The impact of HIV and AIDS on old people is often portrayed as bound up in the care of children fostered in their households when parents die. The impact on old people’s care and general well-being as they age is less often explored. This study aims to elucidate factors which affect old people’s ability to cope with the impact of HIV and AIDS while examining options for improving social protection for old people living in poverty. Since 1989/1990, the MRC/UVRI Research Unit on AIDS has collected demographic data from a population cohort of 20,000 people in South-West Uganda. Data on socio-economic status, based on an asset-index is collected every four years. Households are classified into three groupings: the poor, the less-poor and `the rich’. Among the 523 households included persons aged 70 and above in 2006, while 15% of these consisted of an old person living alone. Longitudinal data from ethnographic studies in 1991/1992 and 2006/2007 with 27 households drawn from the cohort, representing different household types and socio-economic rank, provided information on eight old people (seven women and one man) who are now over 70 years. Two (a man and a woman) were living alone. Seven of the eight had lost children and grandchildren to HIV/AIDS, the majority of whom had provided support for the elderly person in question. Five of the elderly had orphan grandchildren living with them who were under 18 years of age. The nursing care of four, who were infirm, had been adversely affected by the premature deaths of their children. Four of them experienced loss of income because of HIV/AIDS-related expenditures. Higher socioeconomic status, SOCIAL PROTECTION FOR THE POOREST IN AFRICA Learning from Experience 173 large family size and reciprocal relationships with kin and neighbours were particularly important in shielding the elderly from the negative effects of HIV/AIDS-related deaths among their children. Elders without these factors fared particularly badly. What can be done to provide support for older people in this setting? While targeted interventions for those most in need are required, it is evident from our findings that extended family cohesion remains strong and generally provides adequate protection for most elderly people, including those living alone. We suggest that the best way to extend the reach of social protection may be by improving general public services that are not specifically targeted at older people so that families are able to continue to provide help and support in the absence of social pensions. However, in addition to improving services, it is important that respect for age and experience is sustained so that old people do not feel discarded by family and society. That is as important as meeting their practical social protection needs.