ADOLESCENT ACCESS TO HIV PROTECTION MEASURES IN SOUTH AFRICA: A NUANCED UNDERSTANDING OF THE INTERSECTION BETWEEN LAW, PUBLIC HEALTH, AND ETHICS

Abstract

In South Africa, adolescents are at high risk of HIV infection. Legal barriers block access to critical public health services for adolescents; consent requirements for adolescents are complex, and healthcare professionals have a mandatory obligation to report suspected unlawful sexual activity involving adolescents. In this synoptic commentary, the role of South African law in supporting public health priorities is examined to find a balance between reducing the burden of HIV in the country, especially amongst adolescents, and providing protection for adolescents through consent/reporting requirements for unlawful sexual activity. Underpinned by a contextual and human rights approach, it is shown that South African law intersects with public health imperatives and ethics in HIV prevention for adolescents.

Eight selected peer-reviewed publications and two South African AIDS Conference poster presentations are included in this review. Commencing in 2007, the body of work has been developed through legal research using human rights approaches. For the purpose of this thesis, an in-depth reflective appraisal of the published works was undertaken to reveal themes and the primary contributions to knowledge. Reflective analysis was facilitated via the application of a bespoke appraisal framework.

Critical appraisal has highlighted the complexity associated with the interpretation and enactment of existing laws (for instance, overly restrictive or contradictory provisions) related to the public health strategy for addressing HIV infection in adolescents. Central to these challenges is the dual role of the law: adolescent consent laws must both support responsible sexual behaviour and reproductive health whilst also enabling protective measures.

This body of work contributes to a better understanding of the legal norms relating to HIV interventions for adolescents and how access to essential public health services for adolescents might be improved. Within the context of South Africa’s burden of HIV amongst adolescents, a balanced but coherent rights-based approach is required for effective interaction between public health, law, and ethics.