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"My school friends don't know; if you bring up HIV they're quite ignorant." As one of the first countries in southern Africa to start rolling out a national antiretroviral (ARV) treatment programme that now reaches nearly 100 percent of those who need the medication, Botswana has a rapidly growing population of children infected at birth who are surviving into adolescence.Simply referring these teenagers to adult clinics and ignoring their special needs could lead to a reversal in the gains Botswana has made in combating HIV, argues Ed Pettitt, coordinator of the Teen Club programme at the Botswana-Baylor Children's Clinic Centre of Excellence in Gaborone.Mpho Mosala*, 17, another teen leader at the Gaborone Teen Club, has been dating the same girl at his school for the past two years but he has yet to tell her of his status."Right now, I don't think it's so important because we're not doing anything that would expose her," he said."They can't even tell their best friend because they fear that friend will tell others, and they'll never be able to go back to school." For Lally, who started coming to Teen Club last year, realizing that there were other teenagers like her was life changing."I was just living in a dark tunnel, waiting for the day I would die," she said.

I thought it was just me, but I saw a whole lot of excited and happy teenagers." She is now a teen leader and thinks of her friends at the club as "like my family".Recognizing the growing need, Botswana's Ministry of Health is partnering with Baylor to develop an adolescent care package to train health care workers at government ARV clinics in how to cater for teenage patients.While Botswana is slightly ahead of the curve, other countries in the region are also dealing with growing numbers of HIV-positive adolescents and looking for models they can adapt.Raging hormones, peer pressure and coming to terms with a changing body image - growing up is difficult enough without the added burden of living with HIV, and keeping it hidden from friends and classmates."Being a teenager is very hard; you have to keep up with the changing life, do what the others do," agreed Katlego Lally*, 17, in Botswana's capital, Gaborone, who was born with HIV but only learned of her status six years ago.

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