Grandparents Raising Grandchildren Affected By HIV/AIDS in Vietnam: Perceptions of Culture and Community

Background and Purpose: Grandparent, or “skipped generation” caregivers are often overlooked and ignored in the global response to the HIV/AIDS epidemic. Grandparent caregivers are not only a vulnerable population due to age, frailty, and the decreased ability to generate income, but they are vital to the survival of younger generations. Caregivers are not only the providers of food, education and safety for grandchildren, but they are also the gatekeepers to testing and treatment for HIV + orphans. This study explores and describes the lives of skipped-generation caregivers who foster their grandchildren orphaned by HIV/AIDS in Northern Vietnam. We investigated the challenges facing this population, the ways in which grandparents handled their trials on behalf of their families, and the cultural context in which their caregiving role exists. Specifically, this study addresses the following questions: first, how do grandparent caregivers perceive Vietnamese culture with respect to grandparenting orphans affected by HIV/AIDS?; and second, how do these caregivers perceive the surrounding community’s response to their situation and needs?

Methods: Twenty-one in-depth qualitative interviews were conducted with purposively selected grandparent caregivers and seven key informants in urban and rural communities in Hanoi and Hai Phong, Vietnam. Five grandparents were selected from the sample to complete participant observations. The sample included four caregiving couples and 17 single women. The grandparents were predominantly widowed (n = 12) and low income (n= 19). Eight grandparents reported that their grandchild(ren) were HIV+, eight reported that their grandchild(ren) were HIV- and five reported that they did not know their grandchild’s HIV status. Transcriptions from interviews and field notes were analyzed using ATLAS.ti. Two Ph.D.-level researchers trained in qualitative data analysis conducted the analysis using a grounded theory approach, utilizing open coding, focused coding, and axial coding strategies.

Findings: The context of caregiving is heavily influenced by Vietnamese cultural values about family responsibilities and roles, and beliefs about whose responsibility it is to parent familial orphans. The context also includes grandparents’ perceptions of their community, which consisted of 1) feeling isolated by the community, 2) feeling compensated by the community, 3) viewing family responsibility as being greater than community responsibility, and 4) experiencing the paradox of both feeling supported and stigmatized as a family affected by HIV/AIDS.

Conclusions and Implications: This study seeks to expand the knowledge base concerning Vietnamese grandparents raising grandchildren when the family has been affected by HIV/AIDS, a population with a unique cultural context that has been understudied. Implications of this study include a deeper understanding of the caregiving processes and the ability to inform service organizations and HIV sectors working in Vietnam to better assist the needs of grandparent caregivers. While social work is a new and growing profession in Vietnam, the complicated nature of social problems, stigma, policy, and health among these families provides an ideal setting for the skills of a social worker. Social work organizations and social work programs at the university level should partner with local organizations and international NGOs to provide services to grandparent caregivers and orphans.