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Background: Africa is in an orphan-care crisis. In Zimbabwe, where one-fourth of adults are HIV-positive and one-fifth of children are orphans, AIDS and economic decline are straining society's ability to care for orphans within their extended families. Lack of stable care is putting thousands of children at heightened risk of malnourishment, emotional underdevelopment, illiteracy, poverty, sexual exploitation, and HIV infection, endangering the future health of the society they are expected to sustain. Methods: To explore barriers and possible incentives to orphan care, a quantitative cross-sectional survey in rural eastern Zimbabwe asked 371 adults caring for children, including 212 caring for double orphans, about their well-being, needs, resources, and perceptions and experiences of orphan care. Results: Survey responses indicate that: (1) foster caregivers are disproportionately female, older, poor, and without a spouse; (2) 98% of non-foster caregivers are willing to foster orphans, many from outside their kinship network; (3) poverty is the primary barrier to fostering; (4) financial, physical, and emotional stress levels are high among current and potential fosterers; (5) financial need may be greatest in single-orphan AIDS-impoverished households; and (6) struggling families lack external support. Conclusions: Incentives for sustainable orphan care should focus on financial assistance, starting with free schooling, and development of community mechanisms to identify and support children in need, to evaluate and strengthen families' capacity to provide orphan care, and to initiate and support placement outside the family when necessary. [ABSTRACT FROM AUTHOR]