An estimated 58 million persons aged 60-plus live in sub-Saharan Africa; by 2050 that number will rise sharply to 215 million. Older Africans traditionally get care in their old age from the middle generation. But in East and Southern Africa, HIV has hollowed out that generation, leaving many older persons to provide care for their children's children without someone to care for him or herself in old age. Simultaneously, the burden of disease among older persons is changing in this region. The result is a growing care deficit. This article examines the existing literature on care for and by older persons in this region, highlighting understudied aspects of older persons’ experiences of ageing and care – including the positive impacts of carework, variation in the region and the role of resilience and pensions. We advance a conceptual framework of gendered identities – for both men and women – and intergenerational social exchange to help focus and understand the complex interdependent relationships around carework, which are paramount in addressing the needs of older persons in the current care deficit in this region, and the Global South more generally.

Aim: This paper examines financial, emotional, and physical responsibilities elderly women are being asked to take on due to the incapacity of their adult children to care for the next generation; such incapacity is likely to increase as the HIV/AIDS epidemic worsens. Methods: This paper combines quantitative and qualitative data. Census data from the Agincourt health and demographic surveillance system (AHDSS) describe the presence of the elderly (specifically women over the age of 60 and men over the age of 65) in households in the Agincourt study site. Semi-structured interviews with 30 female residents aged 60—75 complement the census data by exploring the roles that older women, in particular, are playing in their households. Results: An elderly man and/or woman lives in 27.6% of households; 86% of elders live with non-elders. Households with a woman over the age of 60 resident (as opposed to those without) are twice as likely to have a fostered child living in the household and three times as likely to have an orphaned child in the household. Elderly women face financial, physical, and emotional burdens related to the morbidity and mortality of their adult children, and to caring for grandchildren left behind due to adult children's mortality, migration, (re)marriage, and unemployment. Conclusions: Older women provide crucial financial, physical, and emotional support for ill adult children and fostered and orphaned grandchildren in their households. As more prime-aged adults suffer from HIV/AIDS-related morbidity and mortality, these obligations are likely to increase.

In much of HIV/AIDS prevention literature, women are depicted as passive and ill‐equipped to confront the epidemic without external support to enhance their status, autonomy, and negotiation skills. This paper critically evaluates this depiction, using data from in‐depth interviews conducted with married couples in rural Malawi. It focuses on the extent to which married women perceive that they have the ability to protect themselves from infection and on the prevention strategies that they employ. Interview data suggest that women have identified a range of contextually appropriate ways to resist exposure to HIV. These strategies include sitting and discussing the dangers of HIV/AIDS with their husbands; utilizing social networks for advice and as advocates; publicly confronting husbands' girlfriends; and divorcing men who do not adopt safer practices. These locally‐formulated strategies are not likely to be followed consistently, and they may not be the most effective strategies in preventing husbands from straying or protecting women from contracting HIV/AIDS. Their existence, however, demonstrates that rural Malawian women believe that they have some agency to protect themselves; and, they are in fact using locally appropriate strategies to do so.

Mainstream research and the popular media often equate female-headship with household vulnerability, crisis, and disorganization. Epidemic levels of HIV/AIDS in some parts of sub-Saharan Africa compound this portrait of hopelessness. In South Africa, the impact of HIV/AIDS on households depends on race, class, and place. As female-headed households increase in number, we need to better understand how female-heads in poor rural areas contend with AIDS related challenges. We analyze qualitative interviews with 16 female heads and the members of their households in a rural community to examine the response to AIDS-related illness, death, or caring for orphaned children. Our analysis examines female-heads' financial and social resources and how these resources buffer against hardship in households affected by AIDS. We find considerable heterogeneity among rural female-headed households and their access to resources to combat AIDS-related hardship. Our findings have important policy implications both in terms of identifying individual and household vulnerabilities as well as leveraging the potential for resilience for female-heads in rural South African communities.