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Children and young people living in households affected by HIV are experiencing poorer educational outcomes compared to their peers. This article explores how different forms of marginalisation interface and manifest themselves in classroom concentration problems, undermining their education. This mixed qualitative methods study was conducted with teachers and pupils from three primary and three secondary schools in the Siaya County of Western Kenya. Specifically, it involved 18 teachers through individual interviews and 51 HIV-affected children and youth through individual interviews (n = 47) and Photovoice (n = 51). Verbatim transcripts were imported into NVivo10 for thematic indexing and analysis. The analysis revealed three core pathways to classroom concentration problems amongst HIV-affected pupils. One, a general ‘lack of care’ and neglect in the context of household poverty and illness, meant that many of the participating pupils went to school hungry, unable to follow classes. Others were teased by peers for looking visibly poor, and felt anxious when in school. Two, some HIV-affected pupils play a key role in keeping their household afloat, generating food and income as well as providing practical support. ‘Caregiving’ pupils often reported coming to school exhausted, with limited physical and mental energy left for learning. Three, many participating pupils had their minds at home (‘caring about’). They were concerned about sick or frail household members, thinking about their next meal and care needs. Although the pupils demonstrated an admirable attentiveness to the needs of others, this came at a heavy price, namely their ability to concentrate in class. The paper argues that care ethics, household poverty and familial HIV are central to understanding the classroom concentration problems of HIV-affected pupils. To ensure school-going children and youth affected by HIV have the same opportunities as their peers, education initiatives must simultaneously alleviate both household poverty and other challenges pertaining to familial HIV. [ABSTRACT FROM PUBLISHER]