Those who fall sick are in the prime of life, and the same age as traditional household heads. When chronic illness and death strike, the composition of a household changes dramatically and affects the roles of household members. Family labour is not there for production, skills are lost, money has to be used to pay for health care, and assets are often sold to raise cash. By the time the parents die, the remaining members of the family can be destitute. Men are often the first to become sick and die, and as husbands, parents, or brothers begin to be affected by recurrent illness, it is usually the women who have to cope with the increased burden of caring for the sick, and who take on greater responsibility for earning money and providing food.
Girls usually take over the roles of their sick mothers and care for other family members.
As their parents decline, girls may be tacitly or explicitly encouraged to bring in money in any way possible. Many resort to work in the sex industry. Others marry early, or accept relationships that may be short-term and unhappy, just to meet basic needs, such as shelter, clothing, and food, for themselves and their siblings. As the epidemic progresses, and the number of orphans rockets, households change even more radically. In sub-Saharan Africa, it is now common for elderly grandparents to look after several young children whose parents have died.