Knodel J, VanLandingham M, Saengtienchai C, Im-em W
Population Studies Center and Department of Sociology, Institute for Social Research, University of Michigan, Ann Arbor 48106-1248, USA.
Soc Sci Med. 2001 May;52(9):1313-27. doi: 10.1016/s0277-9536(00)00233-1.
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.
关于艾滋病流行的讨论很少考虑其对老年人的影响，除非他们是感染者。实际上，无论是在西方还是发展中世界，都没有对父母或其他老一辈亲属参与艾滋病患者生活及照料安排的情况进行系统的定量评估。我们评估了泰国这类参与情况的程度，在泰国，很大一部分老年父母依靠成年子女提供支持，与成年子女同住很常见。通过对农村和城市社区公共卫生系统中的当地关键信息提供者进行访谈，我们获得了关于963例成年艾滋病病例的定量信息，这些病例要么已死于艾滋病，要么目前有症状。结果表明，相当一部分艾滋病患者在患病的某个阶段会回到他们的原籍社区。在死于与艾滋病相关疾病的成年人中，三分之二在疾病末期时与父母同住或住在父母附近，约一半的患者由父母，通常是母亲，担任主要照料者。70%的患者至少得到了父母或其他老一辈亲属的一些照料。绝大多数父母年龄在50岁及以上，许多人年龄在60岁及以上。这种老一辈亲属的参与程度似乎远远高于美国等西方国家。我们认为这种差异反映了泰国和西方在流行病学和社会文化状况方面的不同。泰国的老年人，可能还有许多其他发展中国家的老年人，通过与受感染成年子女的接触而受到艾滋病流行的广泛影响，这一事实对于涉及照料者教育以及社会和经济支持的公共卫生项目具有重要意义。
