The fight to reduce HIV transmission in South Africa is shaped and constrained by complex, interconnected layers of factors ranging from the political to the psychological. The HIV epidemic reached South Africa a decade or so after central and East Africa providing a window of opportunity within which to implement appropriate prevention and management programmes. However, the apartheid government largely ignored HIV/ AIDS and the post-apartheid government has not risen to the challenge of the epidemic so that South Africa looks set to become the AIDS capital of the continent. Current estimates are that one in five adult South Africans are living with HIV or AIDS and 1,700 more are being infected every day. The highest rates of infection are among those aged 20 to 40 years, the most economically active and also the parents to a new generation of children. While the macro-economic impact of the epidemic will only be known with time, many of the social impacts are more easily predicted. By the year 2010 five million children will have lost at least one parent. Already there are households headed by children as young as nine years old acting as guardians to younger siblings, sometimes with no source of income. Having weathered the trauma of losing parents the high rates of mother-to-child transmission mean that they will now have to care for terminally ill siblings
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