Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Knodel, John E., Mark VanLandingham, Chanpen Saengtienchai, and Wassana Im-em. 2001. "Older People and AIDS: Quantitative Evidence of the Impact in Thailand." Social Science & Medicine, 52(9): 1313-1327.
Discussions of the AIDS epidemic rarely consider the impact on older people except as infected persons. Virtually no systematic quantitative assessments have been made 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, a country where substantial proportions of elderly parents depend on adult children for support and where co-residence with an adult child is common. Interviews with local key informants in the public health system in 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-related diseases either lived with or adjacent to a parent by the terminal stage of the illness, and a parent, usually the mother, acted as a main caregiver for about half. For 70%, either a parent or other older generation relative provided at least some care. The vast majority of the parents were aged 50 or more and many were aged 60 or more. This extent of older generation involvement appears to be far greater than in Western counties such as the U.S. We interpret the difference as reflecting the contrasting epidemiological and socio-cultural situation 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 the infected adult children has important implications for public health programs that address caretaker education and social and economic support.