The shift from being a child to a teenager and then becoming an adult is known as puberty. Puberty involves a natural change in the body's hormones which causes physical, psychological and emotional changes. The start of puberty can range from 8-13 years of age in girls and 9-14 years of age in boys. For some, puberty will happen over a short period - around a year-and-a-half, for others it may take up to five years. It is important to know that every child is different and that some of the changes and developments of puberty may be slowed down or delayed in young people who are already living with HIV.

Changes in the Body

Body changes can be internal or external. Most children will have a growth spurt and get taller during puberty. Some body parts, like the head, face and hands, might grow faster than the limbs and torso, because of this, the child might look out of proportion for a while, until the rest of the body grows too. For some children, their centre of gravity changes and this might affect their balance and make them physically clumsy for a while. Organs, bones and muscles all grow during puberty and because their stomachs and intestines also grow, young people need a healthy balanced diet for more energy, a diet with plenty of proteins and nutrients.

Glands in the skin, on the face, shoulders and back become more active during puberty, producing more oil which can result in pimples. Hair can also be oilier. A new type of sweat gland in the armpits and genital area develops during puberty which is why good hygiene is important to prevent body odour.

Puberty for Girls

For girls, breasts will develop at the start of puberty. Sometimes the breasts will develop at different speeds and will be tender as they are growing. A girl's body shapes changes and her hips widen. The external parts of a girl's genitals will also grow as well as underarm and pubic hair, which gets darker and thicker over time. Girls also start their periods (menstruation) during puberty, where the lining of the uterus (womb) is shed every month and discharged with blood through the vagina. Girls might have a clear or whitish discharge from the vagina for several months before their periods start. Some girls get period pain before and during their period, including headaches or stomach cramps. Periods are also often irregular when they first begin.

Puberty for Boys

For boys, the external genitals (penis, testes and scrotum) will start to grow during puberty. It is common for one testicle to grow faster than the other. Boys will also begin to grow body hair under their arms, on their face and on the rest of their body, including their pubic area. A boy's larynx (voice box) will get larger during puberty and his voice will 'break', eventually becoming deeper. During puberty, boys produce more testosterone, which stimulates the testes to produce sperm. They may get erections for no reason and ejaculate (release sperm). Ejaculation during sleep is called a 'wet dream'.

Some boys might have minor breast development, which usually goes away by itself. If it doesn't go away or if a boy's breasts seem to be growing a lot, he should see a doctor.

Helping Young People Deal With Puberty

Puberty is often confusing and some young people may need help dealing with all the changes they are experiencing. Here are some ideas that could help;

- As young people's bodies change, it is important that they have a positive and healthy body image. This means feeling happy and satisfied with their body, as well as being comfortable with and accepting the way they look. A positive body image is strongly connected to self-esteem, good mental health and healthy lifestyle choices.

- As a parent or caregiver, you can encourage a young person to have a positive body image by being positive about your own body, making healthy eating and physical activity part of everyday family life, and by appreciating your own body for what it can do and not just how it looks.

Young people living with HIV need to recognise their body's strength and their ability to live with HIV with the help of ART. Talking to a young person about the changes in their body and how they feel is helpful. Talk to a healthcare worker or counsellor for advice and tips on how to talk to young people in your care.