Principals' strategies for the effective management and implementation of HIV intervention programmes for adolescent girls in secondary schools

The study addresses the pressing public health challenge of HIV/AIDS among adolescent girls and young women in South Africa, a group with disproportionately high HIV incidence and prevalence. Despite multiple school-centred HIV interventions, infection rates remain high, suggesting gaps in reach and effectiveness. School principals are mandated to implement HIV-related policies and interventions but often face expanded and complex leadership roles without adequate support. The research purpose was to explore how principals manage and implement HIV intervention programmes for adolescent girls in secondary schools and to derive strategies for more effective management and implementation. The guiding research question was: What strategies for the effective management and implementation of HIV intervention programmes for adolescent girls in secondary schools can be deduced from conversations with school principals?

The literature highlights adolescent girls’ elevated vulnerability to HIV due to biological, social, and gendered factors, including gender inequality and violence. Despite established school-based HIV programmes (e.g., LO curriculum; initiatives like DREAMS, Love Life, Soul City), implementation challenges and limited impact persist. Principals are expected to provide health-promoting leadership, act as role models, and steward information, yet evidence indicates many lack preparation, support, and clear policy guidance for HIV programme implementation. Monitoring and evaluation are emphasized as critical but are often weak or absent in school settings. The study is theoretically framed by Transformational Leadership Theory (Bass, 1985, 1991), which posits that leaders who provide idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation can guide organizational change beyond transactional exchanges. Prior work suggests that while leadership training exists, it is insufficient for the technical and sensitive demands of HIV programme implementation; transformational leadership may better support adaptive, innovative responses required in this context.

Design: Non-experimental, qualitative, explorative phenomenological design to elicit principals’ lived experiences in managing and implementing HIV interventions for adolescent girls. Settings: Four districts in Gauteng, South Africa (Johannesburg, Ekurhuleni, Tshwane, Sedibeng), including schools in HIV hotspot areas. Participants and sampling: Ten secondary school principals with more than one year’s experience overseeing adolescent girls’ HIV programmes; purposive sampling to obtain rich, in-depth perspectives. Data collection: Semi-structured individual interviews conducted via Zoom, 30–40 minutes each, audio-recorded with consent. Interviewing techniques included probing, paraphrasing, and clarification to deepen responses. Ethics: Approvals from the South African Department of Education and the University of Johannesburg Ethics Committee; informed consent obtained from all participants. Data analysis: Interviews transcribed verbatim, coded using prior (predetermined) codes derived from research questions; data were organized into categories and themes, compared with literature and the theoretical framework for validation. Data management involved discarding irrelevant information and clustering recurrent themes from participants’ experiences. Participant profile summary: All principals had tertiary education; ages 44–58; varying years as principals and as HIV intervention patrons (1–5 years).

- Two overarching themes emerged: (1) Knowledge, practices, and attitudes of principals toward HIV programmes; (2) Proposed leadership and management strategies. Key insights include: - Inadequate professional development: None of the 10 principals had received training specific to managing and implementing adolescent girls’ HIV interventions; principals felt sidelined and underprepared, with knowledge largely self-taught. - Disruption to teaching and learning: HIV intervention activities were often poorly planned/timed by stakeholders, causing timetable disruptions; after-hours sessions had poor learner attendance, suggesting the programme may not reach intended beneficiaries. - Sensitivity of HIV-related issues: The topic’s legal and emotional complexity requires specialized training (including counseling), which principals lacked. - Weak or absent monitoring and evaluation: Principals reported no effective M&E systems, leaving programme outcomes unclear and impeding improvement. - Need for effective partnerships: Principals were often excluded from stakeholder training and planning beyond programme launches, undermining leadership and implementation. - Transformational leadership potential: Participants endorsed transformational leadership to foster proactive, innovative problem-solving. - Proposed strategies (from principals’ conversations): Promote adaptability to local contexts; revise outdated school policies and liability regulations; improve and sustain leadership engagement; establish systematic monitoring and evaluation (formal implementation blueprints, quality control tools, audits/feedback); and strengthen stakeholder networking and coalitions. Study sample/statistics: 10 principals across 4 Gauteng districts; interviews of 30–40 minutes via Zoom; participants aged 44–58, with 1–5 years as HIV intervention patrons; 80% reported knowledge of managing/implementing programmes but lacked formal training.

The findings directly address the research question by revealing specific leadership and management gaps that hinder effective implementation of adolescent girls’ HIV programmes and by articulating actionable strategies to strengthen delivery. Principals’ inadequate training, limited involvement in stakeholder processes, and absent monitoring systems contribute to programmes that disrupt schooling yet fail to consistently reach target beneficiaries. Applying a transformational leadership lens, the study argues that principals require capacity building to provide intellectual stimulation, inspire change, and foster collaborative partnerships necessary for adaptive implementation. Strengthened monitoring and evaluation, clear policy frameworks with implementation guidance, and integration with school timetables can improve fidelity, accountability, and impact. By emphasizing partnerships with NGOs and government, leadership engagement throughout implementation, and policy revision for confidentiality and liability clarity, the proposed strategies align school leadership practices with the complex, sensitive demands of HIV prevention among adolescent girls. Overall, enhancing principals’ transformational leadership competencies and institutional supports is crucial to improving programme reach and effectiveness.

Effective implementation of HIV intervention programmes for adolescent girls is essential to reduce new infections. The study concludes that strong transformational leadership at school level, coupled with targeted programme management strategies, is vital to improve delivery systems. Key contributions include empirically grounded strategies: promoting adaptability; revising outdated policies and liability procedures; ensuring consistent leadership engagement; establishing systematic monitoring and evaluation with formal implementation blueprints, quality control tools, and audits/feedback; and strengthening stakeholder relationships and networking. The study further underscores the need for continuous training linking leadership and management competencies to programme implementation, and for integrating interventions into school curricula and community-based components to ensure continuity (e.g., during disruptions like COVID-19). Collectively, these measures support more effective leadership, management, and execution of adolescent girls’ HIV interventions in secondary schools.

Small, purposively selected sample of 10 principals from four districts in Gauteng limits generalizability beyond similar contexts. Findings rely on self-reported experiences from interviews and may be influenced by participant perceptions. Despite these limitations, the study offers methodologically rigorous, in-depth insights applicable to comparable settings.