Changes in the brain during puberty can affect a child's behaviour, including their sleep patterns and thinking and social skills. Along with physical changes, puberty can bring pressure to fit in socially, to perform academically and to act responsibly. Around this time, young people begin to develop a greater sense of their identity. They develop more independence, and this sometimes conflicts with the expectations of their family or community. If young people struggle to work out who they are and how they fit into the world, they may end up in conflict with their family or friends, and this can leave them feeling angry, isolated, misunderstood or devalued.

This can cause stress and worry, which may lead to mental health issues, substance abuse, depression and suicide. It is normal for young people to feel the ups and downs of everyday living. When young people are sad or worried they might have trouble sleeping, eating, concentrating or being motivated. However, if a young person's feelings of ongoing sadness continue for more than two weeks or start to affect their sleeping and eating patterns and have an impact on their schoolwork, relationships, physical health and their enjoyment of everyday activities, then they might be depressed.

Depression is treatable.  And young people are good at learning the skills they need to cope with problems, so if you are concerned that a young person in your care is depressed, you should get professional help. If left untreated, depression may lead to thoughts of self harm or suicide. Young people living with HIV have many questions about their health, education, career and their future options in terms of relationships, marriage and children. They may also be battling with their own feelings about having HIV and being stigmatised or rejected because of their status or might be concerned about changes in their quality of life and coping with the uncertainty that comes with illness. These factors can lead to a greater likelihood of depression for young people living with HIV.

"I felt isolated, lost and floating in confusion... I didn't know who would come and rescue me. I didn't even know who I could talk to and disclose my status to." Annah Mathekga

You can promote good mental health for the young people you care for by:

• Showing love, affection and care;
• Showing that you're interested in their life by praising their good points and achievements and valuing their ideas;
• Spending time with them;
• Encouraging them to talk about their thoughts and feelings, or if they are not comfortable talking about these, writing them down in a diary or journal;
• Expressing that you have trust and confidence in them to make good decisions and cope with stressful situations;
• Finding out about support groups for other young people living with HIV in your area;
• and Talking to family members, friends, other parents, teachers or health workers if you have any concerns.

Counselling may be very useful for young people to help them to understand their HIV diagnosis better. They should be counselled about the benefits and risks of disclosing their HIV status to other people, and be empowered and supported to determine if, when, how and to whom they choose to disclose. When young people disclose their status to supportive people they can trust, they will get the help and care they need to cope with living with HIV.

Relationships, love and sex

Many of the changes experienced during puberty lead to young people thinking about sex. It is often a time of experimentation with relationships and sexuality. It is important that young people understand good sexual health which means understanding their own body and sexual identity, and being able to express this openly.

Even though it might be uncomfortable to talk to teenagers about sexual and reproductive health, this does not encourage young people to have sex. It can actually delay the age that teenagers start to have sex, because they have been equipped with the knowledge to make safe decisions about sex. Talking about sex also encourages them to make use of sexual health services available to them.

Young people need to know that any sexual experimentation they have must to be safe.

Safe sex means that they need to protect themselves and their sexual partners by using a condom if they are going to have sex. Condoms can reduce the chance of passing HIV onto a negative sexual partner and will protect them from sexually transmitted infections (STIs) and reinfection. STIs can be more difficult to treat when a person is HIV positive, and having an STI can increase the chance of passing HIV to an negative partner.

Safe sex means using a water-based or silicone-based lubricant (lube) with a condom when necessary to stop the condom from breaking. Using a lubricant can also stop the skin from tearing and providing openings for HIV or STIs to enter the body. Never use an oil-based lubricant, Vaseline or other creams or oils as this can make the condom burst.

Safe sex means reducing the number of concurrent sexual partners, and testing for and treating sexually transmitted infections (STIs) quickly, because STIs increase the risk of HIV infection. If your teenager is male, they should consider medical male circumcision (MMC) which removes the foreskin and reduces the risk of HIV infection and STIs.  Medical male circumcision does not totally remove the risk HIV infection, so you should to use a condom when circumcised.

Getting involved in a romantic relationship or having sex can be difficult for young people living with HIV as they might be afraid of rejection if they disclose their status, be afraid of infecting others, or be worried about negotiating safer sex. It is important to support young people by giving them the skills that they need to talk openly with potential sexual partners about their status and about having safe sex.

"Disclosure is an issue. Most of the young people are dating and its telling your partner or disclosing to your new partner that becomes hard... You go through so much to impress... but you still have to explain about your HIV status. That was just too much for me to do. But I always played it responsible. With every girl that had sex with me, at least I know we always used a condom. I'm 100% certain about that and they are also 100% certain about that." Simiso Msomi

You can promote good sexual health for the young people in your care by:

• Talking to them about relationships and how they will know when they think they might be ready to have sex;
• Encouraging them to think about their reasons for having sex or not having sex;
• Talking to them about being able to resist peer pressure;
• Making sure that they feel strong enough to say no to sex if they are not ready to have sex;
• Encouraging them to have sexual relationships only with people they trust and feel safe with;
• Talking about disclosing their HIV status to sexual partners they feel they can trust;
• Ensuring that they know the importance of protecting themselves from reinfection with HIV or STIs by always using a condom when they have sex;
• Ensuring that they know where to get condoms and how to correctly use and dispose of them;
• Making sure that they know that using alcohol or drugs can cloud their judgement about whether or not to have sex;
• And by making sure that they know about emergency contraception to prevent pregnancy and post-exposure prophylaxis (PEP) to prevent the transmission of HIV in case of any accidents when they have sex.

Post-exposure prophylaxis

'Post' means after, 'exposure' means contact and 'prophylaxis' means prevention. Any person who has been exposed to HIV in any way, including through having unprotected sex, can get an emergency course of post-exposure prophylaxis (PEP), which is a 28-day course of antiretroviral drugs (ARVs). PEP is given after exposure to HIV and can prevent HIV from developing in the system. PEP treatment is available for free from government clinics and hospitals. This medicine is only effective when taken within 72 hours (three days) of the incident, as this is how long it takes for HIV to get into the system. It is more effective if taken as soon as possible after the contact. The clinic will start a person on PEP immediately, this involves a combination of two different drugs, which must be taken for 28 days. These drugs may have some side effects, but these can also be treated if they become uncomfortable. PEP cannot be taken if a person is already HIV positive, so a person will be tested for HIV before PEP is given.