Availability “...medications are available. I find all the services I need there” “...they have the services; you can go for a lot of stuff...” And yet, availability is not consistent: Wilkins HRE GBT 8 LBT 8 TW 8 Facility 10 PSI HRE GBT 4 4LBT 4 TW 5 Facility 9 PSI BYO GBT 8 LBT 1 TW 7 Facility 10 Service Providers across all three facilities express a high degree of confidence in the availability of services to key populations: “We are open 24/7; services are available. Anyone who comes can access the service.” (Wilkins) “Lots of services are available: HIV testing, family planning, TB screening, cervical cancer screening, ARV treatment, HIV counselling, ultrasound and X-ray, viral load testing.” (PSI-Harare) “We are different to public health facilities in that we give a preference to services for KPs. And all KPs who are referred to us through GALZ are seen by the doctor.” (PSI-H) “KPs are allowed to be here. There is no service that we say, ‘this is not for you’. If you are a KP, everything is available for you here”. (PSI-Bulawayo) “Wilkins says their Sexual and Gender-based Violence (SGBV) clinic is 24/7, but it’s not there on weekends. I had broken teeth and a swollen face after I was beat up on the weekend. I was actually shaking. I went to the SGBV clinic, but could not be helped. There was literally no one there at the 24-hour clinic.” (male sex-worker) “Services at Wilkins are available. But high availability also means there is a high demand for services from a lot of people. There’s a long wait time. The staff go on lunch and patients wait.” “A small group of us arrived at the clinic at 08h00. We wanted to be tested for HIV. And this was the time that was advertised. But the nurses were in a meeting and no one was available. We waited until 10h00, and then we left.” (LB woman) “There are many services available, but they couldn’t explain to me why I needed the services they were talking about. Like coming to have my viral load tested. I didn’t know what was a viral load, or why I must test it.” (LB woman) “The doctor is mostly not available for us; usually occupied in other sections.” (trans woman) “We visited once to ask for gloves. We waited for about an hour and ended up leaving.” In general, Wilkins’ challenges may be illustrative of a high-demand, high-traffic public health service experiencing severe human resource constraints. Whilst services are available, the system is not agile enough for them to be consistently efficiently administered. “We are running an integrated service, so all services are available here.” (PSI-B) Trans-women, however, identify a more specific limitation, bridging the gap between Facilities are, however, conscious of two limitations: virtually no availability of protective availability of services, acceptability and accessibility: barrier methods for women who have sex with women (WSW); and irregular availability of medication for the treatment of STIs, specifically Podophyllin and Benzathine Penicillin. During these stock-outs, facilities issue prescriptions that patients fill at personal cost at a retail pharmacy. “Services are good – the basics, the general services. But, there is no service package for trans health. No gender counselling, for instance. And they don’t understand trans people.” This perception of good availability is not universally shared by key populations users. With respect to Wilkins Hospital in Harare, users appreciate the generally “comprehensive service and a fully stocked pharmacy”. PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 22