In countries facing severe HIV/AIDS epidemics, the overwhelming majority of those who are infected and affected by HIV are already living in poverty. Further income loss can threaten the ability to meet basic needs such as food, education and access to healthcare. Due to this, understanding the impact of HIV infection and caregiving on household income is essential to improving the health and welfare of HIV-affected individuals and families. This qualitative study examines how HIV infection and HIV caregiving affect household income in a population located within Botswana, a country with high HIV prevalence. We find that extended unpaid leave from work or job loss are common consequences and are associated with failure to meet basic needs in the short and long-term. We make recommendations for policy and programme support, including workplace adaptations and public sector support for meeting health and basic needs of HIV-affected families.