Among the core indicators of the impact of the National Strategic Plan are the percentage of young women and men aged between 15-24 years who are HIV-positive, and changes in the stigma attached to HIV, STIs and TB.

Strategic Objective 1 of the National Strategic Plan (NSP) aims to reduce the impact of HIV, TB and STIs on young people. It also seeks to lessen their vulnerability to HIV by retaining them in schools, increasing their access to tertiary education and improving their work opportunities. In the process, it looks to reduce the stigma surrounding HIV, TB and STIs.

Strategic Objective 2 (SO2) focuses on a mix of biomedical, behavioural, social and structural interventions that would help lower the rate of these infections. Key sub-objectives of SO2 include maximising opportunities for testing and screening as well as increasing access to sexual and reproductive health services for young people. These health services include the provision of male and female condoms and other contraceptives.

The NSP targets a 50% reduction in TB and HIV incidence and also seeks to halve the level of stigmatisation attached to these infections. South Africa can only achieve these goals if we have effective sex education in schools. Thus, the NSP recommends interventions that would help to delay sexual debut, sustain protective behaviour such as the use of condoms, and reduce the number of sexual relationships with older partners. The plan also backs informing young people through methods such as sex education in order to lessen their exposure to infection.

Since the NSP is not a strategy of the Department of Health, it must be funded locally by government and more resources need to be made available at the level of implementation in order to execute the NSP. Each sector,  both government and civil society, should have its own monitoring and evaluation (M&E) mechanism. However, the South African National AIDS Council (SANAC) – responsible for implementing the NSP – has developed a strengthened M&E unit within its secretariat for monitoring progress nationally on issues relating to HIV, TB and STIs. Provincial AIDS councils must be developed further to carry out the equivalent role at a provincial level. This would ensure that continuous feedback and accurate information are available to SANAC.

Sex education is often misrepresented as an attempt to promote sexual activity. In fact, evidence shows that it has the opposite effect (see page 18). Sex education programmes aim to create awareness about sex and to empower young people to make informed decisions.
Sex education in schools can be a useful tool for monitoring key NSP indicators provided there is a well-developed programme in place. The programme needs to be carried out in a sensitive, non-judgmental way. It must be open and honest, taking social and cultural backgrounds into consideration. Different forms of contraceptives and their appropriate use should be discussed. However, any on-site provision of condoms requires consent from each school governing body. What is most important is to hire an educator that students find approachable and whose advice they are likely to seek out. It can also create awareness among young people about the role that they can play in achieving South Africa’s NSP goals.

A useful strategy

The Department of Basic Education (DBE) and Department of Health collaborated to develop the Integrated School Health Programme (ISHP), which should prove a useful strategy for realising the goals of the NSP.

One of the objectives of the ISHP is to improve the general health of school-age children. It provides health screening, on-site services and health education to learners in Grades R, 1, 4, 8 and 10, and is undergoing a phased introduction to schools.

In lower grades the ISHP promotes preventive health strategies, aiming to build awareness and break down stigma surrounding infection. Tuberculosis, male circumcision and substance abuse are among the initial areas that the programme covers with younger learners in grades R, 1 and 4.

In grades 8 and 10 sex education is introduced, addressing topics such as teenage pregnancy, HIV, contraceptives and ways to reduce stigma. On-site services for upper grades offer male and female condoms and leaflets about contraceptive use. Students are also taught about treatment for HIV, TB and STIs. Although the ISHP only focuses on students in certain grades, it is important to sustain the health education of students over their entire school career.

Lowering drop-out rates

Implementing strategies like the ISHP, which would improve sex education in schools, will help to achieve the goals of the NSP. Studies show that access to such education reduces the pregnancy rate among schoolgoers. Drop-out and pregnancy rates are closely linked (see box), with research showing that only a third of learners return to school after a pregnancy. Young people who drop out of school are more vulnerable to the risk of HIV, TB and STIs, and to living in circumstances that cause stigma and stereotypes to flourish.

By reaching young people from an early age, a sound education programme could minimise such problems and make it possible to control the spread of disease.  The incidence of HIV could be stabilised, and curable diseases like TB and STIs gradually eradicated. However, in order to realise these goals and meet the targets of the current NSP, government needs to acknowledge the crucial role that a well-structured sex education can play in the lives of South African youth.

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Pregnancy and dropping out of school

In 2008, 49,599 South African school students between Grade 3 and Grade 12 fell pregnant. The highest rate was among learners in Grades 10 and 11. In 2011, the HIV prevalence among antenatal women between the ages of 15 and 19 was 12.7% compared to 14% in 2010.
School drop-out rates mushroom as learners reach higher grades. Teenage pregnancy is one of the main causes of this problem. The Department of Education has indicated that drop-out rates climb from 1% in grade 1 to an alarming 11.8% in grade 11.

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By Muhammad Zakaria Suleman

Muhammad Zakaria Suleman is a student of law and social justice and a SECTION27 fellow.

Sources: Integrated School Health Programme; Soul Buddyz Club Evaluation: Longitudinal Research Study; ‘28% of school girls are HIV Positive’, Sowetan Live, http://www.sowetanlive.co.za/news/2013/03/12/28-of-schoolgirls-are-hiv-positive?service=print ; Integrated School Health Programme Resource Manual available at http://www. education.gov.za/LinkClick.aspx?fileticket=kN%2FI2VVGCG4%3D&tabid=667 ; Department of Basic Education, ‘Teenage Pregnancy in South Africa – with a specific focus on school-going learners’; The 2011 National Antenatal Sentinel HIV & Syphilis Prevalence Survey in South Africa. Available at http://www.health-e.org.za/documents/f0980fb5107a7ce543a8bd5730e52333.pdf