Most southern African orphans are cared for by extended families but the implications of the spatial dispersal of such families are seldom recognized: orphans often have to migrate to new homes and communities. This paper, based on qualitative research conducted with children and guardians in urban and rural Lesotho and Malawi, examines orphans' migration experiences in order to assess how successful migration might best be supported. Most children found migration traumatic in the short term, but over time many settled into new environments. Although much AIDS policy in southern Africa stresses the role of communities, the burden of care lay with extended family households. Failed migrations, which resulted in renewed migration and trauma, were attributable to one of two household-level causes: orphans feeling ill-treated in their new families or changes in guardians' circumstances. Policy interventions to reduce disruption and trauma for young AIDS migrants should aim at facilitating sustainable arrangements by enabling suitable households to provide care. Reducing the economic costs of caring for children, particularly school-related costs, would: allow children to stay with those relatives (e.g. grandparents) best able to meet their non-material needs; reduce resentment of foster children in impoverished households; and diminish the need for multiple migrations.

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household health care policy human community Foster Home Care Life Change Events Lesotho economic aspect controlled study priority journal Acquired Immunodeficiency Syndrome social support rural health Urban Health health care cost Humans family Adolescent male female Africa Article migration foster care orphanage Emigration and Immigration acquired immune deficiency syndrome caregiver Malawi Child