Although caring for children orphaned by AIDS is increasingly acknowledged as a priority area for HIV/AIDS and development programs, there is limited knowledge on caregivers. Rapidly growing numbers of children orphaned by AIDS warrants increased attention from researchers, policy makers, and program planners. This paper explores dominant theoretical and policy paradigms of care for children orphaned by AIDS. Then, drawing from an analysis of interviews with staff at nongovernmental organizations and community based organizations, and focus groups with caregivers gathered during fieldwork conducted between July 10 and September 8, 2006 in KwaZulu-Natal Province, Republic of South Africa, this paper contrasts local understandings of childcare with theoretical and policy notions of care. Findings from this qualitative study suggest that childcare practices are more diverse and complex than those currently recognized within existing theoretical and policy formulations. Such findings lead to the conclusion that current policy approaches towards care for children orphaned by AIDS face a potentially detrimental disconnect with local realities of care. Re-formulating policies to take into account how local practices of childcare are shifting in dynamic ways in response to the pandemic will be essential for the formulation of effective policies and programs.