The prenatally HIV infected adolescents have largely grown up in a conspiracy of silence and secrecy where nobody tells them they are HIV positive. When they eventually find out their status, the trauma is further compounded by the complexities of adolescence. Drug adherence, disclosure stigma and sexuality are some of the major issues that they struggle with. This cohort is likely to engage in unprotected sex because they have no capacity to disclose or to negotiate for safe sex. They are also likely to stop taking their ARV medication at some point due to side effects, stigma or just lack of commitment. They are also likely to experience depression, early pregnancy and opportunistic infections.