The management of AIDS in South African schools

A ccording to the Third National Sun’ey conducted am ong women attending antenatal clinics in South Africa, 120.000 more peop le are estim ated to have becom e infected with H IV since 1991 (Kustner, 1993a: 34). Pupils and schools cannot be iso la ted from this serious health hazard in our country. In this article the relationship o f confidentiality between a doctor an d his patien t is com pared to the relationship between a p u p il and a teacher. The question arises as to whether a teacher (i.e. the school principal) should be allow ed to breach this confidence by revealing to the s ta ff o f his school the fa c t that a pupil is HIV-infected. Under certain circumstances the public interest in preserv ing human life outweighs the HIV-infected p u p il's right to p r iv a c y .


Introduction
Van Wyk as quoted by Prinsloo and Beckmann (1993:51) emphasises the fact that AIDS is likely to become the most serious health hazard o f this century.The pupils, parents and staff o f our schools are not exempt from this problem.In accordance with the general function o f law in o f our society, the rights as well as the interests o f the individual AIDS sufferer should be carefully weighed against the rights and interests o f the school as a community (Prinsloo & Beckmann, 1993:51).The situation becomes even more problematic when regarded in the light o f the teacher's duty to take care o f the physical (and mental) well-being of each pupil as an individual and the school community as a whole.
No case law exists as yet with regard to the management o f the AIDS problem in South African schools.For this reason existing legislation and case law applic able to the medical practitioner will be analysed in an effort to find proper guidelines according to which the school principal (and the teacher) can manage this problem in our schools.

P roblem s relating to the education and prevention o f A ID S in South A frica
The school and its pupils and teachers cannot be isolated from the rest o f society.For this reason, the trends within society that are relevant to AIDS are also o f re levance to the school situation and should be taken into account in the m a nagement o f AIDS at school.

The continent o f Africa
Africa is deemed to be the continent which has been hardest hit by AIDS (Mann, 1988:60).According to figures released by the W orld Health Organisation, more than 600 000 people in Zimbabwe (one o f South A frica's neighbouring countries) have been infected by the HIV virus (SAPA, 1993:6).According to the same or ganisation, survey data showed that by 1992 HIV had spread throughout the country o f Nigeria, averaging 22 percent in patients and nearly 6 percent in preg nant women (SAPA, 1993:6).

AIDS in South Africa
South Africa cannot be isolated from the rest o f Africa, especially when the practice o f migratory labour is taken into consideration.South African mining, for example, makes use o f many migrant labourers from various parts o f Africa.
Being away from their own families for long periods o f time, they often become involved in loose sexual relationships with local girl-friends and prostitutes (Moodie, 1988:228).Van der Walt adds to this the fact that long-distance drivers have contributed significantly to the spread o f AIDS in Africa.He says that "prostitutes frequented the overnight facilities used by truck drivers" on the main routes (HSRC, 1993:1).In a survey almost 57% o f truck drivers admitted to making use o f the services o f prostitutes, very few making use o f condoms (HSRC, 1993:1).This could o f course contribute considerably to the local spread o f AIDS.
During the months o f October and November o f each year (since 1990) national surveys are conducted among women attending antenatal clinics throughout South Africa to determine the prevalence o f the HIV epidemic in South Africa.The figures o f the third South African National HIV survey which w ere released in M ay 1993, showed that a further 120,000 persons are estim ated to have become infected with the HIV virus since 1991 (Kustner, 1993a:34).The estimated cumulative total now stands at 322,000 (out o f a total population o f 36 million) HIV-infections (Kustner, 1993a:34).(It was estimated in M ay 1987 that South Africa had a mere 6,000 to 7,000 carriers o f the disease see -Strauss, 1988a: 13.) One o f the most alarming facts was the confirmation o f the rapid growth of infection among the youth (Steinberg, 1992:2).The nationwide doubling time at present is 12 months (Kustner, 1993a:34).In research done by the Human Sciences Research Council (HSRC) a third o f the respondents feared that a medical doctor would not respect the confidentiality o f an AIDS patient (HSRC, 1993:1).

Economic factors
Various economic issues have an influence on the prevention o f AIDS.Klugman, from the medical school o f the University o f the W itwatersrand, said that "AIDS is becoming a disease o f the poor, o f the less educated" (HSRC, 1993:2).
It is commonly accepted that a definite link exists between poverty and disease (Head, 1992:17).The relations between disease and overcrowded living condi tions, a poor diet and inadequate housing is a proven medical fact.M any South Africans live in conditions o f poverty where household income is hardly able to cover their basic food supply (Head, 1992:17).It is estimated that about 10 mil lion people in South Africa (out o f a total population o f 36 million) fall into this category (SABC, 1993).One o f the reasons for this is the high unemployment figure o f an estimated 6 million people (SABC, 1993).
Among other things, poverty has an effect on people's ability to afford the recom mended food, medicine and medical care.
The South African government was able to approve only R20 000 000 (less than $6 000 000) for AIDS programmes in 1992 (Stockton, 1992:5).Fortunately, va rious non-governmental organisations such as the NPPHCN, sponsored by private initiative, focus their activities on educational and preventative w ork in the area o f AIDS.

Illiteracy
An educational system disrupted by the political situation in South Africa has left many South African school students bereft o f a reading culture so that they are not fully literate in English (Everett, 1992:8).This has a negative effect on their knowledge about AIDS.

Attitudes towards sex education
Everett (1992:9), a member o f the South African M edical Research Council, re ports that teachers are hesitant about supporting and promoting the Council's educational programmes as they feel that parents and colleagues might be offended.Research by the HSRC directed at establishing teachers' views on AIDS education showed that many teachers excluded all sections o f the pro gramme referring to sex, condoms and safe sex practices, as they felt that nothing should be taught which might be interpreted as condoning or encouraging pupils becoming sexually active (HSRC, 1993:2).M any Christian parents hold the view that small and immature children are confronted by issues such as condom s and sex which are issues that they are not yet mature enough to handle (Van der Walt, 1990:297).This viewpoint is supported by Christian churches in South Africa which believe that moral standards should rather be taken into consideration and that an unconditional openness about sex should be handled carefully (Stockton, 1992:6).

Polygamous traditions
Polygamy is a tradition o f the black tribes o f South Africa.M okhobo (1988:34) says that this tradition continues today because o f the fashion to have sexual contact with a great number o f women.This practice has been confirmed by em pirical research where the respondents thought that m essages to 'stick to one partner' w ere ludicrous (HSRC, 1993:2).

Common law
South African common law with its unique indigenous character, w as developed from Roman-Dutch and English law.A number o f South African common law principles are relevant to the position o f the teacher with regard to his conduct tow ards the HIV-infected pupil.For the purposes o f this article the pupil's right to privacy and the in lo co p a re n tis position o f the teacher will be emphasised.

Right to privacy
The right to privacy is regarded by Neethling et al . (1990:294) , 1990:294).Similar to the well-known relationship o f confidentiality which exists between a medical doctor and his patient is the relationship between a pupil and his teacher, which is also regarded as a relationship o f confidence.
The basic common law principle in South Africa therefore determines that a teacher does not have the right to infringe a pupil's right to privacy.This basic ally boils down to the fact that he will be infringing a pupil's right o f privacy if he informs a third party o f the fact that the pupil is HIV-infected.
An outsider (i.e.teacher) will not be held liable for a deed o f violation, however, if he can justify his act.Grounds for justification are described by Neethling et al . (1990:61) as "special circumstances which reveal that conduct which appears to be wrongful is in reality lawful".The violation o f the right to privacy o f the HIV-infected pupil can be justified on the grounds o f necessity.N ecessity can be defined in terms o f the defendant (i.e. a teacher) finding him self in such a position as a result o f a superior compulsion allowing him to protect his own legal in terests (and even that o f another) by violating in a reasonable way the rights o f an innocent third party (i.e. the AIDS-infected pupil and his right to privacy) (Neeth ling et a l., 1990:61).Some o f the conditions under which a defendant (i.e. the teacher) can claim necessity as grounds for justification are as follows (Neethling e ta l ., 1990:74): The necessity must arise from a present situation or it must be imminent.
Interests such as property and privacy (i.e. the right to privacy o f the AIDSinfected pupil) may be protected.In the court case o f the S tate vs G oliath 1972 3 SA (A) it w as held that even homicide may be justified under certain conditions.
The general principle is that the interest sacrificed should not be more valua ble than the interest which is protected.
The defendant (i.e. the teacher) need not only protect his own interests but he is also entitled to protect the interests o f others (such as children).

The in loco parentis-position of the teacher
The South African teacher's position as a person in loco p a re n tis is based on common law.Literally translated, it means 'to stand in the place o f the parent'.
Although the teacher can never replace the parent as the primary educator o f the child, he acts on behalf o f the parent in the physical absence o f the parent during school activities.His role as person in loco p a re n tis requires the teacher to take disciplinary control o f the pupil and to undertake diligent supervision o f the pupil.
The diligent supervision includes protecting the physical as well as the mental well-being o f the pupil.Teachers who have been found negligent in their obli gation o f diligent supervision towards an individual pupil or the pupils as a group have been held liable for damage on various occasions in the past (Bray e t al., 1989:96).
N ot only does the teacher have a responsibility tow ards the physical well-being o f the HIV-infected pupil, but also towards the rest o f the pupils at school.A teacher could be held liable for the infection o f pupils in a case where, knowing that a certain pupil is HIV-infected, he allows him to participate in a contact sport such as rugby football, thereby endangering the safety o f other pupils.The posi tion would apply even if the teacher is not personally in control o f the specific activity, but where he has knowledge o f the fact that the infected pupil is participating in the said activity which falls under the control o f a colleague.This is especially the case with regard to the position o f the school principal.Here the teacher needs to weigh up the interest sacrificed (the individual HIV-infected pupil's right to privacy) against the right o f the other pupils at school to super vision and physical safety (see the discussion on necessity in a previous para graph).The general principle is that the interest which is sacrificed should not be more valuable than the interest which is protected.Alternative education should be provided for those carriers who, for the reasons given above or owing to rejection, cannot be accommodated in a particular institution.

Legislation
It is important that each case should be dealt with individually.The be haviour and general state of health of all carriers should be monitored regularly as these factors will determine whether they may continue their schooling at a particular institution in the case of their condition stabilizing, or whether they should receive alternative education.
Carriers will therefore have to be placed under continuous medical supervision and medical officers will have to evaluate the ability of the institution concerned to provide the care required.If the risk is too high, the carrier should receive alternative education.
To divulge medical information concerning a patient to a third party without the consent of the patient or the patient's parents/guardians (in instances where the patient is a minor) is illegal and unethical and shows a total disregard for a patient's right to privacy.
In dealing with AIDS sufferers, the following guidelines are to be followed (TED, 1993:10): (i) The underlying principle in dealing with an HIV carrier or AIDS sufferer is to protect the staff, pupils and the general public whilst at the same time respecting the rights of the individual to privacy and confidentiality, provided that the broad interests of the community concerned are not compromised.
(ii) All institutions are to pay particular attention to the following aspects irrespective of whether or not they have HIV carriers or an AIDS sufferer at the institution: * Staff, pupils and parents should be well-informed about the disease.The preconceptions and fears o f members of staff should be allayed.
* Teaching staff should be sensitive to the general state of health of all pupils at all times.Principals should be informed of problematic cases and should deal with these cases discreetly.
* Institutions are to implement routine procedures when dealing with blood or body fluids and these should be strictly adhered to irrespective of whether or not there are carriers at the institution.
Gloves must be used where there is any contact with blood or excretions and they should be destroyed once they have been used.
Gloves and dressings should be sealed in plastic bags and destroyed immediately after use.
Open wounds, sores and grazes should be bandaged.
Hands exposed to contact with blood or body fluids should be washed.
Surfaces which may be infected are to be cleaned and disinfected with a chlorine solvent.
* Pupils are to receive family guidance and health education which deal explicitly with the AIDS problem.They should also be well-informed on the dangers of drug abuse.
* General hygienic procedures should be instituted and brought to the attention of both staff and pupils as these measures will protect everyone involved not only against AIDS but also against other infections.
* Should any pupil sustain an open wound in a contact sport, the referee/supervisor is to stop play and order the pupil off the field until such time as the bleeding has been stopped and the wound has been disinfected and properly bandaged.Although these are only (advisory) guidelines, and therefore not a binding ethical code for medical practitioners, they serve as a very definite indication o f the attitude o f the South African medical profession as to what is to be regarded as a model for the reasonable behaviour o f the medical practitioner.

Case law
Van Wyk (1992:116) regards the unreported case o f M cG e a ry vs K ru g er a n d J o u bert (1991-10-16, case no. 25317/90 (W )) as the locu s cla ssicu s regarding the AIDS sufferer's right to privacy.In this case M cGeary, the applicant (an HIV-infected patient o f the respondent) claimed damages from his medical doctor (Kruger) for breaching his right to privacy by informing the local dentist as well as another practitioner o f M cG eary's condition while they w ere playing golf.The decision o f the court made it clear that medical w orkers have the right to breach a HIV-infected patient's right to privacy by informing another health care w orker o f the patient's condition if it is likely that such a health care w orker might get involved in the treatment o f that patient.The judge came to the conclusion that "in the light o f the major threat posed by AIDS to society internationally ... its victims ... may have their right to privacy affected in the interests o f society.It is considered that the latter interests outweigh the individual's right to privacy" ( Van W yk, 1992:118).He further noted that the seriousness o f the disease de mands a "generous approach to the need for health care w orkers to be kept fully informed and to subordinate the interests o f the patient to that need" (Van Wyk, 1992:118).In the subsequent Court o f Appeal decision (Jansen van Vuuren an d A n oth er N N O v K ru g er 1993(4) SA 842), this decision w as reversed.In this case the judge confirmed that "a doctor could be justified in disclosing his knowledge where his obligations to society were o f greater weight than his obli gations to the individual".He continued to say that in determining whether a me dical doctor was justified in violating his obligation o f privacy towards a patient for the sake o f social interests, the standard o f the reasonable man is to be applied.He held that in this particular situation the medical doctor's violation of the patient's right to privacy was unreasonable since he expressly undertook not to divulge the patient's status.

Attack on poverty
Even although it is not a priority o f the school to fight poverty in South Africa, the breaking down o f poverty will have an influence on AIDS in the macro society of which the school community forms an integral part.
An attack on the conditions o f poverty should become an urgent priority.Recent ly the South African government started making funds available for the communi ty development o f poverty-stricken communities.Apart from this, much private initiative (such as the Ithuba project, the Independent Development Trust, the Southern African Development Bank, the Urban Foundation, the Rural Foun dation, the D.G. M urray Trust) is raising and channelling money tow ards these communities.

Educational guidelines for the management o f AIDS at school
As far as the management o f AIDS within the school is concerned, there are a few legal, managerial and educational considerations which could be regarded as possible solutions to the management o f the problem in our schools.

The fir s t a sp e c t abou t A ID S which pu p ils sh o u ld learn is th at o f sex u a l restraint.
Biblical guidelines such as sexual restraint should be re-emphasized among the young.These will not be o f any use, however, if the correct example is not set by adults.The culture o f immorality holds sway over South Africa (and W estern so ciety) and must be substituted by Biblical values.An educational programme should be instituted w here pupils are informed about the dangers o f AIDS, the ways in which it is transmitted and how one should go about preventing infection.In the United States certain aspects o f the AIDS edu cational programme (such as the use o f condoms) are voluntary (Zirkel, 1992:347).As the views o f all South African parents and Christian churches should be respected, an educational programme based on voluntary (and with the consent o f the parent) attendance by pupils (and their parents) could be consi dered.The programme should be run after school hours to enable parents to attend it.In this w ay the parents can develop confidence in this kind o f pro gramme.It will also assist those parents who have an open relationship with their children regarding sexual issues, to extend this to the issue o f AIDS, and to answer their children's questions (which they might have been too shy to ask in front o f the group during an educational session).Once parents' support for the contents, respectability and aims o f such a programme has been obtained, it will give momentum to the success o f the programme.A programme such as this has been developed and presented by the Transvaal Education D epartment since 1990.According to Louw (1994) this family guidance programme proved to be a big success in the school district o f Pretoria.This was confirmed by Coiy (1994) concerning the success o f the programme in Potchefstroom.
In 1992 the South African M edical Research Council's AIDS Research Pro gramme initiated a unique programme when they developed an AIDS educational comic (Everett, 1992:8).The aim o f the comic is "to influence prevailing youth culture so it becomes more supportive o f behaviour that prevents HIV transm is sion" (Everett, 1992:8).The comic as a medium has proved popular and familiar among South African teenagers and should therefore be a very successful means o f practising AIDS education.Not only w as this comic translated into the indige nous languages o f Zulu and Sotho, but it is also being translated into Xhosa and Afrikaans.

Securing the position o f the teacher
A medical doctor stands in a relationship o f confidentiality with his patients.The right o f a medical doctor to breach this confidence by warning third parties who are at risk o f suffering harm from his patient, is not entrenched by legislation in South Africa.The court case o f M cG ea ry vs K ru g er a n d Jo u b ert in 1991 (Van Wyk, 1992:117) held that a doctor has the right to reveal to a medical colleague that a patient is HIV-infected .
Principles o f M edical Ethics o f the American M edical Association are clear about this (Burchell, 1990:256): Beckmann and Prinsloo (1993:54) state emphatically that "the overriding social interest will justify the unauthorised disclosure o f confidential facts.In some in stances, a doctor may even have a duty to inform".
The position o f the teacher, and especially that o f the school principal, should be regarded as similar in many instances: Between the teacher and the pupils o f his school a relationship o f trust and confidence exists."Education is basically built on a relationship o f trust" (Bondesio, 1989:38), which implies that a special effort should be made to protect the interests o f the child.Bondesio (1989:38) also adds that special care should be taken in order to ensure that the interests o f the child are pro tected by not using sensitive information about the child to his disadvantage or to break the relationship o f trust between the child and the teacher.
As a result o f his in loco p a ren tis position the teacher is responsible for the physical safety and well-being o f all the pupils o f his school.
As possible answer to the question asked by Beckmann and Prinsloo (1993:54) as to 'who will be liable?' if the principal does not inform the teachers, pupils and other persons at school o f the conditions o f the AIDS sufferer and someone does get infected, could be found within the legal guidelines which are applicable to the medical doctor.As mentioned in paragraph 3.2.19(d) the guidelines for the reasonable man (i.e.medical doctor) is to inform other health care professionals o f the condition o f the infected patient in order to offer optimal treatment and care and also to take the necessary precautions in dealing with the patient.A medical practitioner's omission to inform another health care w orker which leads to the unnecessary exposure to, and infection by the HIV virus, would be regarded by the M edical Council in a very serious light, and could even "lead to disciplinary action against the practitioner concerned" (Van Wyk, 1992:121).
Likewise, if the principal's (or a teacher's) omission to inform other staff mem bers about the condition o f the HIV-infected pupil leads to their (the s ta ffs ) unnecessary exposure and infection, he could well be held liable.To enable the teacher to perform these obligations, it is clear that he should be in the same position as the medical doctor whereby he should have the right to inform the staff concerned about the condition o f AIDS-infected pupils.As in the case o f the medical doctor, this is a situation where the public interest at school out weighs the individual pupil's right to privacy.The teaching staff receiving this in formation should, however, be under the obligation o f confidentiality in order to secure the pupil's right to privacy.This viewpoint is confirmed by one o f the most recent circulars (13 August 1993) o f the Orange Free State D epartment o f Education: if after explaining to the pupil and his parent the importance o f reveal ing the condition o f the HIV-infected pupil to the school staff, the parent still re fuses the principal permission to do so, "the principal could as a last resort inform the staff without the permission o f the person or the parent ..." (OFS Department o f Education, 1993:5).
Apart from the right that a principal has to inform his teachers about the condition o f the HIV-infected pupil, a teacher should also have the right to inform the principal to enable the principal to manage the situation.

Legislation
Where educational legislation is at present being promulgated to bring about a unified educational system in the form o f one department it would serve a good purpose if the various stipulations o f the existing legislation w ere consolidated.
In doing so, the provisions o f the Act and the accompanying Regulations o f the E ducational A ffairs A ct (House o f Assembly) should be adopted because: The applicable provisions o f this Act are far more detailed than those o f the other Acts.
It decentralises departmental pow ers by entrusting medical examinations to the man on the spot -the school principal.
as the right o f an independent personality to an "individual condition o f life characterised by iso lation from the public and publicity".One o f the ways in which this right to pri vacy can be infringed is by means o f disclosure or revelation where an outsider acquaints (a) third party with the individual's personal affairs.One o f the forms o f violating an individual's right to privacy by means o f disclosure is the divulging o f private facts contradicting the right to confidentiality (Neethling et a l.

(
House o f Assem bly) These Regulations were promulgated by the M inister o f Education and Culture (House o f Assembly).The Regulations relating to M edical, Psychological and Dental Examinations o f Pupils at Public Schools specify that w here a school principal is o f the opinion that the mental and physical condition o f a child re quires a medical, psychological or dental examination, he may order such an exa mination by a person authorised by the D irector o f Education to do so.It is the duty o f a parent to enforce a pupil to undergo such an examination.The D epart ment o f Education and Training has similar provisions with the exception that the authority to order medical examinations is vested in the person o f the Director of Education o f the Department (Regulations regarding the rendering o f Health Services in Schools; Regulations published under the Education a An education department holds delegated authority which enables it to issue provisions which are in line with the applicable educational Acts and Regulations.An example o f such a departmental provision is the Manual for General School Organisation o f the Transvaal Education Department (TED, 1993).A compre hensive outline dealing with the management o f pupils infected with AIDS forms part o f this Manual (TED, 1993:9): As AIDS cannot be transmitted through casual contact it is important that HIV-carriers and AIDS-sufferers should not be excluded from education institutions unless they * are neurologically handicapped and have no control over the excretion of body fluids; * display deviant behaviour such as biting other pupils or using intravenous drugs; * have skin diseases which result in open sores which cannot be bandaged; or * are sexually active.
200) describes quasi or impure legislation as a body o f rules which exists between law and administrative practice and which is o f great relevance to the exercising o f discretionary administrative powers.The various ethical codes for South African professions such as the medical profession, teaching, etc. are examples o f quasi legislation.Ethical guidelines for the medical profession regarding the handling o f an AIDSinfected patient are quoted by Van Wyk (1992:120, 121): T h e h e a lth c a re p r o fe s s io n s are fu lly a w a re o f th e g e n e ra l ru le s g o v e rn in g c o n fid e n tia lity .C o u n c il is c o n fid e n t th a t i f d o c to rs fu lly d is c u s s w ith p a tie n ts th e n e e d fo r o th e r h e a lth c a re p ro fe s s io n a ls to k n o w o f th e ir c o n d itio n s in o r d e r to o ffe r th e m o p tim a l tre a tm e n t a n d a ls o to ta k e p re c a u tio n s w h e n d e a lin g w ith th e m , th e re a s o n a b le p e rs o n o f s o u n d m in d , w ill n o t w ith h o ld h is c o n s e n t re g a rd in g d iv u lg e n c e to o th e r h e a lth c a re w o rk e rs.If, h a v in g c o n s id e re d th e m a tte r c a re fu lly in th e lig h t o f su c h c o u n s e llin g , th e p a tie n t still re fu s e s to h a v e o th e r h e a lth c a re w o rk e rs in fo rm e d , th e p a tie n t s h o u ld b e to ld th a t th e d o c to r is d u ty b o u n d to d iv u lg e th is in fo rm a tio n to the other health care w orkers con cern ed w ith the patien t.A ll p e rs o n s re c e iv in g su c h in fo rm a tio n m u st o f c o u rs e c o n s id e r th e m s e lv e s u n d e r th e sa m e g e n e ra l o b lig a tio n o f c o n f id e n tia lity a s th e d o c to r p r in c ip a lly re s p o n s ib le fo r th e p a tie n t's care.I f it w e re f o u n d th a t an a c t o r o m iss io n o n th e p a rt o f a m e d ic a l p ra c titio n e r o r d e n tis t h a d le a d (sic) to th e u n n e c e s s a ry e x p o s u re to H IV in fe c tio n o f a n o th e r h e a lth c a re w o rk e r, th e C o u n c il w o u ld se e th is in a v e ry s e rio u s lig h t a n d w o u ld c o n s id e r d is c ip lin a ry a c tio n a g a in s t th e p r a c titio n e r c o n c e rn e d .
Education and training are essential components o f the effort to prevent the transmission o f the HIV virus.According to Heyns (1992:5) all other measures instituted to prevent the transmission o f this disease will "probably fail if they are not supported by an ongoing educational programme".Dr.Kustner (1993b: 1) o f the Department o f National Health and Population D e velopment said that by the year 2000 the number o f HIV infections in South Africa will stand at about 4 million persons o f which young South Africans will form the majority.He also emphasised the fact that young South Africans are to be the key target audiences in the AIDS education process since they are the future and form the group most susceptible to infection resulting from ignorance and unsafe sex practices.
A p h y s ic ia n m a y n o t re v e a l th e c o n fid e n c e s e n tru s te d to h im in th e c o u rse o f m e d ic a l a tte n d a n c e ... u n le s s h e is r e q u ire d to d o so b y la w o r u n le s s it b e c o m e s n e c e s s a ry in o rd e r to p ro te c t th e w e lfa re o f th e in d iv id u a l o r th e c o m m u n ity .
Detailed departmental provisions for the management o f the AIDS problem at school should be made.A w orkable model for this is contained in the existing specifications regarding the management o f AIDS in the Manual for General School Organisation drawn up by the Transvaal Education Department.O R A N G E F R E E S TA T E D E PA R T M E N T O F E D U C A T IO N .1993.Circular: G uidelines for Dealing with Persons w ith the H IV and A ID S, and the P revention o f H IV Infection (0.16/1/4/2/19).Bloem fontein.SABC see S O U T H A FR IC A N B R O A D C A ST IN G C O R P O R A T IO N SAPA.1993.Zim babw e Aids Toll N ow 600,000.The Star, 9 June 1993.SCH A A Y , N 1992.T he Aids P rogram m e o f N ational P rogressive Prim ary H ealth C are N etw ork.AIDS Bulletin, 1(2): 1. S O U T H A FR IC A N B R O A D C A ST IN G C O R PO R A T IO N .11 A ugust 1993.A genda.Johan nesburg.R E PU B L IC O F S O U T H AFRICA. R egulations Published under the E ducation and Training A ct (A ct 90 o f 1979).P retoria : G overnm ent Printers R E PU B L IC OF S O U T H AFRICA .E ducational Affairs Act (H o f Assem bly) (A ct 70 o f 1988) P retoria : G overnm ent Printers.STO C K TO N , N. 1992.Striving for a Com m unity-D riven N ational Program m e. AIDS Bul letin, 1(2):5-7.S T E IN B E R G , M .1992.D em ographics o f AIDS.P ress conference held on 14 M ay 1993.P retoria : M edical R esearch Council S TR A U SS, S.A. 1988a Legal Issues C oncerning AIDS.South African Practice Manage ment, 9(1): 13-14. .STR A U SS, S. A. 1988b.O ordraagbare siektes en aanm elding van aanm eldbare m ediese to estande.South African Practice Management, 9(4):5.T ED see T R A N SV A A L E D U C A T IO N D E PA R T M E N T T R A N SV A A L E D U C A T IO N D E PA R T M E N T (T E D ). 1993.M anual for G eneral School O rganisation.T E D : Pretoria.V A N W Y K , C.J 1992.Vonnisse.Tydskrif vir Hedendaagse Romeins-Hollandse Reg, 5 5 (1 ):1 16-124.V AN D E R W A L T, M 1990.Die im m unologie van HIV .Koers, 55(3):297-315.Z IR K E L , P. A. 1992 A C ase o f Condom s.Phi Delta Kappan, 74(4):347-348 The National Progressive Primary Health Care Network (NPPHCN) finds it dif ficult to do its work regarding the prevention o f AIDS in South Africa owing to the demand for confidentiality and the AIDS patient's right to privacy(Schaay,  1992:4).W hilst in some o f the other African countries, such as Uganda and Zimbabwe, people are open about AIDS, a South African medical practitioner is expected to honour the privacy o f a patient.This w as also the viewpoint held by the court in the case o f M cG e a ry vs K ru g er a n d Jo u bert in 1991 (Van Wyk, 1992:117) and confirmed by the subsequent decision by the Court o f Appeal in Jansen van Vuuren a n d A n oth er N N O v K ru g er 1993(4) SA 842.

ealth A ct (A ct 63 o f 1977) classify
Regulations relating to transmissible diseases promulgated in terms o f the H AIDS as a non-notifiable disease.A ccording to health regulations published in the Government G azette o f 30 October 1987 a school principal who is aw are o f or suspects a pupil (or a staff member) o f being HIV-infected must immediately inform the medical officer o f health (or the admi nistrative head) o f the local authority about the situation(Strauss, 1988b:5).Legislation on education is promulgated at different levels ranging from parlia mentary legislation to second and third level o f subordinate legislation.252 Koers 59(2) 1994:247-262 lzak Oosíhuizen 3.2.

1 Parliam entary legislation 3.2.1.1 The Educational Affairs A ct (House o f Assem bly) (Act 70 o f 1988)
According to Section 53 o f this Act a child is compelled to attend school from the first day o f the year in which he turns 7 years o f age up to the last day o f the year in which he turns 16 years o f age.According to Section 54 o f the Act a child can, however, be exempted from compulsory school attendance by the Head of Education (for such a period and under such conditions as he may determine) w here the pupil, as a result o f continuous ill-health, is not able to attend school.
(This obviously includes the AIDS-infected pupil who, as a result o f continuous ill-health, is not able to attend school.)3.2.1.