The Impact of the AIDS Epidemic on Older Persons
(with a focus on Thailand and Cambodia)


Monograph-Length Reports

Knodel, John E., Jiraporn Kespichayawattana, Chanpen Saengtienchai, and Suvinee Wiwatwanich. 2010. "Older-Age Parents and the AIDS Epidemic in Thailand: Changing Impacts in the Era of Antiretroviral Therapy." UN ESCAP Report. Abstract.

Saengtienchai, Chanpen, and John E. Knodel. 2001. "Parents Providing Care to Adult Sons and Daughters with HIV/AIDS in Thailand." UNAIDS Best Practice Collection: Case Study. Abstract.

Other Publications

Mark VanLandingham, Wassana Im-em, and Chanpen Saengtienchai. "Community Reaction to Persons with HIV/AIDS and their Parents in Thailand." Journal of Health and Social Behavior, 46(4): 392-410. Also issued as University of Michigan, Population Studies Center Research Report No. 05-577, June 2005.

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We systematically examine community reaction to persons with HIV/AIDS (PHAs) and their families in Thailand from a variety of perspectives and using a variety of data sources. We explore these community reactions during the time of the PHAs' illness and after their deaths. Quantitative data sources include a survey of young adult PHAs (n=425); a survey of parents who suffered the death of an adult child to AIDS (n=394 cases); a KAP study of AIDS that includes both older and young adults (n=1174); and quantitative data from local key informants about cases in their area (n=286 cases). Qualitative sources include 18 in-depth interviews of parents who lost an adult child to AIDS; 49 in-depth interviews of village health volunteers; 6 focus group discussions of community health officials; and 6 group interviews with community hospital nurses. Data were collected during 1999 - 2001 from a variety of settings throughout Thailand. We find community reaction to PHAs and their families to be somewhat variable across cases, social group, and type of observer, but overall much more positive than one might conclude from existing research on the topic. The overwhelming majority of key informant reports on communities and affected families, and parents of PHAs report either a generally positive community response or a neutral one. Results from our sample of PHAs, who are recruited from PHA support groups, are more mixed. For that minority who were treated poorly, it is suggested by at least some of our data sources that being male, living in the city, living in an area without an NGO working on AIDS, being described as having problematic character, or being at either extreme of the socioeconomic spectrum may elevate the risk of experiencing negative community reaction. Research and policy implications of the findings are discussed.

John Knodel and Chanpen Saengtienchai. "Older Aged Parents: The Final Safety Net for Adults Sons and Daughters with AIDS in Thailand." Journal of Family Issues Issues 26(5): 665-698 (July 2005). Also issued as Population Studies Center, University of Michigan, Research Report 02-503. May 2002.

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The AIDS epidemic in Thailand, as in other countries with significant numbers of persons with HIV/AIDS (PHAs), has created a major need for health care and material and emotional support for those infected and their families. The government and NGOs offer significant but limited health and welfare services to PHAs and their dependents. Compared to many of the poorest African countries where the AIDS epidemic is far worse, formal health and welfare assistance to PHAs and their families are probably far better in Thailand. Yet this formal safety net still leaves the bulk of care and support to be found outside such organized efforts. Under such circumstances, most needed assistance, both before and after death, is provided within the context of the family. Older age parents typically play a central role in caring for and supporting their adult sons and daughters when then become seriously ill with AIDS. In many cases other family members, especially non-infected adult siblings and spouses of the PHA also help. The fact that more than half of PHAs in Thailand eventually end up living with nearby parents at the final stage of their illness and that parents commonly provide care and support to their AIDS afflicted adult sons and daughters testifies to older age parents as the ultimate safety net in the context of the Thai AIDS epidemic.

Knodel, John and Chanpen Saengtienchai. "Aids and Older Persons: The View from Thailand." In P. Lloyd-Sherlock (ed), Living longer. Ageing, development and social protection. London: ZED, 2004, pp. 249-274. Also issued as Population Studies Center, University of Michigan, Research Report 02-497, February 2002.

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Although little attention has been paid to older adults in the context of the global AIDS epidemic, they not only can contract HIV themselves but, far more commonly, they experience multiple consequences as in their role as parents of younger adults who become ill and die from AIDS. Older persons also make significant contributions to the well-being of younger adults who suffer from AIDS by playing a major role in caregiving to their infected sons and daughters and by assuming the role of foster parents for their grandchildren who are left behind as AIDS orphans emphasizing the consequences for and the contributions by older persons in their role as AIDS parents. This paper addresses the impact of the AIDS epidemic for older adults based on recent research in Thailand. The analysis is based primarily on interviews with key informants about individual AIDS cases and their families; direct survey interviews with AIDS parents and a comparison group of older persons; and in-depth interviews with AIDS parents. The first two permit quantitative analysis while the third is suited for qualitative analysis.

John Knodel and Wassana Im-em. "The Economic Consequences for Parents of Losing an Adult Child to AIDS: Evidence from Thailand" Social Science & Medicine 59(5): 987-1001, September 2004. Also issued as Population Studies Center, University of Michigan, Research Report 02-504, Revised Oct. 2003.

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This report examines the economic consequences for parents of losing an adult child to AIDS in Thailand with emphasis on the effects of parental caregiving. The analysis is based on a combination of quantitative and qualitative data derived from several different data collection approaches. Our main findings are as follows. 1) Parents are frequently and substantially involved in the payment of care and treatment costs. But government health insurance and to a less extent welfare helped alleviate the financial burden this created. 2) Parental caregiving often involved disruption of economic activity. But the duration of parental caregiving was not long thus moderating thus the extent of opportunity costs. 3) Parents frequently paid for funeral costs. But membership in funeral societies and customary contributions from those attending often substantially reduces the cost to parents. 4) Far fewer parents are involved in supporting AIDS orphans. But orphaned grandchildren often will end up with grandparents. 5) Most deceased children had contributed financially to the parental household before becoming ill. But only a minority had been main providers. However poor parents were far more likely than better off parents to lose a main provider and for this to create severe financial hardship. 6) Poorer parents spend much less that better off parents on expenses. But the burden created by expenses is far greater for poorer than better off parents. One important implication of these findings is that programs are needed that recognize and address the plight of older persons who lose a child to AIDS but the programs need to take intro account considerable range of vulnerability that exists and target those who are particularly susceptible to resulting economic hardship.

Jiraporn Kespichayawattana and Chanpen Saengtienchai. "Health Services, Problems, and Needs of Health Personnel at Community Hospital and Health Center Level in Providing Care to HIV/AIDS Patients and Their Families", Journal of Health Sciences vol. 13(3):632-640, July-Aug. 2004 (in Thai).

For most of the Thai population, community hospitals and health centers are the nearest outlets that provide services by health professionals within the government health system. This study examined services, problems and needs of health personnel at the community hospital and health center level in providing care to HIV/ AIDS patients and their families. Qualitative methods involving focus group discussions and group interviews were used in the study. Participants were registered nurses, nurse practioners, and administrative officers responsible for health prevention and promotion as well as for hygiene. Research was conducted in six provinces: Chiang Rai, Lampang, Rayong, Trat, Prachuabkhirikan, and Phetchaburi. Findings indicated that community hospitals mainly provided treatment and care and only secondarily home visits, counseling for health promotion and prevention, and terminal illness care. In contrast, health centers were more concerned with prevention activities but also provided home visits in the local community. Problems and needs identified by health personnel both in community hospitals and health centers included insufficient number of health staff, multiple roles and responsibilities, difficulties in dealing with some HIV/AIDS patients and their families who were uncooperative because of an unwillingness to admit the nature of their illness, stress and anxiety, a need for updated knowledge and poor co-operation and coordination among different organizations dealing with AIDS.

Mark VanLandingham, Wassana Im-em, and Fumihiko Yokota. "Access to Treatment and Care Associated with HIV Infection among Members of AIDS Support Groups in Thailand." AIDS Care (forthcoming). Also issued as Population Studies Center, University of Michigan, Research Report 04-550. February 2004.

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To examine current treatments for persons living with HIV and AIDS (PHAs) in Thailand, we analyze data collected during 2000 from 425 members of PHA support organizations in Bangkok and three upcountry provinces. Nearly all of these respondents report symptoms related to their infection with HIV - about 12% report severe symptoms - and most (71%) report ever having received modern medical care for HIV-related symptoms. A smaller percentage (30%) report ever use of herbal treatments. Small proportions of those who had experienced severe symptoms report treatments with anti-retroviral medication; treatment for opportunistic infections; or treatment for pain. Treatment with ARV or for pain are reported by only 4% of those who had experienced severe symptoms. Only small proportions of the sample are spending substantial sums on HIV-related treatments; the government's health card system appears to play an important role in keeping treatment costs down for PHAs and their families. Being open about one's HIV status to one's community is positively associated with receiving modern treatment in multivariate analysis. Women respondents enjoy greater access to the government's health card system than the men, and are more likely to be open to their communities about their HIV-status. But multivariate models that include controls for illness severity and other potentially confounding factors indicate that women are less likely than men to receive modern treatments for HIV-related ailments. Implications of the findings are

Jiraporn Kespichayawattana and Mark VanLandingham. "Health impacts of co-residence with and care giving to persons with HIV/AIDS (PHAs) on older parents in Thailand." Journal of Nursing Scholarship 35(3): 217-224 (Third quarter, 2003). Also issued as University of Michigan, Population Studies Center, Research Report No. 02-527, September 2002.

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This paper explores these potential health impacts of caregiving for 394 households having older parents who had a child die of AIDS versus 376 households with older persons who did not, based upon original survey data collected during 2000 in three provinces (from 3 sub-regions) in Thailand. We supplement these survey data with qualitative data resulting from 18 in-depth interviews of older persons who had lost an adult child to AIDS. We find that large proportions of older persons with PHA children provide a variety of time consuming and strenuous caregiving services to them. Mothers shoulder most of this burden. Mothers who have had a child die from AIDS reported lower levels of overall happiness than mothers who did not. Mothers and fathers of PHAs who died report lower levels of overall happiness now compared to 3 years ago (before the time of the death of their child) with respect to parents from households that did not experience an adult child death. Many AIDS parents experienced anxiety, insomnia, fatigue, muscle strain, and head and stomach aches during the time they cared for their ill children, and many experienced these problems often.

Chanpen Saengtienchai and Jiraporn Kespichayawattana. "Health services of sub-district health center for person with HIV/AIDS: Views of staff of health centers." (in Thai). Journal of Health Science 12(4): 573-83 July-August 2003.

This qualitative research investigates the role of sub-district health centers in the AIDS epidemic in Thailand. We investigate the provision and receipt of services in relation to HIV/AIDS persons infected and their families. Data were derived from six focus group discussions held with staff from sub-district health centers in six provinces (Rayong, Trat, Phetchaburi, Prachuabkhirikan, Chiang Rai and Lampang). The findings indicated that the social and geographical proximity of sub-district health center staff to persons with HIV/AIDS and their families placed them in a unique position within the public health system to be of assistance. The health center not only provided primary care for infected persons but also served as a place for psychological support, advice, and help with accessing and coordinating assistance from other organizations and programs that provide aid. We conclude with suggestions on how to improve ability and efficiency of sub-district health center staff in services related to persons with HIV/AIDS.

John Knodel and Mark VanLandingham. "Return Migration in the Context of Parental Assistance in the AIDS Epidemic: The Thai Experience." Social Science & Medicine 57(2):327-342, July 2003. Also issued as Population Studies Center, University of Michigan, Research Report 01-492, November 2001.

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Most persons with AIDS (PWAs) eventually require demanding caregiving. This can prompt changes in living arrangements during the course of the illness. Few studies have attempted to examine the potential links between AIDS and migration from this perspective. The present study uses both direct and indirect approaches to examine the extent of return migration of adults with AIDS in Thailand and explores how this is linked to residence with and care by older aged parents. Methodological challenges to the study of this phenomenon are discussed. Despite differences in the nature of information available from our samples and in basic sample characteristics, the findings show a consistent pattern suggestive of extensive return migration among PWAs. The fact that most return migrants die within a few months of their return indicates that they are seeking parental caregiving during the final stages of the illness. The vast majority of PWAs who returned home after becoming ill did so because of their illness, particularly due to a need for care.

John Knodel, Mark VanLandingham, Chanpen Saengtienchai, Wassana Im-em, and Jiraporn Kespichayawattana. "Data Collection Strategies for Studying the Impacts of AIDS on Older Parents: Lessons from Research in Thailand." Population Studies Center, University of Michigan, Research Report 03-537, June 2003.

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The present report addresses the methodological challenges to collection of data on the situation of parents of adults who become ill and die of HIV/AIDS, describes and evaluates the different strategies adopted in our research on the topic in Thailand, and draws lessons for researchers who might wish to conduct related studies in other settings. The specific challenges we discuss involve the sensitivity of the topic, the extended time frame in which impacts may occur, case definition, obtaining an appropriate sample, the need to develop sensitive instruments, and the protection of confidentiality. We then describe in some detail five data collection strategies we developed during the course of our research in Thailand: interviews with key informants about individual AIDS cases and their families; open-ended interviews with AIDS parents; direct survey interviews with AIDS affected and non-AIDS affected parents; assisted self-administered questionnaires to persons living with HIV/AIDS; and extraction of information from welfare applications related to AIDS. To highlight the relative strengths and weaknesses of these different approaches, we compare them in terms of sample characteristics, selected results, and problems they posed for maintaining confidentiality. We conclude with the major lessons from our experience that we believe can help guide future research on this topic generally.

Mark VanLandingham and John Knodel. "Sex and the Single (Older) Guy: Sexual Lives of Older Unmarried Thai Men During the AIDS Era." Population Studies Center, University of Michigan, Research Report Report No. 03-536, June 2003.

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In Thailand and elsewhere, some older persons remain sexually active well into late middle and old age. Sexually active older Thai men without a regular sexual partner may be at risk for contracting HIV. Since many of these older men came of age during an era when unprotected commercial sexual relations was normative for unmarried men, they may revert to these former practices, especially since older men have not been a target of intervention campaigns in Thailand. We explore these hypotheses using qualitative data from semi-structured, in-depth interviews of unmarried older Thai men, most of whom were in their 50's. Opportunities exist for several of the men we interviewed to engage in a fairly wide range of sexual relationships. Some do, but others choose celibacy because of declining interest; a wish to avoid financial hardships thought to be inextricably linked with sexual relationships; a wish to avoid social sanctions; and/or desires to pursue interests thought to be more appropriate for their age group. Risks for acquiring and spreading HIV do not appear to be great but such risks cannot be ruled out given how little we know about the sexual behavior of unmarried men in this age group.

Knodel, John, Susan Watkins, and Mark VanLandingham. "AIDS and Older Persons: An International Perspective." JAIDS Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 33:S153-S165 (June 2003, Supplement 2). Also issued as Population Studies Center, University of Michigan, Research Report No. 02-495, January 2002.

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The impact of the worldwide AIDS epidemic on persons age 50 and over has received relatively little consideration except in the United States where interest has focused almost exclusively on older persons living with AIDS or at risk of infection. The place of older persons in the epidemic deserves international attention because their lives are being significantly affected in a variety of ways. Since most of the epidemic occurs in the developing regions, especially Africa and Asia, efforts to understand and deal with the concerns of older persons in relation to AIDS in those settings needs expansion. Although older persons represent a non-negligible minority of the reported global caseload, a far higher proportion are affected through the illness and death of their adult children and younger generation relatives who contract AIDS. From a global perspective, a broader concern encompassing those who are affected through the infections of others rather than a narrow concern with those who are at risk or infected themselves is called for if the needs of the large majority of older persons adversely impacted by the epidemic is to be addressed.

Wachter, Kenneth W., John E. Knodel and Mark VanLandingham. "Parental Bereavement: Heterogeneous Impacts of AIDS in Thailand." Journal of Econometrics 112: 193-206 (2003). Also issued as Population Studies Center, University of Michigan, Research Report 01-493, November 2001.

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Over the coming decades in Thailand, aging parents whose adult children sicken with AIDS will bear burdens of caregiving and loss. Using demographic microsimulation, we show that the new, lower projections of the HIV/AIDS epidemic still imply that 8% of Thais over the age of 50 in 1995 will lose one or more children to AIDS before their own deaths. The proportion of all losses which are multiple losses can vary from 12% to 33% under a range of assumptions about plausible family-to-family heterogeneity in risks of infection.

John Knodel and Mark VanLandingham. "The impact of the AIDS epidemic on older persons." AIDS 2002, 16 (suppl 4):S77-S83.

This article reviews findings from research in developing countries on how the multiple pathways through which the AIDS epidemic affects older persons, especially in their role as parents of adults who die of the disease. It also addresses why older-aged parents of those who are ill or who have died of AIDS has been largely overlooked in discussions of the epidemic and comments on the potential of these parents to contribute to HIV prevention and the improvement of the quality of care that persons with HIV/AIDS receive.

John Knodel, Wassana Im-em, Chanpen Saengtienchai, Mark VanLandingham and Jiraporn Kespichayawattana. "The Impact of an Adult Child's Death due to AIDS on Older-aged Parents: Results from a Direct Interview Survey." Publication No. 266, Institute for Population and Social Research, Mahidol University, Thailand, 2002 (available in a Thai Language translation published 2004). Also issued as Population Studies Center, University of Michigan, Research Report 02-498, April 2002.

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The present report describes the methodology and findings of a direct interview survey in Thailand of parents of deceased adult children who died of AIDS and a comparison group of older age parents who had not suffered such a loss. The results provide extensive information on living arrangements; parental caregivng; health Impacts; spouses and orphaned children; care, treatment and funeral expense; longer term economic impacts; and community reaction. The detailed results of our survey show considerable diversity in the extent parents are impacted. Clearly personal caregiving and instrumental assistance by parents, especially the mother, can be very demanding. Even when a parent is a main caregiver, other family members, particularly other adult children, often assist the parental caregiver. Parents also often serve as critical links between their ill adult child and the health care system. Care giving often takes a toll on the emotional and physical health of the parental caregiver at the time care is being provided. Only a minority of the AIDS parents had fostered grandchildren left behind by their deceased son or daughter. Overall, the loss of a child to AIDS has a serious economic impact for only a minority of AIDS parents. At the same time, the poor appear to be the most adversely affected. Sustained social stigma directed at parents of persons who died of AIDS is far from universal in Thailand at present. Sympathetic and supportive reactions from others in the community are more frequently reported than negative ones.

Wassana Im-em, Mark VanLandingham, John Knodel, and Chanpen Saengtienchai. "HIV/AIDS-related Knowledge and Attitudes: A Comparison of Older Persons and Young Adults in Thailand." AIDS Education and Prevention 2002, 14:246-262. A longer version entitled "Knowledge and Attitudes of Older People about HIV/AIDS in Thailand: A Comparison with Young Adults" was issued as Population Studies Center, University of Michigan, Research Report No. 01-464, 2001 and published as Publication No. 257, Institute for Population and Social Research, Mahidol University, Thailand (2001).

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Levels of AIDS related knowledge are widely assumed to be high in Thailand, a country with the probably the most effective response to the HIV/AIDS pandemic to date in the developing world. But efforts to verify these levels are sparse in recent years, and very little attention has ever been paid to AIDS knowledge and attitudes among the Thai older population. Since many Thai older persons (age 50 and over) remain sexually active late in life, and since many more will be involved in interactions with and care taking of young adult persons suffering from AIDS, we explore AIDS knowledge and attitudinal data we collected during 1999 from a sample of 773 older Thais from four provinces and Bangkok. The sample provinces were chosen in part to represent different levels of HIV/AIDS prevalence by Thai standards, ranging from high to low. We compare the results with data from a sample of 398 young adults using the same questionnaire, collected at the same sites, at the same time (total N = 1170). We find, as previous studies have indicated, an overall high level of awareness about AIDS, but identify important deficiencies among both the young adults and especially among the older Thais. Implications of the findings are discussed.

Kenneth W. Wachter, John E. Knodel and Mark VanLandingham. "AIDS and the Elderly of Thailand: Projecting Familial Impacts." Demography 39(1) 25-41, 2002.

Recent evidence from Thailand reveals extensive involvement of parents in the caregiving and living arrangements of adult AIDS cases. Based on computer microsimulation and aggregate demographic analysis we estimate (a) project the numbers of older Thais who will lose children to AIDS during their own lifetimes and (b) assess the timing and demographic magnitude of expected caregiving and loss. Although only about 2 percent of the Thai population is estimated to be HIV positive, 11 percent of the Thai population over age 50 in 1995 are likely to lose at least one adult child to AIDS before their own deaths; for Thailand's upper north, the proportion reaches 19 percent. Of parents who lose one adult child, 13 percent are likely to lose two or more. In Thailand, the probability of losing an adult child is about 75 percent greater than if there were no AIDS epidemic. Much higher proportions of older parents will be impacted in many countries in Africa, where HIV is far more prevalent than it is in Thailand. Approaches similar to those used here can help in projecting impacts on older people in these settings.

Chanpen Saengtienchai and John Knodel. Parents providing care to adult sons and daughters with HIV/AIDS in Thailand. UNAIDS Case Study, Best Practice Collection, Geneva: UNAIDS, November 2001. Also issued as "Parental Caregiving to Adult Children with AIDS: A Qualitative Analysis of Circumstances and Consequences in Thailand." Population Studies Center, University of Michigan, Research Report 01-481, July 2001.

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This report provides a qualitative analysis of the circumstances and consequences of parental caregiving to adult children with AIDS in Thailand based on open-ended interviews, primarily with parents of adult children who died of AIDS. The results reveal the circumstances that lead to parental caregiving, the tasks involved and the strains they created, how parents coped with these strains, and the consequences for their emotional, social, and economic well-being. The experiences and consequences revealed are influenced in part by features relatively specific to the Thai setting but at the same time reflect conditions that are likely to be common to many other developing countries experiencing serious epidemics.

John Knodel, Chanpen Saengtienchai, Wassana Im-em and Mark VanLandingham. "The Impact of AIDS on Parents and Families in Thailand: A Key Informant Approach." Research on Aging 23(6): 633-670 (Nov. 2001)

Local key informants provided data on individual adult cases of AIDS for assessing the impact of the epidemic in Thailand on aged parents and other family members. In most cases parents provided care for their infected adult children, often assisted with expenses and frequently played a main role in paying for treatment. For a third of the cases, a family member reduced or stopped working to provide care. For approximately a fifth of parents, the infected adult child was their main income earner. Nevertheless, in most cases the child's death was not judged to have a devastating economic impact for the parents, although poorer families were far more likely to be adversely affected than others. Wide availability of basic government health insurance moderated the economic impact. Although some stigma is associated with AIDS, little residual negative community reaction is directed at family members. Results are interpreted in terms of patterns of intergenerational exchanges of support and services.

Mark VanLandingham and Wassana Im-em. "Living with HIV/AIDS in Thailand: Results from a Self-administered Survey." Population Studies Center, University of Michigan, Research Report No. 01-488, September 2001.

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Survey data collected during 1999 and 2000 of 424 young adults with HIV and/or AIDS (PHAs) recruited primarily from support groups in northern Thailand and Bangkok explore symptoms, treatments, care taking arrangements, migration history and plans, and community reaction. Seventy one percent of the entire group report receiving some type of modern treatment or "western medicine." Among those reporting HIV related symptoms, men are more likely to receive treatment and modern treatment than are women, but not when the analysis is limited to those reporting at least one of the most serious outcomes. Little difference was found in access to treatment across our categories of socioeconomic status. Use of specific conventional treatments used in the west, such as anti retroviral therapy, treatment of opportunistic infections, and palliative care are rarely reported by this sample in response to an open ended question about types of modern treatments received. Herbal remedies and meditation are commonly reported. Two thirds of the group report total expenditures for treatment to be less than $125. The government health card insurance program is reported by 40% of those residing outside of Bangkok as their major source of medical payment. Mothers play key care taking roles for many of the unmarried, and are expected to play major care taking roles for many married and unmarried PHAs in the future should the health of the PHA worsen. Community reaction is variable, but is generally reported as less favorable towards men, Bangkok residents, and those at the extremes of the socioeconomic spectrum. Implications of the findings for the anticipated expansion of treatment protocols are discussed.

John Knodel, and Napaporn Chayovan. "Sexual Activity among the Older Population in Thailand: Evidence from a Nationally Representative Survey." Journal of Cross-Cultural Gerontology 16(2): 173-200. 2001. Also issued as Population Studies Center, University of Michigan, Research Report 00-445, May 2000.

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This report examines sexual activity among Thais aged 50 and over in relation to age, gender, and health status. It is the first such study of older persons based on a large nationally representative survey in any developing country. Results indicate that substantial proportions of older married Thais remain sexually active, although at lower levels than among older persons in Western countries. Sexual activity and desire decline steadily with age for both married men and women, but at any given age both are lower for women. Overall, the sexual desire of husbands is a far more important determinant of sexual activity within marriage than that of wives. Poor health depresses activity and desire. Possible reasons for the low activity levels relative to Western countries are considered, as are the implications for the AIDS epidemic and the quality of life of older persons.

John Knodel, Chanpen Saengtienchai, Wassana Im-em and Mark VanLandingham. "The Impact of Thailand's Aids Epidemic on Older Persons: Quantitative Evidence from a Survey of Key Informants." Publication No. 252, Institute for Population and Social Research, Mahidol University, Thailand. 2000. Also issued as Population Studies Center, University of Michigan, Research Report 00-448. July 2000.

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This report assesses the involvement of parents in Thailand in the caregiving and living arrangements of adult AIDS cases and the economic impact on the families and parents through expenditures on treatments and 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 these issues. 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. 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.

John Knodel, Mark VanLandingham, Chanpen Saengtienchai, and Wassana Im-em. "Older People and AIDS: Quantitative Evidence of the Impact in Thailand." Social Science & Medicine 52 (9): 1313-1327 May 2001. Also issued as Population Studies Center, University of Michigan, Research Report 00-443. January 2000.

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This report assesses the involvement of parents or other older generation relatives in the living and caretaking arrangements of persons with AIDS in Thailand. Interviews with local key informants in the public health system in rural and urban communities provide quantitative information on 963 cases of adults who either had died of AIDS or were currently symptomatic. The results indicate that a substantial proportion of persons with AIDS return to their communities of origin at some stage of the illness. Two-thirds of adults who died of AIDS either lived with or adjacent to a parent by the terminal stage of illness; 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 involvement of older generation relatives appears to be far greater in Thailand than in Western countries such as the U.S., which likely reflects contrasting epidemiological and socio-cultural situations. 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 caregiver education and social and economic support.

VanLandingham, Mark, John Knodel, Wassana Im-em, and Chanpen Saengtienchai. "The Impacts of HIV/AIDS on Older Populations in Developing Countries: Some Observations based upon the Thai Case." Journal of Family Issues 21(6): 777-805, Sept. 2000. Also issued as Population Studies Center, University of Michigan, Research Report 99-441, October 1999 (Revised June 2000). Download PDF file

This report describes features of the older Thai population and the history of the HIV/AIDS epidemic in Thailand, and discusses potential links between them. It addresses both direct and indirect impacts of AIDS on this population, but focuses discussion on how older persons could be indirectly affected by AIDS infections occurring among their adult children. It identifies five major mechanisms through which these indirect effects can occur—finances, health, time commitments, social relationships, and emotional stress—as well as factors that could affect the degree and distribution of such impacts. A research agenda is proposed for exploring the impact of AIDS on older persons in developing countries, drawing upon our current research in Thailand. A number of substantive areas that warrant investigation are discussed, as are the advantages and weaknesses of several methodologies that could be used to pursue these topics.

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