Drawing on a 2008 household study conducted with internal and cross-border migrant households in Johannesburg, South Africa, this article explores the impact of HIV-related sickness and the gendered provision of care on migration patterns. Findings show that the provision of care helps to sustain links between the livelihood systems of urban and rural households. In times of sickness, many migrants choose to return to their household of origin, to seek care. Female migrants play a pivotal role in the provision of care, potentially disrupting their productive livelihood roles within the city in order to return home to provide care.