The United Nations Educational, Scientific and Cultural Organization (UNESCO) Office of the Pacific States commissioned an attitudinal survey on the delivery of Sexual and Reproductive Health (including HIV) education in schools in four Pacific Island Countries: Nauru, Niue, Palau and Samoa. This study involved 261 primary and secondary school teachers in the four countries from both government and faith-based schools. In addition, the study involved almost 350 parents, community leaders and students from across the four countries. The objective of this survey was to gauge and assess the attitudes of key stakeholders (principals, teachers, parents/guardians and students) to school-based SRH (including HIV and AIDS) education. It aimed to review attitudes towards the: Need for SRH information among young people; Need for school-based SRH education; Appropriate age to initiate SRH education; Desired modality (e.g. curricular; co-curricular; extra-curricular); Required content (topics); Number of hours of instruction; Teacher preparation required to deliver SRH education; and Existing SRH education (if available) including: teaching/learning materials; teacher preparation; policy environment. This report documents the findings from the study and identifies key barriers to the implementation of school-based SRH education in four Pacific Island countries. It provides an evidence base that will assist in the further development and progression of SRH education programmes in Pacific Island schools.