Accessibility 2. Operating Hours Wilkins HRE GBT 3 LBT 3 TW 5 Facility 7 “In Harare, PSI is more reliable than Wilkins. We know they are open Monday to Friday. PSI HRE GBT 5 LBT 3 TW 4 Facility 10 Wilkins is not available on weekends or public holidays, although they say they are open.” PSI BYO GBT 0 LBT 1 TW 0 Facility 8 Focus group respondents helpfully defined accessibility – services are there (available), but are they easy to get? – and expanded the criteria by which accessibility might be measured to include physical accessibility, a conducive space where services can be accessed safely and comfortably, an environment that is confidential and private. As the graphs and table show, in as much as key population service users recognised the availability of a range of services from health facilities, they did not think those services were easy to appropriate, naming several barriers to access, many of which are recurring themes across the analysis of availability, acceptability, affordability and accountability. Amongst these limitations to accessibility: 1. Physical distance “PSI in Harare is physically more central than Wilkins. But they are both either in town or in the suburb where our community doesn’t live. There are clinics that are closer to where people live, and with shorter queues and wait-times, but they have not been sensitised to be LGBT friendly.” “Wilkins is the only LGBT friendly clinic across many provinces, far removed from people who are not based in Harare.” PSI in both Harare and Bulawayo, however, offer off-site services to key populations as an outreach programme. “PSI works with an appointment system. But the services are slow. I booked at 09h30 but only got the service at 12h00. It takes a long time. Even if you make an appointment. I spend a lot of my day there. The wait is long. “Services are slow at PSI. I first went at 15h00 on Wednesday and I was told they were closed. The next day I came at 09h00 and got the services I needed by 14h00. No one was in the lab, so I couldn’t get the service when I arrived and had to wait.” 3. A lack of confidence in the clinical competence of service providers and the rigour of their examination. In this context, clinical competence includes promoting and fulfilling the patient’s right to access information, and their rights to give consent based on comprehensive information. “At PSI, we present with an issue. We are scared because of that issue. It is worrying us by the time we come to the facility. But they don’t even look at you properly to examine you fully. Like they’re scared to touch it.” “There is low access to information. Information is often written in a language people can’t understand or its technical. When you try and find out, there’s a barrier. People get frustrated when you ask for information; they look at the line waiting for them behind you.” “When a trans man went to Africa House [PSI Harare] they didn’t give him any information. No definitions. No descriptions. No instructions. No information on risks. They insert this “We’re centrally located in the CBD. Every Jack and Jill comes here, so stigma is likely to be metal thing inside, and it really hurt that person.” low; discrimination is likely to be low. Everyone who has a need comes here. And if people want the services but don’t want to come to the facility, we visit in their places to offer services.” PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 26