When the Mohau children's home opened in 1997, orphans with Aids died every other day. But these days, not one child has been lost in seven years - and as they age with the help of drugs they face the teen complexities of dating and sex.
As the population of children affected by HIV/Aids ages, they need specialised care, notes Harry Moultrie, of Enhancing Children's HIV Outcomes, an agency based in Johannesburg which helps the health department distribute medicine and provide services.
"The health care system is not well structured to meeting the needs of these adolescents," Moultrie said.
South Africa has more people living with HIV than anywhere else in the world and has nearly 3 million orphans, many of whom lost parents to Aids. An estimated 280,000 children younger than 15 are infected with the virus, according to the Institute for Democracy in South Africa, or IDASA.
Dying before turning one
Without medication, one-third of children with HIV would die before they're a year old and half would never see their second birthday, according to AVERT, an Aids charity.
But the wide distribution of antiretroviral drugs in South Africa means many HIV-positive orphans who previously would not have been expected to become adolescents are reaching college age.
A growing number of teenage orphans need more specialised help with the transition into adulthood, especially since so many have HIV themselves and have experienced devastating loss, a recent IDASA study found.
They need support groups on sexual issues and access to free education, health care and training opportunities, said Marietjie Oelofsen, manager of the institute's Government and Aids program.
Moultrie said HIV-positive teens sometimes assert their independence in self-destructive ways, including not taking anti-Aids drugs.
Sibani Mngadi, spokesman for South Africa's Ministry of Women, Children and Persons with Disabilities, acknowledged that the government needs to provide more help for teenage orphans now that their lives are being prolonged.
The government provides financial support to orphans affected by HIV/Aids but that stops when they turn 18, although free antiretroviral drugs continue to be available to them as well as other South Africans of all ages.
There is a growing realisation that more specialised attention must be given to the orphans as they become adolescents and young adults.
One young man from Tembisa, a township near Johannesburg, lost his mother when he was 17 to Aids and turned to Heartbeat, a government-funded organisation that provides after-school programs including career counseling, guidance on sex and drugs and sports opportunities to 4,000 orphans affected by HIV/Aids.
Children sit in circles in community centres, many located in townships, to discuss their problems.
"I just wanted to be a normal kid and away from that mindset (of feeling alone)," said the young man, who asked not to be named because of the stigma associated with HIV/Aids in South Africa. "They understood my background and played a huge parenting role."
He went on to graduate from university and now leads discussions for young adults at the organisation, which like the Mohau children's home is addressing issues like pregnancy and drug and alcohol abuse.
The dangers alcohol and drugs
One 17-year-old boy whose mother died of Aids three years ago said the sessions at Heartbeat taught him the dangers of alcohol and drug abuse and risky sexual behaviour.
"This was very important because some of us didn't know about these things; there's no one telling us what's wrong and what's right," said the boy, who also asked not to be named.
He's one of the luckier ones. It's unclear what percentage of the millions of teenage orphans are not receiving such support. IDASA hopes to get a more detailed picture in an upcoming report.
(Sapa, Jenny Gross, September 2010)