The HIV virus is known to affect men and women in their reproductive age, between 15-49 years, leaving behind a large dependent population – children, the elderly, etc. The elderly play an important role in the epidemic although they are the invisible victims of this epidemic. They may not necessarily be infected with HIV, but are certainly affected by it.
The various roles of the elderly in the HIV pandemic include care-giving to the infected children, co-residence with the infected, providing financial and material support, fostering grandchildren, experiencing the suffering and ultimate loss of a child, and facing negative community reactions. HIV can place a huge physical, emotional and financial burden on the elderly population of a country.
Thailand, in South East Asia, reported its first case of AIDS in 1984. The latest UNAIDS estimates (2013) suggest a 1.1% national adult HIV prevalence. Like many developing countries, Thailand maintains a relatively high involvement of older parents in the lives of the adult children. Seven out of ten elderly people over 60 years live with, live near, or receive some form of material support from their adult children. Corresponding figures show that over two-thirds of HIV+ adults lived with or near their parents. Additionally, a similar proportion of HIV+ adults reported to receiving parental care at the terminal stage of illness.
Caregiving to a HIV+ adult child places a significant burden on the elderly. They lose the material, financial and emotional support from children that they are counting on. In Thailand, a study reported that over 50% elderly HIV caregivers experience fatigue, insomnia and anxiety. However, this information is before the provision of antiretroviral therapy (ART) in Thailand. With the improved access to ART, HIV is increasingly looking like a chronic disease. The lifespan of HIV/AIDS patients is increasing, and those under ART can lead a ‘normal’ life. HIV/AIDS is no longer the death sentence it used to be. Consequentially, the use of ART greatly reduces the responsibilities placed on the shoulders of the elderly population.
A big advantage of ART for the elderly is economic stability. Parents of HIV/AIDS children need no longer use their limited resources on the health of their children. Additionally, they can continue to rely on their adult children with HIV+ for financial support since ART can allow those children to lead a closer to ‘normal’ life. Parents’ psychological well-being has also improved due to fewer worries about the health of their children with HIV/AIDS. Thailand incorporated older people affected by HIV/AIDS as a target group in their 10th National AIDS Plan (2007-2011) for the first time. This not only demonstrates a sensitized understanding of the victims who are infected and affected of HIV/AIDS, but also marks a significant step forward in understanding and providing holistic care for the elderly population in Thailand.
Similar models of HIV care, with the elderly looking after the HIV/AIDS adult children, have been reported in countries including Cambodia and Tanzania. Even with the increasing use of ART, the elderly may play a role, albeit a modified one, in HIV care. There is a strong need for updated and comprehensive data to shed light on the issue to better inform current public health and HIV/AIDS campaigns.
Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.