Caring for HIV-positive orphans in the context of HIV and AIDS: perspectives of Botswana grandmothers

Background: Botswana has a human immunodeficiency virus (HIV) prevalence of 18.6% and an estimated 137 805 orphans in a population of approximately two million people. Many of these orphans are cared for by their grandmothers, who struggle with caring for orphans suffering from a disease they know very little about. Methods: The purpose of this exploratory qualitative study was to explore experiences of grandmothers caring for HIV-positive orphan grandchildren. Results: The ages of the grandmothers interviewed ranged from 60 to 80 years, while the number of orphans under their care ranged from one to nine. The themes that emerged included the following: challenges of HIV treatment, HIV-related stigma, disclosure of HIV status, communication of sexuality issues and the adolescent pregnancies. Cultural beliefs prevented them from talking about sexuality and in some cases, accepting HIV as the cause of death. Conclusions: Grandmothers were challenged by HIV treatment of orphans and their supportive role as caregivers. The lack of knowledge of the disease must be addressed to improve adherence and communication about HIV. HIV programs need to address older persons’ dynamic and diverse needs as individuals. Community home-based care nurses need to support grandmothers caring for HIV-positive grandchildren and refer them to relevant professionals who can assist with the care responsibilities. Implications for practice: Nurses working with older people caring for HIV positive orphans need to develop culturally sensitive HIV education programs that address needs specific to.