MELISSA BLOCK, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block. In Africa, a success in the fight against AIDS has turned into a new challenge. The southern nation of Botswana has done well in treating babies with HIV, so well that a large number of HIV-positive children are now entering adolescence and they face unique medical and social problems.

Some are becoming sexually active. Some no longer want to take their medication and some have developed resistance to the drugs and must switch to more complicated treatments.

NPR's Jason Beaubien reports.

JASON BEAUBIEN, BYLINE: Being a teenager is hard enough without HIV. On a Saturday morning, about 120 teenagers are gathered in the parking lot in front of the Baylor Pediatric AIDS Clinic in the Botswana capital of Gaborone. This is Teen Club. All of the kids here are HIV-positive and for many of them, this is the only place where they're open about their status.

Under a tall shade tree, the teenagers are dancing in a long line, each one holding on to the shoulders of the one in front of them.

The kids, for the most part, look like healthy teens. There's one boy who uses metal crutches, but he's thrown these aside for the conga line procession. Another boy is extremely small. Dressed like a miniature office worker in a dress shirt and slacks, he appears to be only six or seven years old, but he's actually 19 and the oldest kid in the club.

Teen Club convenes here once a month. These teens are playing an impromptu game of keep-away with a soccer ball. On this Saturday, they'll also be voting for their leaders for the coming year and they'll debate at what age should teenagers be required to go to the adult HIV clinics in Botswana?

MOEMEDI: Sometimes, they teach us on how to be - live with HIV.

BEAUBIEN: Moemedi is a spindly 15-year-old. His shoulders, elbows and knees poke at the corners of his clothes. Despite 25 percent of all adults in the country being infected with HIV, there's still a strong stigma in Botswana around the virus. People here whisper when they talk about AIDS. Moemedi says that, except at home or here at Teen Club, he doesn't talk about having HIV.

MOEMEDI: It is very difficult for me to talk about it.

BEAUBIEN: Even for a boy who was infected with the virus at birth, HIV remains cloaked in shame. Moemedi's mother died 10 years ago. He's lived ever since with his aunt, Consulata.

CONSULATA: He is my son, but is from my deceased sister, so I am the auntie, really, to him.

BEAUBIEN: Underscoring the difficulty of talking openly about HIV, Consulata asks that we don't use their last name. Moemedi's mother was never diagnosed with AIDS. She just got sick and died. Consulata says Moemedi also was sick a lot when he first came to live with her. She remembers he had terrible ear infections.

CONSULATA: It was very bad. That's why those ears made me to say something is wrong because why is he always sick? You see, and he's coughing. That's why I finally see that something is wrong somewhere. I have to find out.

BEAUBIEN: After she learned Moemedi was HIV-positive and got him on medication, the ear infections went away and he's been healthy.

CONSULATA: And, even if he can be sick, he'll just be sick like everybody else. Just like everybody else, but really, he's strong now. I can see, he's very strong.

BEAUBIEN: He was five years old when he started on the drugs and he's been taking the pills every morning and every night ever since.

CONSULATA: He usually takes them at, like, six, so if I see the time is going on, I just remind him. Hey, your thing. We just call it a thing. And he just remembers what (unintelligible) his thing.

BEAUBIEN: Moemedi will turn 16 in September. Like so many African boys, he's obsessed with soccer. In the afternoons, he prefers kicking a ball in the yellow, powdery dirt behind his house than doing his homework. At night, he wants to watch Kaizer Chiefs on television, a popular team from neighboring South Africa.

Consulata says his grades are suffering and she has to remind him more often to take his medications.

CONSULATA: Remember, when you're 18 now, your body tells you this and that. You see? It aches there and there if we're so (unintelligible) want some kind of (unintelligible) respect, like the other things keep changing. You see, all sort of things change because he's growing to a man. Right?

BEAUBIEN: And this creates problems for the doctors, nurses, aunts who are trying to safely usher these HIV-positive children into adulthood.

UNIDENTIFIED GROUP: (Singing in foreign language)

BEAUBIEN: Every weekday morning at 7:00 a.m., the waiting area of the Baylor Pediatric AIDS Clinic is packed with women and children. The staff start their day with a prayer session in the lobby, then the daily rush begins. Many of the patients are infants and toddlers, but there are older children, too. Teenagers come before school to refill their prescriptions. Women at the front desk count each of the teens' remaining pills to make sure they're taking the correct number.

Marape Marape is one of the doctors at the clinic. He shows off one of the clean, modern HIV screening rooms.

DR. MARAPE MARAPE: Newborn kids who are born to HIV-positive mothers are sent to us from all over the country. They come here, they get tested. We check whether they have HIV. If they have HIV, then we start them on treatment.

BEAUBIEN: Dr. Marape says, in the past, they were mainly treating babies, toddlers, young kids, but because the drug treatment has been so successful, Botswana is now seeing a boom in teenagers with HIV.

MARAPE: But in the past, these children used to die at a younger age. They're not surviving into adolescence and you know, with adolescence, there are many problems that come.

BEAUBIEN: First, these children have been on drug treatment for many years.

MARAPE: So (unintelligible) so you see a lot of resistance mutations. A lot of them don't take their medications well. They are starting to engage in sexual activities and, you know, you find that the adherence levels are not as good as they used to be.

BEAUBIEN: Most of these teens have lost at least one parent. Some have only recently been told that all those pills they've been taking for all those years are because they're HIV-positive.

A doctor at the main AIDS clinic in the capital says HIV-positive kids tend to do better medically if they're in an orphanage than if they get shipped off to a distant relative. The more chaotic their lives, the worst their health.

That's why at the Baylor Clinic they're trying to expand Teen Clubs across Botswana. The monthly Teen Club is supposed to run from 9:00 a.m. until 1:00 in the afternoon, but on this Saturday the kids don't want to leave. After a lunch of cold cut sandwiches, dozens of kids are still lingering in the lobby of the clinic. They fiddle with cell phones that double as music players, they hold hands. They laugh and lean into each other.

One weekend a month, these kids don't have to hide their HIV status and they get to see that other teenagers are going through the same thing that they are.

Jason Beaubien, NPR News.

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