Acceptability “Contact tracing is very important in the service. But always with consent; we can’t force; we don’t coerce; we respect autonomy of the clients. But it is also a new intervention - maybe Wilkins HRE GBT 10 LBT 3 TW 7 Facility 10 PSI HRE GBT 4 LBT 3 TW 7 Facility 10 PSI BYO GBT 9 LBT 1 TW 5 Facility 10 As a standard for “good health services”, acceptability speaks to the appropriateness of the service to the service user; to fit. It is a measure of the extent to which services are sensitive to the unique identities, cultures and preferences of those who might access them, and the degree to which service users feel comfortable with the services and how they are delivered. Given the stigma and discrimination attached to Key Populations, the risks that are weighed in every decision to seek healthcare, and the potential for compromised privacy and dignity, acceptability features prominently as a determining factor to either encourage or deter a provider gets it wrong and pushes too strongly; thinks they are doing the right thing but doesn’t realise it is too harsh.” “We are non-judgemental. Non-discriminatory. We treat everyone as individuals who are there for the services they require.” The team at Wilkins has a somewhat more moderate self-assessment, acknowledging that LGBT clients may not consistently feel comfortable – that services are a good match for them – and claiming responsibility for those gaps. “Everyone from the security to ground staff to nurses has been sensitised. But, we as health care workers, even though we have been sensitised, maybe we also need more workshops, uptake of services by LGBT people. to be trained, for instance, on STIs [presentation, diagnosis, treatment] for LGBT people.”4 PSI centres in both Harare and Bulawayo are confident in their self-assessment of the “Maybe our clients mistake us when we give health education. Maybe they mistake our tone acceptability of their services to Key Populations. of voice for judgement. Maybe sometimes it is judgement.” “We offer a range of services; people can receive the particular services they need.” Several community respondents recognise that incremental progress is being made towards “We treat every individual as unique.” offered by gay or bisexual men. “Some may not even need to wait in the waiting area, but can go straight to the counsellor; “It’s easy for me as an LGBT person to go there [PSI-Bulawayo] and to see the KP officer; more acceptable, appropriate services; notably, these appreciative insights are exclusively there is flexibility.” someone who understands issues better than anyone else.” “We are working to reduce stigma and discrimination so that no one knows the reason why “PSI is still new to our community, being sensitised on how to handle our community. It’s anyone is seeking services.” “HIV is a priority for us. It’s not a prerequisite to obtaining services, but we strongly offer it as important that we go there; it’s our way to demonstrate ‘we are here’. That the MSMs are not only one white person.” an advantage, as part of a package of services to Key Populations.” “They are still growing up; taking a step. Unlike way back when you’d try and explain, and 4 It is significant to the note that, across the system for health (including facilities and GALZ staff), no evidence of anyone verifying that outcome over time to determine whether sensitisation as a process people talk about sensitisation as an event, and then as an assumed result of that event. It is tacitly is bearing fruit. they don’t understand.” assumed that a sensitisation workshop equates to significant shifts in behaviour or practice, but there is PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 32