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It is estimated that, by the end of this century, over five million children under the age of 10 will have lost their mothers as a result of HIV infection. The psychological implications for the children who survive are extensive. These children suffer not only from bereavements and disruption to family life, they also suffer from prevailing anxieties about their own health and the health of their carers. It is the pervasive threat of death which constitutes chronic trauma for child survivors of HIV infection. Confusions abound in fact and in phantasy of where responsibility lies for the tragedies which surround them. Psychotherapeutic treatment for the survivors concentrates on both the cognitive and the emotional aspects of the traumas to enable the child to grieve and to feel appropriate anger for the tragedy in their life. This paper presents a detailed case history of a 4-year-old African boy of refugee parents who were victims of war as well as AIDS. Using a psychoanalytic framework, the child's distorted perceptions of his world are described and his attempts to make sense of his world and keep hope alive in spite of the continual threat of abandonment is demonstrated.