Education about sex, relationships and HIV and AIDS in African contexts is riddled with socio-cultural complexity. In this paper the authors argue that in extreme contexts education can lead change further by developing young people as significant actors in their own lives and in the lives of the community by bringing about change in attitudes in the community, as well as practices in schools. A qualitative study was undertaken in eight primary schools of the use of student knowledge and voice to change attitudes, impact upon socio cultural beliefs, adult–child dialogue and drive changes in practice in AIDS education. Drawing on a contextual framework that includes a socio-cultural approach to education, Basil Bernstein's well established theories of everyday and school knowledge and Catherine Campbell's notion of AIDS competent communities, it shows how this initiative variably unfolded in six sub-Saharan countries (Botswana, Ghana, Kenya, South Africa, Swaziland and Tanzania – although only the latter three are discussed in detail) and analyses the potential of schools to operate for the benefit of children in difficult circumstances, especially with regard to poverty, gender, sexual violence and health. Participation, dialogue and agency were the key factors.