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I thought it was just me, but I saw a whole lot of excited and happy teenagers." She is now a teen leader and thinks of her friends at the club as "like my family".

"Everyone is open with each other, because when you're in the same situation you understand each other," she said.

"I call it the 'inconvenient truth' of paediatric HIV - it's great that you can put children on ARVs, but you have to realize that one day they're going to grow up and become teenagers, and all the challenges and headaches that come with adolescence are going to impact on their behaviours." Julia Rosebush, a doctor at the Children's Clinic, which provides care and treatment to HIV-infected infants and children through a partnership between the Baylor International Pediatric AIDS Initiative and the Botswana government, has already seen how teenage rebellion can translate into treatment failure.

"A lot of kids throw away their pills - we're finding a lot who are failing first-line treatment already." Pettitt said only three lines of drugs for treating HIV were available in Botswana, and if interrupted treatment caused resistance to these to develop during adolescence, "your long-term prognosis doesn't look good".

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