“One of our members, a sex worker, went for an antibiotic, but was being forced to be tested. She knew her status, and didn’t want to go through all those other processes again just to get antibiotics.” On another level, gay and bisexual men and other men who have sex with men are perceived to be a priority since, for an HIV-focussed facility, they are viewed as a particularly vulnerable target population. By contrast, women who have sex with women are perceived to be lowrisk. “Services, equipment and personnel are available. They can do all the HIVrelated services: blood tests, STI screening, HIV testing. But nothing transspecific.” “I have a (trans) sister who went there for PREP. They gave us the impression that they don’t recognise us when we come in. Their systems don’t recognise us, unless we come in as gay men.” “In Zimbabwe, trans is invisible, non-existent. It’s a whole day spectacle when you go there needing to explain everything. Why you don’t need to see a gynaecologist. Why you might need to be referred to a urologist. They start asking you questions as if you are the doctor. They don’t know, so you need to educate them first yourself.” not available. They are ignorant about them; don’t know what those are.” “No one really takes much time to understand lesbians, so there is very poor information available for us. We are women. We give birth. We engage with men sometimes. And we are in our same-sex relationships and vulnerable to HIV as well. Services are available, but only if you are a heterosexual woman.” “PSI focusses on MSM only. Even lesbians who are peer educators distribute condoms and lubes for MSM when there is nothing for them. The questionnaires we administer are for MSMs. The data for DHIS that we collect can be entered specifically for MSM and heterosexual women, and sex workers. They think we are not affected as LB women, but HIV does affect us.” “Some MSM get access to PREP, but they are married. They are in heterosexual relationships with women at home. Bisexual women and lesbians are also in heterosexual relationships with men sometimes. But those same services are not there for us. We don’t feel left behind. We are left behind.” Perceptions are subjective, and vary between service providers and service users. It is unlikely that PSI will recognise, acknowledge or agree that any client is “forced” into HIV testing. Or that services are so profoundly prejudiced towards men who have sex with men so as to ignore and exclude other sexual and gender identities from care. Perceptions are powerful, however, and have crystallised strongly in the minds of service users “’Basic Services’ are there, but no trans-specific health package. No protective barriers for lesbian or bisexual women and trans women - dental dams, finger cots, female condoms, gloves. No hormones. No gender counselling/sexuality counselling/partner counselling and identity counselling. Things that take your mental health into account. No binders, and knowledge about their effects in case we want information about breast cancer. And gender-affirming or reassignment surgery is legally available to intersex people, but no provisions are there for trans- people.” “You can get generic services there for women. But not as ‘WSW’. Not without discrimination. So, if I’m seeking services, I have to appear heterosexual.” “For some certain groups, there are really excellent services. I got really great services when I went once. But there is favouritism when they deal with LGBT people. They’re more with the gay and bisexual men and trans”. “As LB women, there are no barrier methods for us. No finger cots. No dental dams. They also need to be sensitised to what WSW need. These methods are PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 24