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Immediate causes
The immediate causes of the epidemic are linked to HIV´s modes of transmission. These include unprotected penetrative se; transmission from mother to child before, during or after birth; and transmission through transfusions and the sharing of blood or blood products.
Underlying causes include societal denial and weak political commitment; poverty and social inequality; gender divisions; population movement as a result of famine, war and other causes; human rights abuse; and lack of dialogue about sex and sexuality. All of these make it likely that infection continues to spread.
Young people may be especially vulnerable to infection. They may not receive appropriate kinds of sex and personal relationship education. They may lack access to relevant social support including youth friendly counselling and sexual health services. Young women (and some young men) may be at particular risk through involvement in sex work and prostitution. The tendency for older and more sexually experienced men to prefer younger sexual partners also enhances their vulnerability.
Immediate effects
HIV and AIDS have serious and immediate effects within the family and household. As parents and young people are affected, household income may fall. Additional costs of healthcare, funerals and transport to clinics and hospital may have to be met. While many households develop new ways of coping, other are severely stressed. The changing balance of labour within the home may encourage less labour intensive and less nutritious crops to be grown. Widows and elderly people may lack financial and moral support when, as the sole adult within the family, they have to take on added responsibilities for the care of children and young people.
In order to help families cope, children, and especially girls, may be