"With some of the youths that we've had, we've found that those who have been bounced around in foster care have really had a hard time keeping up with the medicine simply because they have not had the role models, someone who could help them integrate and show them that the illness is not necessarily bad," said Chris Waisman, a social worker at the Adolescent AIDS Program. "They will frequently feel that since the illness is bad, then I am bad. A typical way to deal with these bad feelings is to deny them."
As these children grow into teenagers and teenagers become adults, another challenge providers face is helping them get a sense of their future. Part of that involves helping teens find out what they want out of their relationships, what they want out of their lives and what goals are realistic.
"Helping kids connect to their own sense of what they want, what's possible will be a challenge," Futterman said. "In relationships, [it will be] teaching them not to be afraid to have love as a very important part of their lives and what role sex will have in their lives and helping them make reasonable decisions when they're ready. Many want to have children because they see it as having someone who will love them. But they do not see it in terms of what they will have to give up, that they will have to grow up."
Experts say teens must continue to learn about their illness and continue to take their medication. Safe and responsible sex must to stressed, and women must know about and have access to good prenatal care to protect their newborns. Without continued education, experts say a new generation of teens born with HIV could become potential health risks.
"As a country, we have a tendency [to] think that something is no longer a problem if we've had success combating it and then we withdraw money away from programs," said David Harvey, executive director of AIDS Alliance For Children, Youth and Families in Washington, D.C. "We must not let our guard down."
What happens when HIV-positive teenagers outgrow the foster care system remains another open question.
"On a policy level, more needs to be done once they age out of the foster care system," said Waisman. "Many times, it's not that the kids lack drive, but they do not get enough support. Kids with families have a lot more potential."
A sense of normalcy for these teenagers may be just as vital. Their HIV status may prevent them from ever leading a completely "normal" life, but some say caregivers and counselors must help the children realize their own self-worth.
"They have to learn about themselves. They are not HIV," said Sister Bridget Kiniry. "They are teenagers who have this [virus]. They're more than their HIV — they have to learn what that means."
As "Lady X" grows up, so does The Incarnation Children's Center. She is preparing to attend high school in the fall and says she wants to be the first lawyer in her family.
Now, a social life is still high on X's priority list. A week before her first date, X went on a trip with the younger children to Ringling Bros. and Barnum & Bailey Circus. She was already planning for her big night.
"I can't wait until Friday," she said to a group of volunteers and nurses, balling her fists with glee. "I told them I can't be hanging around all the time with these little kids."