Table 3 Challenging organisational policies in schools and students’ coping strategies

• Public checking of students’ bags at the start of a new term, when medicines might be tipped on the ground

• Requirements that all medicines are handed over to the matron for safe storage and dispensing

• Where medicines could be stored in dormitories, locking of these during the day, and the risk of discovery during random dormitory checks

• A requirement for formal permission to be out of school for health or other reasons, including attendance at Comprehensive Care Clinics, with a range of punishments if breached

• A lack of teaching support and punishment for failing to ‘catch up’, on missed classes

• Storing ARVs in school toilet blocks or outdoor hiding places, requiring special effort to access privately

• Putting ARVs in unmarked containers rather than labelled prescription bottles, risking confusion about identity

• Accepting physical punishment for being late to class (typically, ‘caning’) to allow a student to take ARVs in private between breakfast and class, rather than explain the reason for lateness

• Choosing to miss school to collect ARV refills without giving an explanation, choosing a risk of physical punishment rather than disclosure of their status; or explaining school absences as due to less stigmatizing conditions. Another approach was intentionally being the ‘naughty student’ who missed school on purpose so that no one would know when they missed school for refills

• Using own time and borrowing other students’ notes to try to catch up on missed classes