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HIV/AIDS remains a critical public health concern globally, with Sub-Saharan Africa most profoundly impacted. South Africa, which experiences one of the world’s highest HIV prevalence rates, requires schools to implement HIV/AIDS policies aimed at supporting affected learners. This study explores how these policies are enacted in Western Cape schools, emphasising the scope and limitations of the support offered. Drawing on Bronfenbrenner’s Ecological Systems Theory, the research considers the layered environmental influences shaping policy implementation from everyday school interactions to broader societal norms. A qualitative study was conducted with a sample of 40 participants, comprising 20 School Management Team members and 20 Life Orientation teachers, selected through purposive sampling. Data were collected via semi-structured interviews and analyzed thematically, revealing critical factors such as educator preparedness, stigma, resource shortages, leadership variation, and external partnerships that collectively influence policy outcomes. Although HIV/AIDS policies provide a vital framework for learner support, their effectiveness is undermined by inconsistent training, persistent stigma, insufficient funding, and variable leadership commitment. Conversely, strong internal mechanisms, such as School-Based Support Teams, and collaborative ties with NGOs and healthcare providers significantly bolster policy execution. The findings underscore the necessity of integrating HIV/AIDS policies into the everyday practices of schools, anchored by comprehensive training, adequate resources, and proactive leadership. Suggestions include improving teacher training, starting specific programs to reduce stigma, ensuring steady funding, and building partnerships with outside organisations, which will provide useful information for future studies and efforts to better support students affected by HIV/AIDS.