1. Increasing the visibility and expanding the understanding of women who have availability, accessibility and affordability are influenced by the non-availability of sex with women as a vulnerable “Key Population”. A recurring theme throughout the medication, an issue that results in their having to pay for prescribed medication from analysis: that HIV transmission and prevention programming has focussed on men retail pharmacies. It would seem, however, that the same drugs seem to be in shortage: who have sex with men, while women who have sex with women are virtually ignored. benzathine penicillin and Podophyllin, indicated in the treatment of genital warts. This Whilst conventional HIV- messaging has made clear for decades that women carry may, conceivably, be a procurement, supply and distribution issue. Drugs are provided a disproportionate burden of infection, this message seems to cease to apply when to facilities through the National Pharmacy. It is possible that the State through the women are no longer heterosexual. Consequently, their sexual and reproductive health Department of Health is not ordering sufficient quantities from that Pharmacy because needs remain misunderstood and unmet. SRH-services for women are based around it is unaware of the demand. Alternatively, it’s possible that these drugs are distributed reproduction and fertility, and protective barrier methods are limited to male condoms in equal proportion to all health facilities. Since they are for the treatment of warts and and female condoms. The presumption of prevention programming for women is specific sexually transmitted infections, they may expire in most facilities that may not heteronormative. And the reported low visibility of women at facilities who identify be treating clients who require those services. This gives the inaccurate impression of openly as lesbian or bisexual supports the assumption that they don’t exist and that low general demand, and does not give sufficient evidence of high specific demand. they are not vulnerable to HIV, a narrative that should be challenged with evidence to Could it be possible that the stock-out issue might be remedied simply by recognising reveal the story behind these identities: many are mothers, many have occasional or certain facilities require and are supplied with higher concentrations of these drugs (as regular relationships with men, many have concurrent female partners. It is likely that in facilities with high demand for STI-management) to match demand? more robust investigation and data would demonstrate considerably higher numbers of women who identify as lesbian, bisexual or WSW are vulnerable than are reflected Of the many possible issues for influencing, these may be easy entry-points into positive in services provided for them. advocacy for Key Populations that shift both the quality of care and service, and the policy environment, but through a safer, accessible health lens that requires the specific needs and 2. Provision of stand-alone STI services. This issue is highlighted most prominently identities of these populations be acknowledged. by the PSI New Start centres that are, primarily, HIV test and treat facilities. LGBT people or sex workers who present with an active, symptomatic STI simply want a walk-in service where that infection can be examined, diagnosed and treated. Having to access the desired services through an obligatory HIV-programme pathway is a deterrent to access for Key Populations. This seems to be an issue for policy-dialogue. While it makes sense that presenting with STIs may suggest exposure and risk for HIV, and that clients should be encouraged to access services for ART or PREP, it also makes sense that people presenting with an STI (and who may be HIV-negative) are also more susceptible to HIV, and efficient management of their present infection is preventative. From the feedback of the focus groups, not being able to access discrete STI- services on demand is limiting utilisation of the facility by Key Populations. That policy is not KP-friendly. It may be that health facilities will be keen to collaborate around influencing that policy position, so that resources are allocated that recognise STI-service availability as a characteristic of a KP-friendly health service. 3. Drug stock outs. At each of the three facilities, user perceptions about service PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 43