The HIV/AIDS epidemic is often associated with adults aged between 20 and 40 and, to a lesser extent the young orphan children who are left behind. Older adults (60 years and over) are also very much affected by the epidemic and are often the unknown and unseen victims. Not only are older adults infected with the HIV virus, but also they are often the indirect victims through HIV infection of their adult children. During the illness and subsequent death of their adult children, older people suffer adverse multiple consequences in terms of loss of finance, poor health, social stigma, emotional trauma, and so on. However, very little qualitative research has been done on the impact of HIV/AIDS on older people, particularly in the developing world, probably because the impact of the epidemic on older people is not easily observable.
At the same time that older people are experiencing negative consequences of HIV/AIDS as a result of their children suffering from the disease, they also make substantial contributions in helping the society cope with the epidemic by their role in caregiving to their infected children. In doing so, they take a great burden off the health care system. In many cases, the older parents also take on the role of parenting their orphan grandchildren.
This thesis examines in greater depth the socio-economic impact of HIV/AIDS on older people in two sub-districts in rural northern Thailand. These two sub-districts have experienced a significant number of AIDS related deaths in their communities. It is hoped that the results of this study will give greater insight into the challenges faced by older people who are indirectly affected by HIV/AIDS. These insights are expected to lead to suggestions and recommendations for developing appropriate and effective programmes for reducing the negative impact of HIV/AIDS on older people and supporting them in their caregiving role.
Chapter 1 (Introduction) provides the rationale for the study on the socio-economic impact of HIV/AIDS on older people. The problem statement and research questions are presented. A brief discussion on the research design and methodology is described.
Chapter 2 (The HIV/AIDS Situation in Thailand: Literature Review) examines the HIV/AIDS situation in Thailand, focussing on the magnitude of the epidemic and the trends in terms of age, sex, regional distribution and projections. The routes of transmission of the epidemic and the socio-cultural factors that contribute to the spread of HIV in Thailand are also discussed. A major part of the chapter describes the macro and micro-level impacts of HIV/AIDS on older persons. The role of older persons as caregivers is also discussed. The chapter highlights the results of previous research and the mechanisms through which HIV/AIDS can indirectly impact older people, namely, economic, physical, social, time and emotional constraints.
Chapter 3 (Research Methodology) explains in detail the research design and methodology. The coding system for the interviewees and the profiles of the two sub-districts chosen for the research are also described. The chapter concludes with a brief discussion on the limitations and generalization of this research.
Chapter 4 (Analysis of Findings) analyses the data obtained from the interviews and identifies a number of significant struggles faced by older persons who have adult children with HIV/AIDS. The research enabled a deeper understanding of the social, psychological, physiological, emotional and economic impacts of HIV/AIDS on older people. Older people also suffered multiple burdens of care and support for their adult children with the infection and orphan grandchildren. The long-term care and the subsequent death of their children further deteriorated their physical condition. Many of them experienced stress and had developed stress-related physical and psychological illnesses.
In rural Thailand where there is a strong tradition for multi-generational households to support the older people and other dependent family members, the high number of young adults dying of AIDS puts this tradition of family support under tremendous strain.
One major impact of HIV/AIDS on older people is economic. As the ravages of the epidemic continue, coupled with the economic woes of the Asian financial crisis, many older people are made poorer. Due to old age, declining health and lack of work opportunities, many were forced to sell off their belongings in order to pay for the medical and increased household expenses.
Socially, older people also suffered discrimination. Not only did they have to endure the stigma associated with the epidemic because of HIV infection in the family, they also had to deal with the psychological, social, and emotional ramifications of HIV/AIDS and poverty. The social and economic isolation they faced, unfortunately, also destroyed the earlier community cohesion.
This research revealed that the emotional sufferings and the psychological stress the older people undergo are considerable. The problems related to raising a new generation is unique and is a new experience in these villages where so many children have become orphans in a short period of time. The emotional status of the children and the related issues faced by older people in their upbringing are both physically and psychologically challenging. Although there are positive developments of families uniting and communities becoming more supportive, issues dealing with raising a new generation are still a challenge for those older people who are parenting their grandchildren.
In terms of gender, this study reveals the quality of the roles women perform and the lack of support they receive. Traditionally women have performed the role of homemaker and carer while the men have gone out to earn and provide for the family. What has been observed in this study is that the traditional role of caring continues to be with women, yet they are also going out to earn incomes to support the additional financial needs in the family. It is evident from the study that the burden or additional responsibilities is heavier on women then men.
The study clearly establishes the time constraints on older people as a result of the additional burdens of HIV/AIDS and the consequences. They are unable to regularly attend work, unable to participate in social activities through the older people's clubs and unable to attend to their spiritual needs of visiting temples and making merit. Furthermore, the dynamics of family relationships come under stress due to lack of time that is needed to build relationships.
The research clearly identifies the important contributions of older people with respect to the health care of PWAs and provides recommendations for combating the adverse social and economic consequences they face. These recommendations are aimed not only to give immediate support to older people, but also to develop a long-term strategic plan to tackle the HIV/AIDS epidemic in the country.