RESUMEN
Background: Thailand HIV/AIDS epidemics have been driven in specific populations from homo/bisexuals through pregnant women, youths and mobile population. Strategic actions for impact mitigation on people living with HIV/AIDS and their households are needed. Methodology: Economic impact of HIV/AIDS morbidity on case (with HIV/AIDS)/ control households in rural Thailand and coping mechanisms was conducted in two districts of Phayao province in Northern Thailand: among 300 households in Mueng district (or active villages) and 300 households in Pong district (or less active villages). Main economic indicators from the historical and alternative simulation with 20 percent decrease and increase in health care to change of historical-alternative simulation was performed. Results: Main economic indicators from the historical simulation showed that total income, consumption and saving per capita in case respectively was 69, 47 and 265 percent lower than in control. From alternative simulation with 20 percent decrease in health care showed negative percentage change of historical-alternative simulation while alternative simulation with 20 percent increase in health care showed positive change. From follow-up studies, action to minimize distress was followed and mobilization of control to case household was demonstrated. Scope of accessibility was created and sustained such as medical services e.g. VCT, OI prophylaxis, ART and specific laboratory support including CD4 and viral load. Conclusion: The studies showed that total income, consumption and saving per capita in case was lower than in control households and increase in health care support was an important mechanism to mitigate the impact of HIV/AIDS to households. Strengthening the partnership between the communities, governments, donor agencies, NGO, private sectors in mitigating the impacts of HIV/AIDS are potential focus areas for strategic mainstreaming at the household level. The remaining questions are how social networks affect the impact, vulnerability and responses to HIV/AIDS and poverty. The extension of studies beyond rural economy and dissemination of information are essential further actions.
RESUMEN
Introduction: A high gap of communication between physicians and patients has been widely documented. Based on Habermas, communication problems originally came from systematization and technology, in which these conditions lead physicians to form inappropriate communications called ‘strategic action’ (SA). To avoid communication conflicts, Habermas promotes the ‘communicative action’ (CA) The objective of this study was to prove theoretical conditions of occurrences of SA and CA in physicians’ thoughts. Methods: Samples were collected from in-training physicians at King Chulalongkorn Memorial Hospital. A self-administered, Thai-version, questionnaire was the study tool. The questionnaire was composed of eight scales that were constructed and qualified. A theoretical model of multiple relationships causing SA and CA was tested by path analysis. Results: The total respondents were 173. Analyzed data indicated the theoretical model was valid (RMSEA = 0.000). Conditions that significantly influenced SA were ‘medical ideology (MI)’ (total effect = 0.10), ‘system ideology (SI)’ (total effect = 0.09) and ‘cognitive-instrumental rationality’ (total effect = 0.30). Conditions that significantly influenced CA could not be identified. Based on the theory, ‘morality ideology should influence moral-practical rationality’, but ‘system ideology’ was found to significantly influence instead (path coefficient= 0.25). Discussion: The ‘technocratic ideology’ (MI and SI) together with the cognitive-instrumental rationality was proved to lead physicians’ SA. These findings confirmed 1) the significance of thoughts that base personal actions and 2) an extension of systematization that influenced on moral rationality. Probably, this influence might obstruct the natural moral developments so that CA could not be developed. In other words, systematization facilitates SA. Conclusion: Physicians communications were fundamentally SA because of continuing embedded ‘technocratic ideology’. Therefore, solving physicians’ inappropriate communication should realize the significance of ideology and rationality levels, such as, cessation of embedding ‘technocratic ideology’.