The role of parents and family members in ART treatment adherence: Evidence from Thailand.

High levels of treatment adherence are crucial for the success of expanding ART treatment programs everywhere. Augmenting adherence through treatment supporters is one promising strategy. Most discussions focus on peers, especially members of PHA groups, for this purpose. Far less attention is given to family members and especially older age parents. Yet ART recipients often live with or nearby parents and other family members who are highly motivated to ensure the treatment's success. This study examines the extent that family members, especially parents, assist adherence in Thailand. Results indicate that most adult ART patients live with family members and over half live with or in the same locality as a parent. Family members, including parents, commonly remind ART patients to take medications, especially if coresident. Moreover, parents often remind patients to get resupplies and sometimes accompany them to appointments. Clearly close family members, including parents, should be explicitly incorporated into adherence augmentation programs and provided adequate information to facilitate their role as long-term adherence partners, not only in Thailand but wherever ART recipients are closely linked to family members through living and caregiving arrangements.

Community Reaction to Older-age Parental AIDS Caregivers and their Families: Evidence from Cambodia.

Accounts of community reaction to persons with HIV/AIDS and their families typically focus only on negative reactions stemming from stigmatization with little acknowledgement of variation over time and across settings. To usefully guide local interventions, a broader view is needed that also encompasses attitudes and actions stemming from sympathy and friendship. We examine community reaction in Cambodia to families from the perspective of parents of adults who died of AIDS or currently receive antiretroviral therapy. Survey evidence and open-ended interviews reveal a mixture of reactions with respect to social relations, interactions with local officials, gossip, business patronage, funeral participation, and orphaned grandchildren. Positive support is often dominant and reactions typically improve substantially over time. Misplaced fears of contagion through casual contact underlie most negative reactions. Moral condemnation or blame is not evident as a source of negative reactions. Overall a sufficiently supportive atmosphere likely exists in many localities to facilitate community based efforts to mitigate the epidemic's impact on affected families.

Overlooked potential: older-age parents in the era of ART.

The advent of widespread ART provision in low- and middle-income countries requires not just medical attention, but also social and psychological support to encourage and monitor strict adherence to drug regimens. Developing innovative approaches to providing this broad support is a major challenge, especially within the financial constraints of resource-limited countries hardest hit by the epidemic. In this study, we examine the role of older-age parents in monitoring ART treatment and caring for their HIV-infected children and grandchildren in Cambodia. Our results are based on 25 open-ended interviews with older-age parents of people with AIDS (PWHA). A high level of co-residence when PWHA become ill and a sense of parental responsibility and emotional attachment facilitate high parental involvement in their children's and grandchildren's illness, care and treatment. Our interviews indicate that parents play an important role in encouraging their children to get tested and to access treatment if they test positive. They consistently monitor antiretroviral therapy (ART) adherence and opportunistic infections and remind PWHA to attend medical appointments and support-group meetings. Parents also provide for the nutrition and hygiene of PWHA essential to the success of ART treatments. We find that despite low levels of education, older parents were able to express clear, correct and detailed knowledge of complicated ART treatment regimens, nutrition and hygiene. Overall, our findings show that older parents play a pivotal role in care and treatment if they are provided with proper resources and training and have the ability to understand the necessity and details of ensuring strict adherence to medications. Based on these results, we suggest that explicitly including older parents in policy and programs for care and treatment would allow Cambodia and other countries to take advantage of this unique and effective but overlooked asset in AIDS care and treatment.

Community reaction to persons with HIV/AIDS and their parents: an analysis of recent evidence from Thailand.

We systematically examine community reaction to persons living with HIV/AIDS (PHAs) and their older parents in Thailand. We focus on parents as well as PHAs because parents are major providers of care for their ill adult children. Our analyses are based on several sources of recently collected survey and qualitative data from a wide range of perspectives. We find important variations in community reaction to PHAs and their families, but overall these reactions are much more positive than is widely assumed. We conclude that much existing research on community reaction to AIDS neglects both a rich body of social theory on stigma and a strong tradition of population-based empirical research in sociology. Much existing research also fails to adequately distinguish between key aspects of the social settings where most AIDS cases occur and the social settings where most of the stereotypes surrounding AIDS-related stigma have originated. A closer marriage between empirical and theoretical approaches to social stigma is required to advance our understanding of this critically important dimension of the AIDS epidemic.

Measuring psychological well-being: insights from Thai elders.

PURPOSE: Psychological well-being, an important indicator of successful aging, may be conceptualized quite differently across cultures. Using a mixed-methods approach, we developed a measure of psychological well-being based on the indigenous expertise of Thai elders. DESIGN AND METHODS: Data were collected from older people in Thailand in four stages with staggered qualitative and quantitative methods: individual and focus group interviews (n = 67); a preliminary survey (n = 477); cognitive interviews (n = 30); and a second survey (n = 460). We analyzed the resulting psychological well-being items to identify their underlying factor structure and psychometric properties. RESULTS: Confirmatory factor analysis suggested that psychological well-being has two components: intrapersonal and interpersonal. The subscales for this measure have adequate reliability and validity. IMPLICATIONS: This research provides evidence for cultural variability in the nature of psychological well-being and highlights the importance of developing measures that are culturally relevant.

HIV/AIDS-related knowledge and attitudes: a comparison of older persons and young adults in Thailand.

Levels of AIDS related knowledge are widely assumed to be high in Thailand, a country with 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 within the Thai older population. Because many Thai older persons (aged 50 and over) remain sexually active late in life, and because 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 to include a wide range of prevalence levels and social contexts regarding the epidemic. 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 = 1,171). We find an overall high level of awareness about AIDS across our age groups of interest, but also identify important deficiencies among the young adults and especially among the older Thais. Implications of the findings are discussed.