Adolescence is a difficult and critical time of experimentation, new experiences and vulnerability. Experimentation may include drugs, reflecting on sexual orientation and also sexual experiences [1]. Globally, youth risk behaviour, including risky sexual behaviour, drug abuse and violence, is a public health concern and South Africa is no exception [2]. Estimates show that approximately 14 million young people die each year from Sexual and Reproductive Health (SRH) challenges, despite availability of social, economic, demographic and health benefits of safe sex [3]. The SSA region accounts for the highest burden of adolescent HIV globally, and adolescent girls, in particular, are disproportionately affected, accounting for three out of four new HIV infections [4].
The latest UNAIDS statistics show that adolescent girls and young women (AGYW) from sub-Saharan Africa [5], aged 15–24, remain at substantial risk of acquiring HIV [5]. Every week, an estimated 4900 incident infections occur among women in this age group globally [5]. In SSA, approximately six out of seven new infections occur among adolescents aged 15–19 years, and young women aged 15–24 years are twice likely to be living with HIV than their male counterparts [5]. AGYW accounted for 63% of all new HIV infections in 2021 [5]. Expedited prioritization and actions to reduce incident infections in particular among adolescent girls and young women from sub-Saharan Africa are therefore required to attain the UNAIDS 95-95-95 targets by 2030 [5]. The distribution of STIs, as well as HIV incidence and prevalence in heterosexuals, is shifted toward younger age groups especially for females in comparison to males [6]. In SSA age disparity is positively associated with HIV prevalence where the incidence of HIV increases swiftly from young to middle age [6].
For older adolescents aged 15–19 years, knowledge of HIV and other sexually transmitted diseases is important to promote the use of condoms and prevent sexually transmitted disease transmission and unintended pregnancy [7]. For younger adolescents, knowledge of reproductive health (menstruation, for example) and the implications of this for sex and reproduction are important in understanding the consequences of sexual debut [7]. The National Adolescent and Youth Indicators report revealed that most study participants had the correct knowledge, in that they knew condoms are effective at preventing the spread of HIV; but also reported a high teenage pregnancies and termination of pregnancies amongst girls aged 10–19 years in Limpopo province [8].
In many sub-Saharan Africa countries, sexual and reproductive health (SRH) needs of young people / youth are often underserved and underestimated despite their demonstrated need and the urgency of these services [9]. This is partly explained by multiple barriers in accessing SRH services including inconvenient operating times, long distance and waiting times, parental consent, transport costs, fears about interactions with healthcare staff which includes fear of judgemental staff and the lack of both confidentiality relating to non-divulging of personal patient information by staff, as well as privacy at clinics which relates to lack of secluded patient consulting stations [10]. There is also considerable stigma associated with premarital sexual activity in many South African communities, including being shamed by health care workers and this is linked to low levels of service utilization [11]. This has led youth into risky sexual behaviour resulting in high STI and HIV prevalence among young people, early pregnancy, and vulnerability to unsafe abortions and delivery complications resulting in high rates of death and disability [9], [12], [13].
In terms of services, evidence shows that school health programs can support young people in adopting lifelong behaviours and attitudes that reduce their risk of HIV, other STIs, and pregnancies [14], [15],[16]. Based on this, the South African government has subsequently taken steps to put an Integrated School Health Program (ISHP) in place [8] but evidence of successes and challenges are not currently available as these projects often have limited coverage or limited periods of implementation or follow-up [9]. For any school-based program to be deemed successful, learners have to use the services that are provided. The program must also be comprehensively tailored to meet the needs of the population it intends to serve. Thus, seeking out adolescents’ views and preferences for HIV and contraceptive services will highlight both promising directions and persistent challenges in preventing pregnancies and treating HIV and other STIs in this population.
Though significant progress has been made in advocating for the rights of adolescents to access HIV and contraceptive services; many young people in Sub-Saharan African still face the risk of HIV, STIs and unintended pregnancies [17], [18], [19], [20]. This suggests that there are many gaps both in terms of young people accessing healthcare services and also in having the opportunity to voice their own preferences for the HIV and contraceptive services that are available to them. Thus, exploring and understanding the preferences of young people for HIV and contraceptive services could potentially have a positive influence on critical sexual and reproductive health issues that they encounter. This study sought to explore the opinions and preferences of high school learners and stakeholders who support the provision of services to adolescents with regard to the acceptability and feasibility of various models for offering HIV and contraceptive services to learners. In addition, it sought to identify the characteristics of HIV prevention and contraceptive service delivery that are important to school-going South African adolescents when making decisions regarding whether and how to access care.