When it appears appropriate for the individual and after discussions, and with agreement from the young person and the parents, joint consultations with the paediatrician and the adult HIV doctor will begin. In clinics where most of the young people have attended for many years the adult doctor will already be a well-known face. Parents may or may not be part of this. Over a period of time the adult doctor will take over the consultations, this may be as short/ long a time as is considered necessary. Although the young person’s doctor may no longer be the paediatrician, other team members e.g. the psychologist or clinical nurse specialist may still be actively involved.

Transition of care from a paediatric to adult setting is not specific to HIV, but occurs in a number of paediatric specialities (e.g. cystic fibrosis, congenital heart disease, diabetes etc). Indeed the over all principles of helping young people to gain knowledge and independence and maintain good self esteem can be applied to all adolescents with or without chronic diseases. However, there are important differences for young people with HIV which may make this process more difficult. Other family members are also likely to be infected and one or other parent may even have died. HIV is a sexually transmissible infection, which is a complex burden for a young person developing their sexual identity to carry. HIV remains a stigmatised condition so it is very hard to share this diagnosis with peers (unless they are also infected).

For these reasons it is especially important that young people are

• well educated about their condition and its treatment.
• confident in their ability to talk about HIV with those who they want to know about their condition.
• have a support system, so they know where to get help and advice when they need it.
• offered genuine choices as to where to continue their care (e.g. transfer to a clinic which is not treating their parents).