UCLA

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. Previous studies on grandparent caregivers have shown that the stresses, challenges and trials facing this population cut across race, country, culture and ethnicity. This dissertation explores and describes the lives of skipped-generation caregivers who foster their grandchildren orphaned by HIV/AIDS in Northern Vietnam. I investigated the challenges facing this population and the ways in which grandparents handled their trials on behalf of their families. Specifically, 1) what is the meaning of skipped generation caregiving in families affected by HIV/AIDS in Vietnam? 2) What is the context in which meaning is formed? 3) How do understandings of meaning and context relate to motivations for caregiving and coping? An ethnographic approach was used to conduct in-depth, qualitative interviews with 21 older caregivers and seven key informants. I completed unstructured participant observations with five caregivers from the sample. Techniques commonly associated with Grounded Theory were used to analyze the interview transcripts and field notes. Participants were mostly female and ranged in age from 55 to 78. I found that grandparents typically underwent four phases of their "caregiving career:" 1) caregiving for their biological child, 2) caregiving for their adult child because of drug abuse and HIV-related illness, 3) simultaneous caregiving for their adult child dying of AIDS and their grandchild, and 4) caregiving solely for the grandchild after the death of the parents. In addition, a framework is presented that describes the overarching themes related to phase four. This framework includes the central contextual, social and physiological processes that emerged during the period of caregiving following their adult child's death. This model represents the overlapping understandings of disease, caregiving and coping held by grandparents who were raising grandchildren due to HIV/AIDS, and it illuminates contextual factors such as perceptions of culture and community that influence their coping and caregiving strategies. The voices of grandparent caregivers must be a vital component to influence and inform service organizations and HIV sectors working in Vietnam. Based on a deeper understanding of the caregiving process, I offer suggestions on how home-based caregivers can help to support grandparents who are raising grandchildren. I present recommendations for programs at the local and government levels in Vietnam to support skipped generation caregivers and their families. I conclude by making recommendations for future research about grandparents who are raising grandchildren.