School governing bodies and parents will no longer be able to prevent pupils from getting condoms at schools, according to a new basic education department policy released on Wednesday.
Almost a quarter of all new HIV infections are among young women between the ages of 15 and 24, data from the Human Sciences Research Council show. But condoms have been largely absent from the one place where most young people spend much of their time: school.
Until now, policy allowed school governing bodies to develop their own plans to address HIV infections among pupils that took into "account the needs and values" of schools and communities. This allowed schools and community leaders to have the final say about whether condoms were available on school grounds – often a hard "no".
In its new policy on HIV, the basic education department says parents and staff can no longer keep condoms out of schools and that roving health department teams or other qualified health workers will provide sexual and reproductive health services to pupils.
This includes contraception for pupils 12 years and older as well as youth-friendly health services such as screening for sexually transmitted infection – preferably in their home languages. Mobile health teams already screen some pupils for dental, eye and hearing problems. Where these teams don't exist, the policy says alternatives must be found.
It is the education department's first HIV policy in almost 20 years and replaces a 1999 policy that has since fallen out of step with the law.
Legislative amendments in the past decade have progressively extended adolescents' rights to access sexual and reproductive health services without parental consent. Although the legal age of consent remains, in most cases, 16, those 12 years and older can seek out HIV testing and contraception without their guardian's approval.
The country's Choice on Termination of Pregnancy Act imposes no age restrictions for people seeking abortions.
The international humanitarian organisation Doctors Without Borders (MSF) already provides school-based HIV testing. Since 2016, MSF has tested almost 8 000 pupils for HIV and provided condoms in about 40 schools in the Western Cape and KwaZulu-Natal. The majority of these pupils are now regularly tested for the virus.
MSF's medical co-ordinator for South Africa, Amir Shroufi, says the department's new policy is laudable, but the real test will be in changing mindsets and funding implementation.
"Everyone who works in this space knows that schools are a key place to access the people who are really key … if you want to make an impact on controlling the HIV epidemic," he says.
"A lot of barriers [to reproductive services for adolescents] come at the level of the school so it's important to somehow get parents, principals and governing bodies on board and dispel some of their misconceptions.
"A common misperception among parents is providing adolescents with condoms will make them have sex earlier. There has never been any evidence that that's been the case."
Shroufi says his organisation spent weeks speaking to parents, principals and boards to overcome reservations about providing services on school grounds.
Public interest law organisation Section27 , which previously protested for condoms in schools, says work needs to be done to ensure school governing bodies don't derail the department's ambitious plan.
"You have to bring parents and school governing bodies on board. Everybody essentially has the best interests of the kids at heart – you just need a respectful dialogue about why this is in their best interest," Shroufi says.
Both organisations say it is not just about pupils' access to services but about whether these programmes are tailored for them – from the pamphlets they read to where condoms are located.
"Adolescents really like to have a say. If you ask them, they'll give you very good feedback about what's good and what's not good about the service you're delivering," says Shroufi.
What's unlikely to work for teens? Language in the new policy that hints some of them may be forced to ask nurses and staff for access to condoms, warns Section27.
MSF and Section27 say this is likely to stand in the way of adolescents wanting to use condoms to prevent infections and pregnancy. So what's a better solution? Old-fashioned condom dispensers in the loo.
MSF adds that it has serious concerns about how the new plan will be funded. Shroufi explains that, in KwaZulu-Natal, their school services relied heavily on trained community members who counselled pupils.
The bulk of them lost their jobs after funding for the Expanded Public Works Programme was slashed, he says.
"This policy is saying that we're going to identify, for instance, kids who have been sexually harassed – and if they've been raped they will need access to comprehensive medical services and forensic examinations if they want," says Shroufi.
"Counselling is massively important in that but there are gaps around this, so where is this going to come from?"
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