Reporting on children and reporting on HIV are two ethically challenging areas of journalism. The reported introduction of HIV testing in schools is an issue that encompasses both and it is to be commended that it was handled in such a balanced, measured and informative way by The Star. For over a week from 7 to 14 March The Star ran a series of articles written by a diverse range of contributors addressing the pros, cons and avoidable or potential pitfalls involved in introducing such a scheme, and for this it gets a GLAD.

“Test that no pupil can fail” (The Star, 07/03/2011, p. 12) was written in a personal capacity by Olive Manyana who is the Deputy Director of research and media monitoring in the Office of the Gauteng Premier. Manyana wrote that she was “a bit shocked by the brouhaha” in response to the initiative. She argued that “continuing to pretend that pupils are not engaging in sexual intercourse is naive at best and criminal at worst”, but acknowledged that “if this initiative is not administered properly” it could result in “anything from pupils being stigmatised by their peers to them committing suicide.” The author concluded that the programme should only be run when certain conditions have been met, and with “a full staff complement including counsellors, nurses, outreach practitioners and doctors.”

Misheck Ndebele is a Wits lecturer and wrote his PhD thesis on “Targeting HIV Risk Behaviour Among Adolescent Learners in South Africa”. Ndebele’s article “HIV school tests need review” (The Star, 08/03/2011, p.10) asked “are we convinced that pupils will be subjected to acceptable ethical processes during these HIV tests?” The author was concerned that “most parents or guardians, especially from disadvantaged communities, do not have the relevant training and skills to deal with HIV positive children” and that “current studies … show that for various reasons – personal, traditional, cultural or religious – most teachers are not committed to teaching HIV/Aids education.” While Ndebele was not opposed to rolling out HIV testing to schools per se, he warned that “the nation cannot afford to lose in such a campaign” and that the government “must get things right the first time.”

Cati Vawda who wrote “Support vital in testing pupils” (The Star, 09/03/2011, p.14) also spoke about the “practical challenges” involved. Vawda is the Director of the Children’s Rights Centre and Chair of the Yezingane Network, a national network addressing children’s rights in the context of HIV. The author emphasised the importance of the initiative involving children where “HIV prevalence spikes between the ages of 15 and 24,” but also highlighted potential pitfalls, for example that “current counselling and testing provisions require only a single pre- and post-testing counselling session. Psychological and social support provisions for teens need to be much more extensive.”

In “Support for HIV+ adolescents” (The Star, 10,03,2011, p.12) three authors, Marnie Vujovic, Saranne Meyersfeld and Helen Struthers examined an issue that has gone unaddressed in The Star’s articles before this point, that of children who were born HIV positive. The three women are involved in developing a series of manuals to address the particular needs of HIV positive adolescents. They highlighted existing shortcomings in dealing with children who are HIV positive saying that “no guidelines exist to give clear and simple instructions for health-care providers for meeting the sexual and reproductive health needs of positive adolescents,” and that “this silence is partially the result of conflicting cultural and societal value systems… added to this is the common fear that talking about sex might encourage teens to become sexually active.” The authors stressed that these shortcomings have to be addressed because “reinforcing healthy practices and promoting a reduction in risk behaviours can allow HIV-positive adolescents to lead longer, more meaningful lives.”  According to the article this would require “a revamp of the existing life skills curriculum to achieve changes needed by teachers, parents and caregivers.”

Senior Researcher at SECTION27, which incorporates the Aids Law Project, Jonathan Berger wrote “Testing drive deserves support” (The Star, 11,03,2011, p.14). Berger argued that South African society is shifting its perceptions about HIV testing as having the “potential to undermine human rights’ to viewing “knowledge of an HIV-positive status as the gateway to appropriate care”, though he accepted that “HIV services are (still) at times provided in a manner that violates human rights.” In order to learn lessons from the past he called for authorities to roll out the campaign “in a measured, phased manner after thorough and consultative planning.” The author stipulated measures that he believed must be taken if the programme is to be successful, and placed special emphasis on the necessity that children alone, and not their caregivers, should be asked for their consent to participate.

Joanne Brink is the head of the Education Department at the Foundation for Professional Development and she wrote the final article in the series “Shift focus from HIV to health” (The Star, 14/03/2011, p.10). The author spoke of how “discussions in the Grade 8 to 12 pupil focus groups confirmed an extensive factual knowledge of HIV – pupils were able to quote statistics and recite the majority of HIV transmission and prevention methods. Yet they did not see themselves at risk, even though most reported being sexually active.” Brink emphasised feedback from pupils on what they wanted, for example she wrote that “they said we should not be “coming in saying ‘HIV HIV’, but should rather make the campaign part of a wider focus about looking after their overall health.” The author also highlighted the potential positives of the campaign, including that “for many this will be their first open conversation with an adult about sexual health and choices.”

These articles accessed a range of experts, each with a different informed perspective on this complex issue. Despite the varied viewpoints communicated in this series of articles, there was broad agreement on broad principles, including that rolling out such a programme must be done with extreme care if it is to be successful and that the input of children is important in achieving this.

Different commentators also identified positives and negatives when considering particular aspects of the campaign. An example of this was with regard to counselling for children who are tested. Misheck Ndebele posed this scenario: “Imagine a child who has just tested positive and has received brief counselling from staff in a mobile clinic near the school. Hungry, tired and depressed, he walks a long distance home.”  On this issue, as mentioned above, Cati Vawda outlined that currently only two counselling sessions are provided, one before and one after testing. She argued that the “psychological and social support systems for teens need to be much more extensive.” Joanne Brink argued that the “pre- and post-test counselling experience will provide pupils with the opportunity to ask direct questions and reflect on their own behavioural choices,’ while Marnie Vujovic, Srenne Meyersfeld and Helen Struthers suggested that “under the guidance of an informed and compassionate counsellor, it becomes possible to consistently counter the confusing messages that young positive teens encounter.’ These views identified potential strengths and weaknesses in the campaign as currently envisaged.

Not only did this series of articles offer differing perspectives but it also presented the reader with useful statistics and information, including that “by age 21, women are five times as likely as men to have HIV” (“Support vital in testing pupils”, The Star, 09/03/2011, p.14) and that “in 2006 alone, some 64,000 children were infected with HIV through mother-to-child transmission.” (“Support for HIV+ adolescents”, The Star, 10,03,2011, p.12).

MMA is very GLAD that this series of articles accessed a diverse range of experts in order to explore this complex issue that has the potential to significantly impact the lives of South Africa’s children. This is a fantastic example of dedication to educating and informing the population about a very important children’s issue.