Marais, HeinLiterature on the impact of serious AIDS epidemics anticipates severe outcomes, and places special emphasis on the epidemic’s likely effects on productive and governance capacities. Implicit in many impact scenarios is the assumption that the effects are distributed more or less uniformly across society, and are channeled ‘naturally’ through and across sectors. This article examines evidence of the AIDS epidemic’s impact at household level, and in the health, education and economic sectors of South Africa. It shows that the epidemic’s impact is strongly shaped by the highly unequal distribution of power, entitlement, risk and responsibility in South Africa. The article concludes that many of the costs associated with the AIDS epidemic are being displaced into the lives, homes and neighbourhoods of poorer South Africans, especially black African women - thus deepening poverty trends, as well as reproducing and hardening the polarized character of South African society. Priority steps to remedy these trends are outlined.Health EquityGlobal HealthHIV/AidsResearchstudiesHIVAIDSimpactinequalitypovertywomenhouseholdhomebased careworkplacesocial protectionArticle