title: Meeting the sexual and reproductive health needs of high-school students in South Africa: experiences from rural KwaZulu-Natal.
abstract: BACKGROUND
  Adolescents in South Africa (SA) have a huge unmet need for sexual and reproductive health (SRH) services. Integrating such services into schools may overcome many of the current barriers to access.
  
  
  OBJECTIVE
  We describe an SRH service model developed for high-school students and its implementation in 14 high schools in rural SA.
  
  
  METHODS
  Following consultation with community and other key stakeholders about the demand for and acceptability of adolescent-targeted SRH services, a three-tier school-based model was developed that included: (i) in-school group SRH information and awareness sessions; (ii) in-school individual SRH counselling and customised HIV counselling and testing (CCT); and (iii) referrals to in-school fixed, in-school mobile or public sector primary SRH clinics.
  
  
  RESULTS
  From October 2011 to June 2012, 70 consultative meetings were held. There was overwhelming support for the pilot founded on concerns about the high HIV prevalence and teenage pregnancy rates among adolescents in the community. SRH information was provided to 8 867 high-school students, 4 171 (47.0%) of whom accessed on-site CCT services for HIV. The gender-specific prevalence of HIV in these students was 3.3% (64/1 962) and 1.1% (24/2 209) for females and males, respectively. Two hundred and thirty-nine students (5.7%) were referred for clinical services at in-school fixed, in-school mobile or public sector primary SRH clinics.
  
  
  CONCLUSIONS
  The SRH service provision pilot was acceptable in the community and seems feasible for scale-up. Further work is required to understand inter-school variability in uptake, identify additional service needs of students, and characterise SRH demand dynamics.
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. Frohlichj@ukzn.ac.za.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Frohlich
authors.forename: Nolunthando
authors.initials: N
authors.lastname: Mkhize
authors.forename: Rachael C
authors.initials: RC
authors.lastname: Dellar
authors.forename: Gethwana
authors.initials: G
authors.lastname: Mahlase
authors.forename: Carl T
authors.initials: CT
authors.lastname: Montague
authors.forename: Quarraisha
authors.initials: Q
authors.lastname: Abdool Karim
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D017146:Models, Organizational; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data; D034121:Reproductive Health Services / Q000458:organization & administration*; D012423:Rural Health; D012572:School Health Services / Q000458:organization & administration*; D012731:Sex Counseling / Q000379:methods / Q000458:organization & administration; D012736:Sex Education / Q000379:methods / Q000458:organization & administration; D012725:Sexual Behavior; D013019:South Africa / Q000453:epidemiology; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult