Among and within families affected by the HIV epidemic, there will be some children or families of children at particular risk of destitution and of HIV infection: urban families without the support of their extended families, families who for whatever reasons lack the support of their communities, children struggling to survive on the streets, children suffering sexual abuse within families, and others. For many of these young people, survival sex, sex in exchange for money, clothing, affection, shelter, food, etc., is a basic coping strategy.

Components of this programme element could include:

• Assistance to street children. Special strategies need to be developed to help children living on the street to have greater control over their lives, to have the means to avoid infection and to seek alternatives to the street. Street children and others living in marginal circumstances may not only be isolated from the wider community, they may be actively persecuted by it. Providing a broad range of measures to help increase their safety, health and well-being may help reduce their social marginalisation.

• Reducing the susceptibility of young women to infection.⁸ Girls and young women may be particularly susceptible to HIV infection not only because they are less able to control the situations in which they have intercourse but also because their genital area provides less of a barrier to the virus and is easily irritated or torn. Communities and families need to assist young women to wait longer before becoming sexually active and to be able to ensure that all their sexual activity is safe.