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ANNEXURE B

DRAFT NATIONAL POLICY ON HIV/AIDS FOR LEARNERS IN PUBLIC SCHOOLS

NOTICE NO ... OF 1998

DEPARTMENT OF EDUCATION

I, Sibusiso Mandlenkosi Emmanuel Bengu, Minister of Education, hereby give notice in terms of section 7 of the National Education Policy Act, 1996 (Act No. 27 of 1996) that, with the concurrence of the Minister of Finance, and after consultation with the Council of Education Ministers and the organised teaching profession, I have determined the following national policy in terms of section 3(3) and 3(4) of the said Act to be applied in respect of HIV/AIDS in public schools and to prevail over any provincial law or policy dealing with HIV/AIDS in public schools.

NATIONAL POLICY ON HIV/AIDS FOR LEARNERS IN PUBLIC SCHOOLS

In keeping with international standards and in accordance with education law and the constitutional guarantees of the right to a basic education, the right not to be unfairly discriminated against, the right to life and bodily integrity, the right to privacy, the right to freedom of access to information, the right to freedom of conscience, religion, thought, belief and opinion, the right to freedom of association, the right to a safe environment, and the best interests of the child, the following policy shall constitute national policy.

1 DEFINITIONS

(1) In this policy any expression to which a meaning has been assigned in the South African Schools Act (Act No. 84 of 1996), shall have that meaning and, unless the context otherwise indicates -

"HIV" means the human immune deficiency virus;

"AIDS" means the acquired immune deficiency syndrome, that is the final phase of HIV infection; and

"Universal precautions" refers to the concept used world-wide in the context of HIV/AIDS to indicate standard infection control procedures or precautionary measures aimed at the prevention of HIV transmission from one person to another and includes instructions concerning basic hygiene and the wearing of protective clothing such as rubber gloves.

2 PREMISES

(1) There are no known cases of the transmission of HIV in the school environment.

(2) HIV cannot be transmitted through day to day social contact. The virus is transmitted only through blood, semen, vaginal and cervical fluids and breast milk. Although the virus has been identified in other body fluids such as saliva and urine, no scientific evidence exists that these fluids can cause transmission of HIV.

(3) Because of the increase in infection rates, learners with HIV will increasingly form part of the school population. More and more children who acquire HIV perinatally will, with better medical care, reach school going age and attend primary schools. Indications that young people are sexually active mean that increasing numbers of learners attending secondary schools might be infected. Moreover, evidence suggests an increasing risk of HIV transmission related to sexual abuse of children in our country. Intravenous drug abuse may also become an increasingly important source of HIV transmission among learners. Although the possibility is remote, recipients of infected blood products (for instance haemophiliacs), may also be present at schools.

(4) Because of the nature of HIV antibody testing and the window period it is impossible to know with absolute certainty who has HIV and who not. Even if mandatory testing for HIV were to form part of a school's admission requirements and if it were repeated at regular intervals, it would be impossible to know with certainty who is infected and who not, or to effectively exclude all learners with HIV. Testing for HIV and excluding those who test positive are therefore not considered meaningful ways in which to achieve an HIV-free school environment.

(5) Compulsory disclosure of a learner's HIV status to school authorities is not advocated as this would serve no meaningful purpose. Any learner with HIV or his or her parent would however be free to disclose such information voluntarily. Genuine voluntary disclosure of a learner's HIV status should be welcomed and an enabling environment should be cultivated in which the confidentiality of such information is ensured and in which unfair discrimination is not tolerated.

(6) Children with HIV should lead as full a life as possible and should not be denied the opportunity to receive an education to the maximum of their ability. Their infection as such does not expose others to significant risks within the school environment that cannot be eliminated by ordinary measures or reasonable adaptations.

(a) The insignificant risk of transmission of HIV in the school environment can be effectively eliminated by following standard infection control procedures or precautionary measures (also known as universal precautions) and good hygiene practices under all circumstances. This would imply that in situations of potential exposure all persons should be considered as potentially infected and their blood and body fluids treated as such.

(b) Strict adherence to universal precautions under all circumstances in the school environment is advised.

(c) Current scientific evidence suggests that the risk of HIV transmission during sport and play activities is also insignificant: There is no risk of transmission from saliva, sweat, tears, urine, respiratory droplets, hand shaking, swimming pool water, communal bath water, toilets, food or drinking water. The statement about the insignificant risk of transmission during sport and play activities, however holds true only if universal precautions are adhered to. Adequate wound management has to take place at the sport field when a player sustains an open bleeding wound. Boxing and rugby could probably be regarded as sports representing a higher risk of HIV transmission than other sports.

(d) Public funds should be made available to ensure the application of universal precautions and the supply of adequate information and education on HIV transmission. The state's duty to take all reasonable steps to ensure a safe school environment is linked to compulsory school attendance for learners and should be regarded as a sound investment in the future of South Africa.

(7) The constitutional rights of all learners should be protected on an equal basis. If it is therefore ascertained that a learner poses a medically recognised significant health risk to others, appropriate measures may be taken. A medically recognised significant health risk in the context of HIV could include the presence of untreatable contagious (highly communicable) diseases, uncontrollable bleeding, unmanageable wounds, or sexual or aggressive behaviour which may create risk of HIV transmission. Furthermore, learners with infectious illnesses such as measles, whooping cough and mumps should be kept from school to protect all other learners, and especially those whose immune systems may be impaired by HIV. Schools should inform parents of inoculation programmes and of their possible significance for the well-being of learners with HIV.

(8) Learners should receive education about HIV/AIDS in the context of life skills education on an ongoing basis. HIV/AIDS education should not be presented as an isolated learning content. It should be presented in a scientific but understandable way.

(a) The purpose of education about HIV/AIDS is to prevent the spread of HIV infection, to allay excessive fears of the epidemic, to reduce the stigma attached to it, and to instill non-discriminatory attitudes towards persons with HIV/AIDS. Education should ensure that learners acquire age-appropriate knowledge and skills in order that they may adopt and maintain behaviour that will protect them from HIV infection.

(b) In the elementary classes, education about HIV/AIDS should be provided by the regular educator, while in secondary grades the guidance counsellor would ideally be the appropriate educator. Because of the sensitive nature of the learning content, the educator selected to offer this education should be specifically trained, should feel at ease with the content and should be a role-model with whom learners easily identify.

(c) Ideally all educators should be trained to give guidance on HIV/AIDS. Educators should respect their position of trust and the constitutional rights of all learners in the context of HIV/AIDS.

(9) In order to meet the demands of the wide variety of circumstances posed by the South African community and to acknowledge the importance of governing bodies and parents in the education partnership, this national policy is intended as broad principles only. It is envisaged that the governing body of a school should preferably give operational effect to the national policy by developing and adopting an HIV/AIDS policy at school level which would reflect the needs, ethos and values of a specific school and its communities within the framework of the national policy.

3 NON-DISCRIMINATION AND EQUALITY WITH REGARD TO LEARNERS WITH HIV

(1) No learner with or perceived to have HIV or AIDS may be unfairly discriminated against.

(2) Learners with HIV should be treated in a just, humane and life-affirming way.

(3) Any special measures in respect of a learner with HIV should be fair and justifiable in the light of medical facts, school conditions and the best interests of the learner with HIV or those of other learners.

4 ADMISSION TO SCHOOL AND HIV TESTING

(1) No learner should be denied admission to or continued attendance at school on account of his or her HIV status or perceived HIV status.

(2) There is no medical or scientific justification for routinely testing learners for evidence of HIV infection. The testing of learners for HIV as a prerequisite for admission to or continued attendance at school is prohibited.

5 SCHOOL ATTENDANCE BY LEARNERS WITH HIV

(1) The needs of learners with HIV with regard to their right to a basic education should as far as is reasonably practicable be accommodated within the school environment.

(2) Learners with HIV are expected to attend classes in accordance with statutory requirements for as long as they are able to function effectively.

(3) Academic work should be made available for study at home, and parents should be allowed to educate learners with HIV when they become incapacitated through illness, or if they pose a medically recognised significant health risk to others at school. Learners who cannot be accommodated in this way should be accommodated within the education system in residential institutions for learners with special education needs.

(4) Learners with HIV who develop HIV-related behavioural problems or neurological damage should be accommodated within the education system in suitable institutions for learners with special education needs.

6 DISCLOSURE OF HIV-RELATED INFORMATION AND CONFIDENTIALITY

(1) No learner, or his or her parent, is compelled to disclose his or her HIV status to the school authorities.

(2) Any learner with HIV (above the age of 14 years) or his or her parent is however free to disclose voluntarily the learner's HIV status. Genuine voluntary disclosure of HIV status should be welcomed. In the event of voluntary disclosure it may be in the best interests of a learner with HIV if a member of the school staff directly involved with the care of the learner with HIV is informed of his or her HIV status either by the learner's parent or by the learner him- or herself (if the learner is above the age of 14 years).

(3) Any person to whom any information about the medical condition of a learner with HIV has been divulged shall keep this information confidential.

(a) Disclosure to third parties may nevertheless be authorised by the informed consent of the learner (if the learner is above the age of 14 years), or his or her parent; or be justified by statutory or other legal authorisation.

(b) Unauthorised disclosure of HIV-related information could give rise to legal liability.

7 A SAFE SCHOOL ENVIRONMENT

(1) All schools should implement universal precautions to effectively eliminate the risk of transmission of all blood-borne pathogens, including HIV, in the school environment.

(a) The basis for advocating the consistent application of universal precautions lies in the assumption that in situations of potential exposure to HIV, all persons are potentially infected and all blood and body fluids should be treated as such. All blood, open wounds, sores, breaks in the skin, grazes and open skin lesions, as well as all body fluids and excretions which could be stained or contaminated with blood (for example tears, saliva, mucus, phlegm, urine, vomit, faeces, and pus), should therefore be treated as potentially infectious.

(i) Blood, especially in large spills such as from nose bleeds, should be handled with extreme caution.

(ii) Skin exposed accidentally to blood should be cleaned promptly with water and disinfectant.

(iii) All bleeding wounds, sores, breaks in the skin, grazes and open skin lesions should ideally be cleaned immediately with a suitable antiseptic such as hypochlorite (for instance bleach or Milton), 2% gluteraldehyde (for instance Cidex), organic iodines, or 70% alcohol (for instance ethyl alcohol or isopropyl alcohol).

(iv) If there is a biting or scratching incident where the skin is broken, the wound should be washed thoroughly with running water and disinfectant.

(v) Blood splashes to the face (mucous membranes of eyes, nose or mouth) should be flushed with running water for at least three minutes.

(b) All open wounds, sores, breaks in the skin, grazes and open skin lesions should be covered securely with a non-porous or waterproof dressing or plaster so that there is no risk of exposure to blood.

(c) Cleansing and washing should always be done with running water and not in containers of water. Where running tap water is not available containers should be used so as to pour water over the area to be cleansed.

(d) All persons attending to blood spills, open wounds, sores, breaks in the skin, grazes, open skin lesions, body fluids and excretions should wear protective latex gloves to effectively exclude the risk of HIV transmission. However, emergency treatment should not be delayed because gloves are not available. Bleeding can be managed by compression with material that will absorb the blood, for example a towel. However people who have skin lesions should not attempt to give first aid when no latex gloves are available.

(e) If blood has contaminated a surface, that surface should be cleaned with a fresh clean bleach solution and the person responsible for this should wear latex gloves. Other body fluids and excretions which could be stained or contaminated with blood (for instance tears, saliva, mucus, phlegm, urine, vomit, faeces, and pus) should be cleaned up in similar fashion.

(f) Blood-contaminated material should be sealed in a plastic bag and incinerated or sent to an appropriate disposal firm.

(g) If instruments (for instance scissors) become contaminated with blood or other body fluids, they should be washed and placed in a strong bleach solution for at least one hour before drying and re-use.

(2) All schools should ideally have available at least two first aid kits each of which contains the following -

(a) two large and two medium pairs of disposable latex gloves;

(b) two large and two medium pairs of rubber household gloves for handling blood-soaked material in specific instances (for example when broken glass makes the use of latex gloves inappropriate);

(c) absorbent material;

(d) waterproof plasters;

(e) disinfectant (such as hypochlorite);

(f) scissors;

(g) cotton wool;

(h) gauze tape;

(i) tissues;

(j) containers for water;

(k) a resuscitation mouth piece or similar device with which mouth-to-mouth resuscitation could be applied without any contact being made with blood or other body fluids.

(3) Universal precautions are in essence barriers to prevent contact with blood or body fluids. Adequate barriers can also be established by using less sophisticated devices than these described in 7.2. Alternatives would, for example include the following -

(a) unbroken plastic packets for use on hands where latex or rubber gloves are not available (these should be in supply indoors and outdoors);

(b) common household bleach for use as disinfectant, diluted one part to nine parts water (1:10 solution) made up as needed.

(4) Each educator should preferably have a pair of rubber household gloves in his or her classroom.

(5) Rubber household gloves should be available at every sport event and should also be carried by the playground supervisor.

(6) First aid kits should be stored in one or more selected (class)rooms in the school and should be accessible at all times, also by the playground supervisor.

(7) Used items should be dealt with as indicated in 7.1.6 and 7.1.7.

(8) The contents of the first aid kits, or the availability of other suitable barriers, should be regularly checked by a designated school staff member and discarded items should be replaced immediately.

(9) A fully equipped first aid kit should be available at all school events, outings and tours and should be kept on vehicles for the transport of learners to such events.

(10) All educators and other staff, including sport coaches, should be given appropriate information and training on HIV transmission, the application of universal precautions, and the importance of adherence thereto.

(11) All learners should be given appropriate information and training regarding the application of universal precautions.

(a) Learners should be trained to manage their own bleeding or injuries.

(b) Learners, especially those in pre-primary and primary school, should be instructed never to touch the blood, open wounds, sores, breaks in the skin, grazes and open skin lesions of others, nor to handle emergencies such as the nosebleeds, cuts and scrapes of friends, on their own. They should be taught to call the assistance of an educator or other staff member.

(c) Learners should be taught that all open wounds, sores, breaks in the skin, grazes and open skin lesions on all persons should be covered with waterproof dressing or plasters at all times, not only when they occur in the school environment.

(12) Parents of learners should be informed about the universal precautions that will be adhered to at a school.

8 PREVENTION OF HIV TRANSMISSION DURING PLAY AND SPORT

(1) The risk of HIV transmission as a result of contact play and contact sport is generally insignificant.

(a) The risk increases where open wounds, sores, breaks in the skin, grazes, open skin lesions or mucous membranes of learners without HIV are exposed to infected blood.

(b) Certain contact sports (rugby and boxing) may represent an increased risk of HIV transmission.

(2) Adequate wound management, in the form of the application of universal precautions, is essential to contain the risk of HIV transmission during contact play and contact sport.

(a) No learner may participate in contact play or contact sport with an open wound, sore, break in the skin, graze or open skin lesion.

(b) If bleeding occurs during contact play or contact sport, the player should be taken off the playground or sport field immediately and appropriately treated as described in 7.1.1 to 7.1.4. Only then may the player resume playing and only for as long as any an open wound, sore, break in the skin, graze or open skin lesion remains securely covered.

(c) Soiled clothes must be changed.

(3) A fully equipped first aid kit should be available wherever contact play or contact sport takes place. A first aid kit should be kept on vehicles used for transport of learners to sport events, sport outings or sport tours.

(4) Sport participants with HIV should seek medical counselling before considering participation in sport in order to assess risks to their own health as well as the risk of HIV transmission to other sport participants.

(5) Staff members acting as sport administrators, managers and coaches should ensure the availability of first aid kits and the adherence to universal precautions in the event of bleeding during sport participation.

(6) Staff members acting as sport administrators, managers and coaches have special opportunities for meaningful education of sport participants with respect to HIV/AIDS. They should encourage sport participants to seek medical counselling where appropriate.

9 EDUCATION ON HIV/AIDS

(1) A continuing HIV/AIDS education programme should be implemented at all schools for all learners, educators and other staff.

(2) Age-appropriate education on HIV/AIDS should form part of the compulsory curriculum for all learners and should be integrated in the life skills education programme for pre-primary, primary and secondary school learners. This should include the following -

(a) providing information on HIV/AIDS in South Africa and developing the life skills necessary for the prevention of these;

(b) inculcating from an early age onwards basic first aid principles, including how to deal with bleeding;

(c) emphasising the role of drugs, sexual abuse and violence in the transmission of HIV;

(d) encouraging learners to make use of health care, counselling and support services (including services related to reproductive health care and the prevention and treatment of sexually transmitted diseases) offered by community service organisations and other disciplines;

(e) teaching learners how to behave towards persons with HIV;

(f) cultivating an enabling environment and a culture of non-discrimination towards persons with HIV;

(g) providing information on appropriate prevention and avoidance measures, including abstinence and the use of condoms.

(3) Education and information regarding HIV/AIDS should be given in an accurate and scientific manner and in language and terms that are understandable.

(4) Parents of learners should be informed about all HIV/AIDS education offered at the school, the learning content and methodology to be used as well as values that will be imparted. They should be invited to participate in parental guidance sessions and should be made aware of their role as sexuality educators and imparters of values at home.

10 DUTIES AND RESPONSIBILITIES OF LEARNERS, PARENTS AND EDUCATORS

(1) All learners should respect the rights of other learners.

(2) The Code of Conduct adopted for learners at a school should include provisions regarding the unacceptability of behaviour which may create risk of HIV transmission.

(3) The ultimate responsibility for learners' behaviour rests with their parents. Parents of all learners -

(b) are expected to require learners to observe all school rules aimed at preventing behaviour which may create risk of HIV transmission;

(b) are encouraged to take an active interest in acquiring any information or knowledge on HIV/AIDS supplied by the school, and to attend meetings convened for them by the governing body.

(4) It is recommended that a learner with HIV and his or her parent should consult medical opinion to assess whether the learner poses a medically recognised significant health risk to others. If such a risk is established, the Health Advisory Committee or governing body should be informed.

(5) Educators have a particular duty to ensure that the rights and dignity of all learners are respected and protected.

11 REFUSAL TO STUDY WITH A LEARNER WITH HIV

(1) Refusal to study with a learner with or perceived to have HIV should be preempted by providing accurate and understandable information on HIV/AIDS to all learners and their parents.

(2) Learners who refuse to study with a fellow learner with or perceived to have HIV should be counselled.

(3) The situation should be resolved by the principal and educators and, if necessary, with the assistance of the governing body of the school in accordance with the principles contained in this policy.

12 SCHOOL LEVEL POLICIES

(1) This national policy constitutes a set of basic principles.

(2) The governing body of a school should preferably develop and adopt its own school level policy on HIV/AIDS to give operational effect to the national policy. The school level policy may however not deviate from the basic principles of the national policy.

(3) Major role-players in the school community (for example religious and traditional leaders, traditional healers and representatives of the medical or health care professions) should be involved in developing a school level policy on HIV/AIDS.

(4) A school level policy on HIV/AIDS should reflect the needs, ethos and values of the specific school and its communities. The school level policy could, for instance, contain provisions regarding the supply of condoms by the school in accordance with the needs and values of the specific school and its communities.

(5)In the absence of a school level policy on HIV/AIDS the national policy applies.

13 HEALTH ADVISORY COMMITTEE

(1) Where community resources make this possible, it is recommended that each school should establish its own Health Advisory Committee as a committee of the governing body. Where the establishment of such committee is not possible, the school may draw on expertise available at provincial, regional or sub-regional level within the education and health systems.

(2) Where it is possible to establish a Health Advisory Committee, the Committee should -

(a) be set up by the governing body and should consist of school educators and other staff, representatives of the parents of learners at the school, representatives of the learners, and representatives from the medical or health care professions;

(b) elect its own chairperson who should preferably be a person with knowledge in the field of health care;

(c) advise the governing body on all HIV/AIDS-related matters and especially what is considered to be a medically recognised significant health risk in connection with HIV;

(d) be responsible for developing, approving and adopting a school level policy on HIV/AIDS and review it from time to time, especially as new scientific knowledge about HIV becomes available; and

(e) be consulted on the provisions relating to the prevention of HIV transmission in the Code of Conduct.

14 IMPLEMENTATION

(1) The Member of the Executive Council shall be responsible for the implementation of this policy.

(2) The principal, or the head of a hostel, shall be responsible for the practical implementation of this policy at school or residential level, and for maintaining an adequate standard of safety according to this policy.

(3) It is recommended that a governing body should take all reasonable measures within its means to supplement the resources supplied by the state in order to ensure the availability at the school of adequate barriers (even in the form of less sophisticated material) to prevent contact with blood or body fluids.

(4) Strict adherence to universal precautions under all circumstances (including play and sport activities) is advised as the state will be liable for any damage or loss caused as a result of any act or omission in connection with any educational activity conducted by a public school.

15 REGULAR REVIEW

(1) This policy should be reviewed regularly and should be adapted to changed circumstances.

16 APPLICATION

(1) This policy applies to learners in public^[588] schools which enrol learners in one or more grades between grade zero and grade twelve.

17 INTERPRETATION

(1) In all instances, this policy should be interpreted to ensure respect for the rights of learners with HIV as well as other learners.

18 WHERE THIS POLICY MAY BE OBTAINED

(1) This policy may be obtained from The Director-General, Department of Education, Private Bag X895, Pretoria, 0001.

[588] According to sec 1, 12(2) and 12 (3) of the South African Schools Act 1996 (Act No. 84 of 1996) public schools include the following: ordinary public schools; public schools for learners with special education needs; and hostels for the residential accommodation of learners in these schools. According to information supplied by the Department of Education public schools for learners with special education needs include schools for physically disabled children; schools for mentally disabled children; schools for children with behavioural deviations (clinic schools); residential institutions for severe and profound types of "special needs"; hospital schools; and schools of industry, reform schools and places of safety for learners who have found themselves in trouble with the law or are in need of protection.