourself and each other.” “At the end of the day you don’t feel comfortable asking or answering questions.” 5. In as much as facility staff have been through sensitisation workshops, negative attitudes persist, deepening the professionalised stigma experienced by KP-service users at facilities. “We can talk about accessibility, but what do we access if it’s not available for us? All of the services you can have, all of it is perfect, as long as you pretend to be something else.” “Access to PEP is not given to males. It’s given to raped women. I’m a trans woman. When I was forcefully assaulted by a guy, I couldn’t access PEP because they saw me as a male. “Another trans man went to the facility for cervical cancer screening and was shouted at by a nurse in public. ‘Why are you sitting there? We don’t allow men to sit there. This line is for And no one believes a man can be raped. Or that if you had unprotected sex – even if you say it was forced – that it’s the same as rape. Besides, who is going to report that to the police?” women.’ He ended up leaving and told me ‘I’d rather die than go back there.’” “Some people in the facilities are really good to us. But that is not the same across the whole PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 27