Introduction: The HIV/AIDS pandemic is reducing life expectancy and raising mortality. An increasing orphan population is perhaps the most tragic and long-term legacy of the HIV/AIDS pandemic. By 2010 sub-Saharan Africa is expected to have an estimated 50 million orphans and it will be staggered by this challenge. By the middle of 2006, 1.5 million children under the age of 18 years were maternal orphans in South Africa, and 66% of these children had been orphaned as a result of HIV/AIDS. Although government and non-government organisations have responded by building orphanages, most of Africa's orphans have been absorbed into extended family networks. Many of these extended family caregivers are ageing and often impoverished grandparents.

Methods: This was a descriptive, qualitative study using the free attitude interview technique. All family caregivers who consulted at the Hoekfontein Clinic, North West Province, South Africa between March and June 2006 formed the study population. A total of nine one-on-one interviews had been conducted by the time saturation of data was reached.

Results: All nine caregivers were women, mostly grandmothers (67%), and the orphans were between the ages of 5 and 20 years. Emergent themes were: poverty and lack of money; bureaucratic difficulties and lack of assistance from the social support services; lack of support (financial, physical and emotional) from other family members; frustrations of coping with rebellious orphans; pain of caring for the terminally ill family members; feelings of despondency (hopelessness); conflicts in the family; and the rejection of orphans by their fathers.

Conclusions: The study showed that the family caregivers experienced a lack of welfare and family/emotional support in their care of HIV/AIDS orphans. It is recommended that health care workers, including social workers and home-based caregivers be trained on available social support from government and non-governmental organisations for caregivers of HIV/AIDS orphans.