Over the past decade, we have convened international meetings alongside International AIDS Society conferences. This is to identify opportunities to inform health policy and programming to ensure that children with perinatal HIV exposure thrive to their fullest potential. Globally, there are now over 16 million children under 15 years of age who were exposed to HIV in utero, at birth and during breastfeeding. When a child is born HIV-free, it does not guarantee that they will thrive in a similar way to a child born to a woman who is not living with HIV. Research has shown increased vulnerability to infectious morbidity and mortality, poorer growth and neurodevelopmental deficits compared with children not exposed to HIV. Risk of health disparities and opportunities for resilience include biological, social and structural aetiologies. For the 10th Symposium on Children and Adolescents with Perinatal HIV Exposure, we will hold a pre-conference involving dialogue and presentations from families and adolescents affected by HIV, policy makers, clinicians and researchers. Presentations will span infancy through adolescence.