HIV testing in South African schools
The Lancet reports on an initiative in South Africa to increase HIV testing rates by testing children in school:
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 major HIV/AIDS civil society organization in South Africa, Treatment Action Campaign (TAC), supports the initiative to test in schools, but calls on those implementing the program to properly prepare the public before testing students.
I think concerns about consent are legitimate. In our research on opt-out testing of pregnant women in Malawi (earlier, ungated version), we found that though women technically had the right to refuse HIV tests, HIV testing was generally seen as compulsory in accessing prenatal care. In a school setting, where listening to authorities is expected, can we really expect students will exercise their right to refuse testing?
Particularly important but only briefly discussed in TAC’s statement on the school testing campaign, is the availability of treatment services for children who test positive. Another parallel I saw to our Malawi research was a government’s interest in increasing the numbers tested, but without a complementary increase in relevant treatment outcomes. If a primary justification for the HIV testing in schools intervention is that it will lead to increased access to treatment for HIV-positive students, then it is essential that the department of health not only scale up its provision of pediatric AIDS care, but also create the necessary referral structures.