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Catherine Mathews, PhD, Sally J. Guttmacher, PhD, Alan J. Flisher, PhD, FCPsych, Yolisa Mtshizana, BA, Andiswa Hani, BTech and Merrick Zwarenstein, MBBCh

Catherine Mathews, Yolisa Y. Mtshizana, and Andiswa Hani are with the Health Systems Research Unit, South African Medical Research Council and the School of Public Health and Primary Health Care, University of Cape Town, Cape Town, South Africa. Sally J. Guttmacher is with the Department of Health Studies, New York University, New York, NY. Alan J. Flisher is with the Department of Psychiatry and Mental Health, University of Cape Town. Merrick Zwarenstein is with the Knowledge Translation Programme and Department of Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada.

Correspondence: Requests for reprints should be sent to Catherine Mathews, Health Systems Research Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa (e-mail: cm{at}cormack.uct.ac.za).

Objectives. We examined the process of obtaining "active," written parental consent for a school-based HIV/AIDS prevention project in a South African high school by investigating (1) parental consent form return rates, (2) parents’ recall and knowledge of the research, and (3) the extent to which this consent procedure represented parents’ wishes about their child’s involvement in the research.

Methods. This cross-sectional descriptive study comprised interviews with parents of children in grades eight and nine in a poor, periurban settlement in Cape Town.

Results. Within 2 weeks, 94% of 258 parents responded to a letter requesting written consent and of those, 93% consented, but subsequent interviews showed that 65% remembered seeing the consent form. At the end of the interview, 99% consented to their child’s participation.

Conclusions. These findings challenge many of the assumptions underlying active written parental consent. However, they should not be used to deny adolescents at high risk of HIV infection the opportunity to participate in prevention trials. Rather, researchers together with the communities in which the research is undertaken need to decide on appropriate informed consent strategies.