“I am very scared to go there without a transfer letter; I’m scared they will turn me away”
Ritshidze has been documenting for years how changing between clinics can become a nightmare. In 2024 1,508 people said that they or someone they knew had been denied services without a transfer letter — something that is not required by HIV treatment guidelines to start or restart your ARVs. On top of that, 2,392 people also reported being denied services without an ID, and 450 people were denied services for not being South African.
Now following the U.S government funding suspension in South Africa, this problem is only worsening. NGO-run mobile services that were funded by USAID and CDC were shut down overnight, forcing people living with HIV to have to go back to public health facilities. Many people did not receive communication let alone a transfer letter, understandably as result of the rush and confusion related to the stop work orders. David* (not real name) a mobile clinic user in this situation spoke to us about his experience:
When David was diagnosed with HIV in the winter of 2024 it was a life-changing moment. The news he received meant he would have to be on life-long treatment to protect his own life and to stay virally suppressed and avoid transmitting HIV to others.
The 34-year-old is a Malawian citizen but has lived in South Africa for 14 years in the Musina area in Limpopo. He says part of what made it easier for him last year was being diagnosed at a mobile clinic run by the Wits Reproductive Health and HIV Institute (Wits RHI).
The work of non-governmental organisations like Wits RHI is an essential pillar of the country’s HIV response. Many of these NGOs focus on reaching people who would otherwise be lost to care in the public health system, including those in more rural areas, such as Musina.
“Everything worked well there at the Wits mobile clinic; I didn’t have many problems so it was easy,” he says. He was initiated on treatment through the mobile clinic services and received his first first seven months’ of ART there.”
But that all changed in February this year when the institute had to discontinue its services. Wits RHI was a beneficiary of U.S government funds and was one of many implementing partners who saw some of their work come to an abrupt stop with the funding freeze announced in January by the Trump administration.
For David, the only place he can turn to now is the public facility closest to him – the Nancefield Clinic. Even though a switch of facilities seems straightforward enough, David explains why it isn’t the case.
“I am very scared to go there without a transfer letter; I’m scared they will turn me away,” he says. As he tells his story he’s already gone one month without receiving his HIV treatment.
“It makes me very worried because I can feel my body is not right now. My legs are in pain and it wasn’t like this when I was taking my pills,” he says. He is also anxious that he doesn’t know what his CD4 count is currently.
HIV experts warn that interruptions in treatment put people at risk to become ill from opportunistic diseases and serious complications. This could lead to hospitalisation and death.
Because the Wits mobile clinic services were shut down virtually overnight, many people, like David, could not get any paperwork arranged. A transfer letter can make it easier for patients to navigate the public health system.
Ritshidze’s community-led monitoring over the last six years has shown that people living with HIV are routinely denied care and access to services when nurses demand that they produce a transfer letter. This despite South Africa’s policy that ARVs be made available to anyone who tests positive – regardless of CD4 count or immigration status, and without needing a transfer letter.
For David, there is a second fear of using the public facility and it’s a fear that he will be discriminated against because he’s a foreign national in the country. He says: “If I go there with my Malawi passport, and not a South African ID, I know the nurses will ask too many questions and then it makes things harder for me.”
David is aware of the risks of being off his ARVs, he’s also aware of his health rights, but the realities of facing up to nurses who do not want to provide him with HIV services, or being the target of xenophobic hatred is real. So damningly real that it’s enough for him to choose to stay away, even when he knows his health and possibly his life depends on him getting back onto his lifesaving treatment.
The government has launched a campaign to get 1.1 million more people on HIV treatment, but this will not happen while it is becoming harder for people living with HIV to collect ARVs and stay on their treatment. We need the South African government to step in following the suspension and loss of U.S government funding to ensure that services are maintained and no-one is turned away who needs ARVs. The Guidelines on managing clinic transfers must be immediately implemented at all health facilities: continuing a person’s ARV treatment on the day of arrival without requiring anyone to collect transfer documentation before or after being enrolled in the new clinic. Especially now that services have closed with no possibility of collecting transfer documentation.
* Identity withheld
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This is part of a series of stories that TAC is collecting to expose the realities in our clinics following the U.S government funding suspension. Follow our website and social media channels as we publish testimonies that highlight the impact on the lives of people living with HIV and other public healthcare users.
To find out how we are affected by the funding suspension see: https://www.tac.org.za/news/us-funding-cuts-to-health-and-hiv-services-threaten-lives/
For more information:
Ngqabutho Mpofu: 072 225 9675 | ngqabutho.mpofu@tac.org.za
Xabisa Qwabe: 076 850 6736 | xabisa.qwabe@tac.org.za
