Young people between the ages of 13-24 are the fastest growing group of individuals newly diagnosed with HIV in the U.S. Half of all new HIV infections occur among people under 25. In fact, every hour, two Americans under age 25 are infected with HIV.

Telling someone you're HIV-positive can be difficult at any age, but imagine being a teenager and thinking about how to tell your family, friends and boyfriend or girlfriend. One of the hardest decisions facing an adolescent with HIV is whether to keep the virus a secret.

Discovering an HIV Diagnosis

After an HIV diagnosis, many youth keep their status a secret from peers, family members and sexual partners. It's not uncommon for newly diagnosed adolescents to try and make the news "go away" by ignoring it. Unfortunately, attempting to ignore their HIV status often leaves them feeling lonely and depressed. During this time it is important for youth who are HIV positive to remember they are not alone! There are many other people their age who are going through the same thing.

Adolescent Development

Adolescents feel invincible and immortal, yet they struggle with developing a sense of their own identity and often worry about being normal. Being physically attractive, dating and developing close friendships are also concerns.

Adolescents experience the world through their interaction with others. As a result, they fear rejection from family members and friends and are concerned about being labeled by peers or potential partners. Many face their HIV diagnosis with fear, denial and avoidance.

Adolescents and Medication

Since adolescents have the notion of being invincible, ("It will never happen to me"), many fail to take their medications. They want to establish a sense of themselves as "normal" and "not sick" and not be different from their peers. They don't want daily reminders of their illness. However, taking their medication can help many young people live a more normal and healthy life.

Getting sick often or having a lot of doctors visits may send a red flag to the peers of HIV-positive teens that something about them is different. By taking their medication, HIV-positive teens may not get as sick or have as many doctors visits. However, they may not want others to see them taking their pills.

To avoid this stigma, many youth take their medication either in the morning before school or at night. Youth can also be creative in the way they transport their medications to school or other outings. There are pieces of jewelry such as watches and lockets that can double as pillboxes.

Deciding to Disclose

Thinking ahead about reasons for telling, or not telling is one of the best ways to prepare for disclosure. Medical staff and family members of adolescents should support disclosure as a process and encourage appropriate timing, organization of support systems and using the right words. They can also support the youth by being open with them about the challenges and advantages of disclosure.

Here are a few questions those who support adolescents in the disclosure process can help them ask and answer:

• Why do you want to tell them?

• Why do you feel they need to know?

• Will they understand the importance of keeping it to themselves?

• What are the advantages of telling them?

• What are the disadvantages of telling them?

• How realistic are your expectations?

• Are you likely to regret having told them?

• In the future, are you likely to regret not having told them sooner?

If an adolescent is not ready to disclose their HIV status to someone they know personally, they can anonymously call a hotline or HIV service agency. There are also support groups strictly for adolescents. They're a great place to get information, vent intense emotions and make new friends.

The following are some agencies that can provide support and referrals for youth impacted by HIV:

• Advocates for Youth: www.advocatesforyouth.org

• AIDS Alliance for Children, Youth and Families: www.aids-alliance.org

• YouthHIV: www.youthHIV.org

• CDC National AIDS Hotline: (800-CDC-INFO)

Irie L. Session is the Adolescent Services Coordinator for Bryan's House, a non-profit agency serving children, youth and families impacted by HIV/AIDS.