The government and the South African National Aids Council are holding talks with the education, children's rights and HIV sectors to iron out the fine details of a national policy for school-based HIV testing.
Testing is expected to start at high schools next month during weekends and holidays.
The idea is that telling pupils their HIV status could let them get treatment early on and help prevent the spread of the infection.
But opponents of the voluntary testing say children, some as young as 13, may not be psychologically ready to cope with a positive result or the stigma likely to go with it. Another issue is confidentiality.
"We suspect we may be heading for disaster,” said Allen Thompson, from the National Teachers' Union. “Even parents are afraid to take HIV tests, so you can imagine a 13-year-old. Some will be afraid to say no to their teachers," he told the Guardian.
He said the health department were using children to try and meet its target of the world's biggest HIV testing scheme. The goal of the programme, which started last April, was to have screened 15 million people by June but it has fallen behind.
About three per cent of South African children are HIV-positive, according to a 2010 report by the country’s Human Sciences Research Council. About 13 per cent of those aged 12 to 14 said they had had sex in the last year, and just over a quarter of girls aged from 12 to 18 said they’d had cross-generational sex with men who were at least five years older − an HIV risk factor.
“The campaign, really, is a preventive strategy to try and help young people to really start to understand the dynamics between their sexualities and their sexual relationships and the choices they make around sexualities," said the Department of Health’s Dr Thobile Mbengashe. “And one of those choices is that you need to know your status," he told PlusNews.
"The first thing we do is make sure the person understands the diagnosis, but we also try to contain [their reaction] because it’s a bad piece of news,” said Bruce Forgrieve of Shout-It-Now, an HIV education and testing charity. “It's not a death sentence by any means but… you can imagine how traumatic that is, regardless of the age group you're working with," he said.