Teens and HIV: The Transition Into Adulthood

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The teen years bring a variety of physical, mental, and emotional changes that can be both exciting and challenging. For you, a teen living with HIV (HIV+), the transition into adulthood can be even more challenging because you have to live and cope daily with a chronic condition. Life may seem overwhelming at times. However, learning about teen development and how these changes affect your feelings and behavior can help make things a little easier.

If you would like to find out more about teens' risk of acquiring HIV, see our fact sheet on What Parents and Providers Need to Know about HIV Risk and Teens.

Physical Changes

A teen's body grows faster than any time since infancy. During a "growth spurt," a boy can add four inches of height and a girl three inches of height. Body weight increases, too, and while this normal weight gain includes both muscle and fat, boys tend to add proportionally more muscle and girls add proportionally more fat. During puberty, hormonal changes in boys can cause a deeper voice, facial hair, and hair under the arms and in the pubic area. Girls begin to develop breasts, get fuller hips, and grow underarm and pubic hair. Even the brain is growing and maturing.

It is common for teens to feel self-conscious about these changes, especially if they grow at a faster or slower rate than their peers. Teens living with HIV may also have additional physical issues. If you are starting new HIV drugs, you may have some uncomfortable side effects, such as nausea, diarrhea, dizziness, muscle pain, or fatigue. Usually these go away after the first two or three weeks as your body adjusts to the new drugs.

Sometimes HIV drugs can cause a body change called lipodystrophy. This is a weight gain in the central part of your body, such as your stomach, chest, shoulders, and waist. Lipodystrophy can also include a loss of fat in the face, arms, legs, hips, and buttocks. These body changes may also make you feel self-conscious about your appearance, and can leave some teens with feelings of poor self-image and low self-esteem. Some young people may want to stop taking their HIV drugs. It is important that you talk to your health care provider if you are feeling this way so that you take the necessary steps to improve your health. The good news is that newer HIV drugs do not cause lipodystrophy nearly as often as older HIV drugs did.

While increased growth makes it important for all teens to eat a healthy diet, it is important for you to make a special effort to protect your immune system by eating a balanced diet, getting enough rest, and exercising regularly. If you are not getting all the vitamins and minerals you need for your growing body from the foods you eat, you may consider taking supplements after consulting with your health care provider.

Mental Development

In addition to physical growth, your mental processes of perception, memory, and judgment will develop during your teen years, as will your emotional and decision-making abilities. Even adults living with HIV find that taking HIV drugs every day can be annoying, hard to remember, and maybe difficult to hide from others. HIV drugs can be a constant reminder of your condition. In addition, you may be embarrassed about regular school absences that you take to visit your health care provider. All of this may make you feel more self-conscious and sensitive to what others may think of you.

It is common for many teens to think that things happen and people react in certain ways because of them or something they did. Sometimes, unfortunately, this can lead to feelings of low self-esteem. Teens who do not feel good about themselves are more vulnerable to peer-pressure and more likely to make poor decisions about their health. They may seek the approval of others (peers) to make up for not having a positive view of themselves.

As a result, they may be more tempted to use drugs or alcohol, or to engage in unsafe sexual activity. Those with self-esteem problems may also experience problems with depression, or have suicidal thoughts. If this is true for you, it is very important that you talk to your health care provider or another trusted adult. There are many ways to get help feeling happier and more confident about yourself, and to learn to make better, more empowering decisions. If you are having thoughts of hurting or killing yourself, you can call the National Suicide Prevention Lifeline at any time in the US at 1-800-273-8255. Click here to access the world map of the International Association for Suicide Prevention and find crisis centers with help near you.

Social and Emotional Growth

Teens deal with several social and emotional issues. One of the most important issues teens struggle with is their identity. Asking "who am I?" and "how do I fit in the world?" are normal questions. Some teens find it difficult to feel accepted and create a circle of friends. Among these teens, feeling alone and like 'no one gets you' can be common.

Teens are known to take risks and experiment with smoking, drugs, alcohol, sex, and sexuality. Unfortunately, these kinds of risk-taking behaviors can get in the way of your good judgment. If you are drunk or high, you are more likely to have unprotected sex. Having unprotected sex exposes your partner(s) to HIV, and may expose you to other sexually transmitted infections or diseases or infections (STIs of STDs) such as herpes, hepatitis B or C, or genital warts. STDs can interfere with your HIV treatment. There is also the risk of getting infected with another strain of HIV if you have unprotected sex with a partner who also has HIV; this can cause additional damage to your immune system.

It is important to know that in some places, not disclosing your HIV status before having sex is illegal and you can go to jail (even if you practice safer sex!). If you are drunk or high, you may forget to tell a sexual partner about your HIV status and may be vulnerable to serious legal consequences.

Even though living with HIV may make you feel isolated at times, it is important to have open, honest, and supportive friendships. Many teens living with HIV are afraid to tell their friends that they have HIV for fear of rejection or mistreatment. In fact, this can be one of the hardest decisions that a teen living with HIV can make. While telling someone may relieve the burden of keeping such an important secret and may give you the love and support you need from friends, it can also be scary.

Some things to consider before disclosing your HIV status:

  • Why do I want to tell this person about my HIV status?
  • Will he or she keep my confidence?
  • What happens if he or she tells other people?
  • What will happen if the relationship is changed by my disclosure?

If you want or need some support in disclosing your status, you can get help from your health care provider, a parent, a trusted relative, an HIV peer educator, or a friend.

Lastly, the teen years are all about preparing yourself for adulthood and your future. And your future may seem scary. Questions like "Should I go to college or university?", "Will I find love?", "Can I get a job?", "Will I be able to have children?", or "Will I ever have a normal life?" may arise. With the treatments now available, people living with HIV can live very healthy, normal, and long lives.

Support for the Teen Living With HIV

Where can you find help and support? Trusted family members, friends, teachers, counselors, clergy, and health care providers can be a valuable support system. Many communities have local HIV support groups, too -- try looking in the Poz directory for some places near you in the US, and NAM's e-atlas for locations worldwide. Some support groups are specifically for teens and/or young adults. In a support group, you can talk openly, safely, and confidentially with others who have similar situations and concerns.

You can also find support through online support groups and blogs (please visit A Girl Like Me to learn more). If you choose to participate in an online group or blog, it is important that you be careful not to share information about yourself that you do not want publicly available. Once information like your name, address, school, or workplace is out there (on the Internet), there is no way to get it back or erase it. If you join an online group or blog, you may want to use a pseudonym (made up name) or 'handle' instead of your real name to preserve your privacy.

There are also some important things that your parents, or guardians, can do to help you:

  • Answer questions about sex honestly and accurately
  • Encourage and model a healthy lifestyle, such as good eating habits and physical activity
  • Respect your privacy
  • Allow you to handle as much of your care as possible, including setting medical appointments and taking HIV drugs; encourage you to understand and be a part of medical decisions
  • Help you set both short term and long term goals that are realistic and achievable
  • Provide lots of love, compassion, and patience!

If your parents or guardians are not already doing these things, it is probably because they are learning how to live well with your HIV just like you. Show them this article to help them.