Condom Access in South African Schools: Law, Policy, and Practice

In 2007, South Africa’s new Children’s Act came into effect [1,2], expanding the scope of several existing children’s rights and explicitly granting new ones. The Act gives to children 12 years and older a host of rights relating to reproductive health, including access to contraceptives and to information on sexuality and reproduction, and the right of consent to HIV/AIDS testing and treatment [1]. These rights reflect growing concern over the need to prevent HIV in the country’s youth. South Africa has the highest number of persons living with HIV in the world [3]. Persons aged 15–24 account for 34% of all new HIV infections and have an HIV prevalence of 10.3% [4,5]. A critical challenge for HIV prevention efforts in adolescents is to ensure that these newly guaranteed reproductive health rights are realized. For youths in South Africa, access to condoms is limited. Barriers to access include substantial travel time and cost of travel to sites of condom distribution [6], the fact that government clinics distributing free condoms are usually closed when students are out of school, the judgmental and often hostile attitude of providers, and the cost of condoms in shops [7]. One way to increase condom access for adolescents is to make condoms available in schools. This is a socially divisive approach. Some believe availability of contraception will encourage sexual activity [8]. Others cite the early age of sexual debut [9,10] and the futility of HIV prevention education that emphasizes condom use without providing sexually active youth with access to condoms [11]. Reflecting these tensions, South African government policy is unclear, and school staff are often unsure if condom distribution in schools is permissible. As a result, most schools hesitate to distribute condoms, and those few that do distribute condoms do so discreetly [12]. Given the continuing high HIV incidence rates in youth, it is important to examine current South African laws and policies governing condom distribution in schools, policies of international donor agencies supporting HIV/AIDS prevention programs in South Africa [13], and community perceptions surrounding condom distribution in schools. We reflect on our experience in developing a policy on condom distribution for Mpilonhle, a nongovernmental organization involved in HIV prevention in schools, focusing on germane South African and PEPFAR (the US President’s Emergency Plan for AIDS Relief) policies and on the attitudes of students, school staff, and parents towards condom distribution in schools. Condom Access in South African Schools: Law, Policy, and Practice