Access to treatment and care associated with HIV infection among members of AIDS support groups in Thailand.

To examine the types and distributions of treatment received among persons living with HIV and AIDS (PLWHAs) in Thailand, we analyzed data collected during 2000 from 412 members of PLWHA support organizations in Bangkok and three upcountry northern provinces. Most (74%) of the respondents report ever receiving modern medical care for their HIV-related symptoms; 31% report ever using herbal treatments. Small proportions of those experiencing severe symptoms related to activity limitations report treatments with anti-retroviral medication, treatment for opportunistic infections or treatment for pain. Multivariate analysis suggests that the government's health card system plays an important role in keeping treatment costs down for PLWHAs and their families, that being open about one's HIV status to one's community is positively associated with receiving modern treatment for HIV-related ailments, that being female is negatively associated with receiving modern treatment and that living upcountry (as opposed to living in Bangkok) is associated with using herbal remedies. Policy implications of the findings are discussed.

Access to contraceptive services among unmarried young people in the north-east of China.

OBJECTIVE: The concerns about the potential threats of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) have increased, since, in China, there is a lack of sexual education and condom use is rare. A community-based survey was conducted in September 2001 in Changchun city among 1227 unmarried young people aged 15-24 years (619 males and 608 females) to assess risky sexual practices and the obstacles to accessing appropriate contraceptive and other services. METHOD: The study comprised a survey employing self-administered questionnaires, as well as key informant interviews, focus group discussions and in-depth interviews. This paper investigates the factors associated with young people's access to contraceptive services. RESULTS: Results showed that 16% of young people had experienced premarital sexual intercourse and, among them, only 48.2% used contraceptive methods during the first sexual intercourse; 29.9% used a condom. Drug stores were the main source of contraceptives. CONCLUSIONS: While data are sparse, findings suggest that the hostile and judgmental attitudes of providers, as well as the lack of counseling and privacy, were the key obstacles that unmarried youth encountered in their search for contraceptive services. Findings suggest the need for a reorientation of the contraceptive services to focus on unmarried youth, and generally to make contraceptive services more accessible to young people.

Older people and AIDS: quantitative evidence of the impact in Thailand.

Discussions of the AIDS epidemic rarely consider the impact on older people except as infected persons. 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, 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 an AIDS-related disease 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%, 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 older. This extent of older generation involvement appears to be far greater 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.