Purpose: This study explores and describes the role of grandparent caregivers raising grandchildren who have been orphaned by AIDS in Vietnam. The term “skipped generation caregiver” has been popularized and defined in the literature as grandparents raising grandchildren, when the biological parents are absent from the grandparent-headed household. Many studies have examined the role of skipped generation caregivers, as the role transition from grandparents to grandparent caregiver. Studies have found that the role of grandparent caregivers is often off-time or unexpected, creating a significant shift in daily routine. However in the context of families affected by HIV/AIDS, the role of grandparent caregivers remains understudied. HIV/AIDS often causes a reorganization of the family caregiving structure (Poindexter, 2002; Nyasani, Sterberg & Smith, 2009; Schatz & Ogunmefun, 2007). There is a need to understand this change from the perspective of the grandparent, which has shown to be challenging role with financial burdens, health related aging issues, lack of social support, and limited access to educational information (Nampanya-Serpell, 2002).
Method: In-depth semi-structured interviews were conducted with 16 grandparents, and 4 families were selected for participant observations in both rural and urban communities in Hanoi and Hai Phong, Vietnam. Transcriptions from interviews and field notes were analyzed first through initial coding. Then focused coding was done using ATLAS.ti to identify particular codes that were significant and frequent, which were then used to identify patterns and themes across participants. Rigor was enhanced through collaborative analysis as the initial coding of 9 of the 16 interviews was cross compared with another researcher's coding.
Results: The results of this study indicate that for grandparent caregivers, a cross-generational caregiving role had endured for many years. The caregiving role can be characterized as an alternating flow of care that involved 3 stages: 1) grandparents cared for their adult child, due to HIV-related illness and addiction, 2) grandparents simultaneously gave care to their adult child dying of AIDS and their grandchildren, and 3) grandparents became the sole caregiver to grandchildren after the death of their adult child. Grandparents agreed that the middle stage was the most challenging stage of care, due to financial and emotional burdens. Interwoven in these stages were the themes of the temporary nature of the caregiving role due old age and the elimination of expectations of filial piety over time.
Conclusions and Implications: This study provides new information for international social work programs working with families affected by HIV/AIDS. For grandparents raising grandchildren in the context of HIV/AIDS, there is a need to rethink the meanings of caregiving to include a cross-generational caregiving role that reaches beyond the limitations of “skipped generation caregiving” and appears to be more fluid and porous than other caregiving roles. The findings from this study highlight the complexity of HIV-caregiving roles in later life. The study will also be used to develop recommendations for humanitarian, HIV, and AIDS sectors on how to identify and support skipped generation caregivers and households in Vietnam.