This paper explores the role of the family in caring for orphans and other children in poor urban communities having some of the highest levels of HIV/AIDS prevalence in the world. A range of family forms in Swaziland was found to be caring for orphans. Child-headed households and lone-elderly carers were not the most common; maternal kin played a more important role in orphan care than did paternal kin, indicating both stresses due to AIDS and the dynamic nature of the family. Women of all ages were bearing the brunt of the extra care responsibilities caused by the epidemic. There was limited involvement in children's well-being by agencies of any kind and orphan care remained largely situated within kin structures. The AIDS epidemic was impacting on families in a variety of ways, with a corresponding increase in poverty and vulnerability. Carers did not perceive orphans as a separate category of children requiring assistance over and above any other vulnerable child. Families require assistance at the household, community and national level. Meanwhile, community-based initiatives were poorly developed. Welfare sector policies should strengthen the family model of childcare by increasing support to the poorest families rather than treating orphans as a separate category of vulnerable children and thereby excluding other needy children.