Abstract
Today, 1.8 billion adolescents stand at the challenging crossroads between childhood and the adult world. Nine out of ten of these young people live in the developing world and face especially profound challenges, including HIV. Adolescents living with HIV are an emerging group in the global HIV/AIDS epidemic. HIV incidence remains highest among 15–24 years olds, with approximately 40 % of horizontal transmission occurring within this age group. Furthermore, as access to highly active antiretroviral therapy (HAART) improves globally, the population of vertically infected adolescents is expected to grow. While youth aged 10–19 accounted for 1 % of the total number of patients receiving HAART in South Africa in 2008, this proportion will grow to approximately 5 % by 2020, mainly as a result of vertically infected children surviving into adolescence. Moreover, South Africans between 13 and 19 years comprise roughly 30 % of the population, so treatment and care for HIV-positive adolescents will become increasingly important over the next decade. Although most adolescents navigate this challenging developmental stage successfully, it can be especially difficult if there are additional stressors to overcome, such as HIV. HIV adds a significant burden to adolescent development, including issues of stigma, orphanhood and bereavement, increased poverty and food insecurity, adherence and disclosure challenges, high sexual risk taking behavior, and especially, increased risk for poor mental health outcomes. In addition, public health services are confronted with the host of psychosocial issues this population brings, as young people transition more independently to adult clinics. These complications will be explored in this chapter using Bronfenbrenner’s ecological model of human development as a framework from which to understand adolescent health and development.