Objective: Assess the impact of AIDS on prevalence of orphanhood and care patterns. Methods: Descriptive analysis of nationally representative household surveys from 40 countries in sub-Saharan Africa. Results: Overall 9% of children under 15 years have lost at least one parent in sub-Saharan Africa. On average one in six households with children are caring for orphans. Orphans more frequently live in households that are female-headed, larger, and have a less favourable dependency ratio. The head of the household is considerably older. Child caring practices differ between countries, and between non-orphans and orphans. Based on the country medians, almost nine out of 10 non-orphans live with their mother and eight out of 10 non-orphans live with their father. Single orphans are less likely to live with their surviving parent: three out of four paternal orphans live with their mother and just over half of maternal orphans live with their father. The (extended) family takes care of over 90% of the double orphans. Orphans are approximately 13% less likely to attend school than non-orphans. Double orphans are most likely to be disadvantaged. Conclusion: The epidemic has caused rapid recent increases in the prevalence of orphanhood. Prevailing childcare patterns have dealt with large numbers of orphans in the past, and to date there is no consistent evidence that this system is not absorbing the increase in orphans on a large scale. Yet, there is some evidence that orphans as a group are especially vulnerable, as they live in households with less favourable demographic characteristics and have lower school attendance.