The changing impact of the AIDS epidemic on older-age parents in the era of ART: evidence from Thailand

"I am adhering to HIV treatment so that I can live to support her": A qualitative study of upward intergenerational support in South Africa

Background

Intergenerational family care, which was upended by the HIV epidemic in sub-Saharan Africa (SSA), may return to a pre-HIV era arrangement as access to antiretroviral therapy (ART) expands and treated adults can once again provide support for older household members. Empirical research has demonstrated positive 'spillover effects' of ART uptake from treated adults to younger generations, yet much less is known about the nature and breadth of such effects to older generations. This study explores the role and lived experiences among adults who take up ART and those of an older generation with whom they live.

Methods

We conducted a qualitative study consisting of semi-structured interviews (n = 46) embedded in the Agincourt Health and Demographic Surveillance System (HDSS) in rural South Africa, between July and September 2022. We purposefully sampled two respondent categories: (i) young or middle-aged adults on ART (aged 18-59 years old); and (ii) older adults (aged ≥60 years old) who were affiliated with a young or middle-aged adult on ART. We used thematic content analysis to extract, code, and categorise relevant text by types of upward spillover effects from ART in younger adults to older adults. Quantitative data was extracted from the existing Agincourt HDSS database and matched to qualitative interview data based on Clinic link unique identifiers of study participants.

Results

Mean age was 41 years among young or middle-aged adults (n = 29) and 72 years among older adults (n = 17). Among younger adults, time on ART ranged from five months to more than 21 years. Both young or middle-aged adults on ART and older adults reported positive spillover effects for older adults across five main tiers: caregiving, financial support, physical and mental health, living arrangements and household relationships, and stigma and reputation. Spillover challenges included financial costs and caregiving responsibilities following ART initiation of young or middle-aged adults, although these additional caregiving responsibilities were generally not perceived as particularly burdensome.

Conclusions

ART is likely to benefit older adults in South Africa whose families are affected by HIV. This study identified a wide range of perceived spillover effects from ART in younger adults to older adults, including improvements to upward intergenerational support. These qualitative findings offer a guide to researchers, policymakers, and donors to capitalise on the broader societal effects of a large-scale health intervention to further support family structures and meet the needs of a growing older population.

Delayed Disclosure of HIV Status and Lack of Resources Affect Older Persons during Care of Adult Family Members with AIDS-Related Illness in Rural Mpumalanga, South Africa

Purpose

This paper examines the older persons' knowledge of HIV and AIDS and explores the effect of delayed disclosure of HIV status and lack of resources during care.

Methods

The study site was health facilities in Thembisile Hani subdistrict, Mpumalanga Province, South Africa. Older persons aged 60 years and above were selected using purposive sampling for in-depth interviews. Thematic analysis was used to analyse the data.

Results

Providing physical care to sick adults is labour intensive for the already weak older persons. They undertake the caring role within constraints arising from lack of resource such as gloves, diapers, and soap with which to perform the caring role. Taking care of the sick needed resources for specialized care and money for transport to the health facilities. This put a strain on the finances and rendered the older persons food insecure. Furthermore, disclosure of HIV status was delayed, and some older persons cared for the sick adult children without knowing that they were HIV-infected and had AIDS-related illnesses. The nondisclosure of their HIV status by the sick prevented them from taking precautionary measures to prevent the risk of infection during the provision of care. This was heightened by the limited knowledge of HIV/AIDS of the older persons.

Conclusion

Older persons undertake the caring role with diligence under trying conditions due to lack of resources and the nondisclosure of HIV status of the adult children they take care of. Healthcare workers should educate older persons to take preventive precautionary measures when caring for family members even when there is no suspicion of HIV infection. In addition, access to the incapacity grants provided for individuals sick with AIDS-related illnesses could relieve the older persons from financial constraints.

Aging in the Context of HIV/AIDS: Spaces for Renegotiation and Recomposition of Mutual Solidarity in Burkina Faso

PURPOSE

The HIV-infected older people in sub-Saharan Africa are inevitably vulnerable to chronic health-related conditions, yet the needed social support for these people is mostly inadequate. Drawing on the anthropology of disease and health paradigms, this study explores the recomposition of multidimensional and multidirectional nature of mutual familial support for older people living with or affected by HIV/AIDS in Burkina Faso.

METHODS

We conducted multiple in-depth interviews among 147 individuals recruited from nonprofit organizations in Ouagadougou, Bobo-Dioulasso, Ouahigouya, and Yako through 2 projects funded by the National Agency for AIDS Research. Thematic and narrative analytical frameworks were used to analyze the data.

RESULTS

We found that older people suffered serious socioeconomic and psychological challenges associated with HIV/AIDS. Older people were particularly vulnerable to the double burden of HIV/AIDS and caregiving responsibility for family members infected with the disease. However, the infected older people who received adequate treatment and familial support regained sociocultural positions as agents for cultural transition and material/emotional resources.

CONCLUSIONS

Although HIV/AIDS potentially renegotiated the nature, intensity, and direction of familial support for vulnerable older people, the extrafamily solidarity seems an integral part of the great cycle of reciprocity and intrafamily mutual support. Health and policy interventions targeted at strengthening the interpersonal relationships and support for HIV/AIDS-infected and HIV/AIDS-affected older people are needed to improve their independence and well-being.

Factors influencing quality of life (QOL) amongst elderly caregivers of people living with HIV/AIDS in Phayao province, Thailand: a cross-sectional study

Background: There are many impacts on quality of life among elderly people living with HIV patients. This study aimed to assess factors influencing quality of life among elderly people living with HIV/AIDS in a northern province of Thailand. Methods: This cross-sectional study was conducted in Phayao province, Thailand. A systematic sampling technique was employed to select study participants. 152 elderly participants aged 60 years and older with a family member living with HIV/AIDS were recruited to the study. They were interviewed using the World Health Organization Quality of Life-Older Adults Module (WHOQOL-OLD) questionnaire. Stepwise multiple regression analysis was performed to determine the factors influencing quality of life among elderly people affected by family member living with HIV/AIDS. Results: The results of the study showed the mean age of elderly participants was 67.20 + 52 years, most of which were female (97 persons, 63.8%). The mean time taking care of HIV/AIDS patients was 6.61 + 4.96 years. In term of health status among the elderly participants, the majority did not have chronic diseases (61.4%), amongst those with chronic diseases (38.6%), hypertension and diabetes were the most common. The average quality of life score was at a fair level.  The time taking care of HIV/AIDS patients and health status were significant predictors of quality of life among participants 8.1 % ( R 2 =.081; p < .05). Conclusion: In order to improve quality of life among elderly caregivers to family member living with HIV/AIDS, time taking care of HIV/AIDS patients and health status should be focused on, amongst other factors. Help and support from the government, community, health organizations, academic research, and family members can help improve quality of life amongst the elderly.