Background/Introduction: Orphans and vulnerable children (OVC) in sub-Saharan Africa have been the focus of much popular and academic writing and the growing body of evidence cannot be overlooked. Existing research focuses on projections of OVC numbers, interventions, outcomes and descriptions of care arrangements. A lot of information exists on their poor sexual and reproductive health (SRH) status—most of it quantitative. The purpose of this paper is to present the voice and perceptions of OVC in regards to their SRH. Methods: This was a mixed-methods qualitative study drawing from phenomenology and it used purposive sampling to recruit 129 participants. Results: OVC perceptions and priorities do not always intersect with those of professionals and this has implications for existing and planned interventions. For example some OVC think favorably about early marriages while others have mechanisms of self-protection again SRH harm although this is not usually acknowledged. Conclusions: OVC demonstrate agency; therefore positioning them at the heart of service planning and delivery is an effective strategy in increasing the uptake and impact of interventions seeking to address their sexual and reproductive health needs.