“They are not sensitised. We get strange looks at reception. We are pointed out between the nurses: ‘...those are the LGBTI...’” “Sensitivity has to start from the gate...” “They really need to get sensitised, starting from the guard at the gate.” It is PSI, however, in both Harare and Bulawayo that attracts consistently unfavourable feedback. As respondents reflect, they cannot avoid considering a set of interrelated factors that may present legitimate barriers and limitations to availability and how it is perceived. Poor availability of medication is a recurring theme, across all populations that access PSI in both Harare and Bulawayo: “Frequently, there are no meds available, and you’ve been waiting there a long time.” “It takes at least two hours or more if I want to be treated.” “There’s usually a queue at reception, and you wait over 20 minutes there. Then you wait until Auntie Mavis is free to see you. She comes to get you and there’s a consultation with her. She tells you to go for testing. There’s a queue there for another 30 minutes. Then you have to wait 30 minutes for your results. Then back to Mavis. Then you need to see a doctor. More queueing. Then you get a prescription, but have to get it stamped at reception. Then another queue there for that stamp. Then to the dispensary and more waiting. It can easily take 4-5 hours.” Availability of drugs and efficiency of services are two relatively generic systemic issues in many health facilities. Two other factors material to availability, however, relate to PSI’s specific location of its work within an HIV-epidemiological framework. Unlike Wilkins, PSI’s New Start Centres are not general hospitals. They are primarily HIV-service facilities, with a mandate to increase testing and treatment of HIV. This institutional priority is recognised by key population users; it has a marked effect on their perception of service availability. “The supply of medications is less available. They are not reliable.” “You might find they don’t have all the necessary medications, like for STIs. When it comes to medications, they write prescriptions and you have to buy at a pharmacy. This costs us money we don’t have. And you have to face more judgements at the pharmacy.” Congested, over-burdened facilities and a long wait-time are experienced as a limitation on the availability of good services. “Services are available, yes. But it takes a long time to be treated. You need to set the whole day aside, and then the examination is very quick, not thorough. It’s a rush job. They don’t take the time with you. And we somehow have this expectation here that when we go to a hospital we don’t just want to be diagnosed in two minutes. We want someone to look.” On one level, the menu of services available at PSI are predicated on HIV as an entry-point. “If I want to be treated for an STI, I’m forced to get tested for HIV. I should have a right to choose, not be forced.” “I’m like a peer counsellor. I recently referred someone to PSI for STI treatment. They were told they must test for HIV before they could get other services and treatment. If they tested positive, they would go for ART. If they tested negative, they would go on PREP.” “Someone came from Mutare all the way for the service in Harare, but was forced to go through these other HIV testing channels first before getting other services.” “Services are there but the quality of care is poor.” “Services are slow; maybe there are too many people. You can stay in the queue for more than an hour.” “I came at 09h00 with four friends who wanted to be tested, but we waited there until 17h00” PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 23