Thirty two studies of the impact of HIV/AIDS on households conducted over the last decade were reviewed. The direct and indirect costs of HIV/AIDS to households increase with severity of illness and ultimately death. HIV/AIDS morbidity and mortality affect household income and expenditure patterns. Households employ various survival strategies to alleviate loss of labour and income, survive the financial cost and optimise the use of safety networks. Various gaps were found in the literature, which future studies could explore. Household surveys should be multi-disciplinary and longitudinal in nature so that the full impact of HIV/AIDS could be assessed over time. Copyright 2005 Economic Society of South Africa.

This is the first description of the effects of adult morbidity and mortality on children residing in Soweto, an urban African setting in South Africa, in the era of HIV/AIDS. We conducted a prospective cross-sectional household survey in Soweto identified by a stratified, two-stage cluster sample. In total, 4912 households were surveyed: 4501 households with children and 411 households with no children under the age of 16 years. We present detailed information on 22 724 individuals. Forty-four per cent of all households were classified as sick households, i.e., had at least one sick adult. Twentytwo per cent of all adults were categorized as being sick; 12% reported being ill from an HIV/AIDS or tuberculosis (TB)-related illness in the past month. Women contributed 61% of all illness. Eleven per cent of children had lost a parent. In sick households, child health was adversely affected (increased vulnerability to disease, p < 0.0001; incomplete immunizations p = 0.02). Children from sick households were less likely to have their school fees paid (p = 0.0001); were more likely to be absent from school (p < 0.0001), be unsupervised while doing homework (p = 0.01); and go hungry (p < 0.0001). Abuse occurred more frequently in sick households (p < 0.0001). Children with deceased parents were more likely to have had HIV/AIDS-related symptoms or be HIV infected (p = 0.002), go hungry (p < 0.0001) and face abuse (p = 0.03). From this study we conclude that the health, education and welfare of children is compromised in sick households and in households where parents have died. HIV infection has impacted negatively on the children in Soweto.

World Bank Working Papers are published to communicate the results of the Bank's work to the development community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally-edited texts. Some sources cited in this paper may be informal documents that are not readily available. This volume is a product of the staff of the International Bank for Reconstruction and Development/The World Bank. The fi ndings, interpretations, and conclusions expressed in this volume do not necessarily refl ect the views of the Executive 1. UNICEF 2009: "Steps towards harmonizing external support for health care provision for the Somali people." * 40 feet in height and 6-8 inches in diameter

The encouragement of care of orphans and vulnerable children by non‐profit organisations (NPOs) is a major policy response to the HIV and AIDS epidemic in South Africa. The purpose of this article is to present a quality–cost model with five performance indicators for quality and two for costs and to test these against actual performance using data collected from nine rural and urban organisations in 2004 and 2005. Six NPOs had acceptable cost but all had unacceptable quality scores; three had unacceptable cost and unacceptable quality scores. Each rural caregiver had many more orphans and vulnerable children beneficiaries than their urban counterparts but made fewer total visits. As a result, urban beneficiaries received, on average, 3.5 times more visits than their rural counterparts. The results suggest the need for different performance indicators and expectations for rural and urban NPOs and that monitoring and evaluation using the model could improve horne community‐based care services.