School: a place for children to learn their HIV status?

Abstract

The South African Government has announced that it will soon launch a controversial step in its national campaign to test 15 million people for HIV by June this year. Under the plans, children and adolescents will be offered voluntary HIV testing and counselling in high schools.The details of the initiative are thin at present. The health department has promised that the campaign will be “professional” and “responsible”; that testing will be done in private spaces on school premises during weekends and school holidays; that it will be phased in; and that extensive monitoring and evaluation will be done. An expert task team has been set up to work on implementation, including the provision of age-appropriate counselling, support, and care, and they will make their recommendations public in due course.The team has a lot to address. Under South African law, children aged 12 years and older can give consent to a HIV test. But how should a health worker determine whether consent provided by a 12-year-old or adolescent is sufficiently informed? Will those who test positive get access to antiretroviral therapy? How will health workers ensure confidentiality? Will children be pressured by peers or parents to divulge their test results? Will condoms be given to those who come for testing? And how often will testing be offered? The task team should also be allowed to consider whether schools are the best place for children to learn their HIV status.Problems in the national HIV testing and counselling campaign, launched last April, also heed a cautionary warning. Monitoring and evaluation of the campaign has been poor and there have been reports of HIV-positive people not being referred for treatment, clinics not complying with national testing and counselling protocols, and anecdotal reports of coercive testing.18% of young people (15–24 years) in South Africa report having first sex by 15 years, and early sexual debut is associated with increased risk of HIV infection. Improving access to age-appropriate HIV testing, treatment, and counselling for children and adolescents is, therefore, important. But South Africa must take its time and consider how best to do this, to ensure the campaign does not do more harm than good. The South African Government has announced that it will soon launch a controversial step in its national campaign to test 15 million people for HIV by June this year. Under the plans, children and adolescents will be offered voluntary HIV testing and counselling in high schools. The details of the initiative are thin at present. The health department has promised that the campaign will be “professional” and “responsible”; that testing will be done in private spaces on school premises during weekends and school holidays; that it will be phased in; and that extensive monitoring and evaluation will be done. An expert task team has been set up to work on implementation, including the provision of age-appropriate counselling, support, and care, and they will make their recommendations public in due course. The team has a lot to address. Under South African law, children aged 12 years and older can give consent to a HIV test. But how should a health worker determine whether consent provided by a 12-year-old or adolescent is sufficiently informed? Will those who test positive get access to antiretroviral therapy? How will health workers ensure confidentiality? Will children be pressured by peers or parents to divulge their test results? Will condoms be given to those who come for testing? And how often will testing be offered? The task team should also be allowed to consider whether schools are the best place for children to learn their HIV status. Problems in the national HIV testing and counselling campaign, launched last April, also heed a cautionary warning. Monitoring and evaluation of the campaign has been poor and there have been reports of HIV-positive people not being referred for treatment, clinics not complying with national testing and counselling protocols, and anecdotal reports of coercive testing. 18% of young people (15–24 years) in South Africa report having first sex by 15 years, and early sexual debut is associated with increased risk of HIV infection. Improving access to age-appropriate HIV testing, treatment, and counselling for children and adolescents is, therefore, important. But South Africa must take its time and consider how best to do this, to ensure the campaign does not do more harm than good.