Monday, Dec 9
Sharon Kardia: Genomics in the Health & Retirement Study
Knodel, John E., Chanpen Saengtienchai, Wassana Im-em, and Mark VanLandingham. 2000. "The Impact of Thailand's AIDS Epidemic on Older Persons: Quantitative Evidence from a Survey of Key Informants." PSC Research Report No. 00-448. July 2000.
Discussions of the AIDS epidemic rarely consider the impact on older persons and when they do, focus is typically on those who are infected themselves. Virtually no systematic quantitative assessments exist of the involvement of parents or other older generation relatives in the living and caretaking arrangements of persons with AIDS in either the West or the developing world. We assess the extent of such types of involvement in Thailand and examine the parental characteristics associated with them. We also examine the economic impact on the families and parents through expenditures on treatments and a number of other routes. Interviews with local key informants in the public health system in an extensive sample of rural and urban communities provided quantitative information on a total of 963 adult cases who either had died of AIDS or were currently symptomatic.
The results indicate that a substantial proportion of persons with AIDS move back to their communities of origin at some stage of the illness. Two-thirds of the adults who died of AIDS either lived with or adjacent to a parent by the terminal stage of illness and a parent, usually the mother, acted as a main caregiver for about half. For 70 percent, either a parent or other older generation relative provided at least some care. The vast majority of the parents were age 50 or more and many were age 60 or older. The economic impacts appear to be severe for only a minority of parents although those who are from the poorer economic strata are particularly likely to be substantially affected adversely. The wide availability of government health insurance likely moderates the economic impact on families.
A substantial majority of families in the upper north are reported to be open to the community about a family member being ill with AIDS but only about half of families outside the upper north were considered to be open. Negative community reactions during the time of illness to families with a member who had AIDS was reported for a fifth of the families in the upper North and a third elsewhere. Following the death, few cases of residual negative reaction were reported anywhere.
This extent of older generation involvement in living and caregiving arrangements appears to be far greater in Thailand than in Western countries such as the US. We interpret the difference as reflecting the contrasting epidemiological and socio-cultural situations in Thailand and the West. The fact that older people in Thailand, and probably many other developing countries, are extensively impacted by the AIDS epidemic through their involvement with their infected adult children has important implications for public health programs that address caretaker education and social and economic support.