Use of unpaid and paid home care services among people with HIV infection in the USA

Service utilization among older adults with HIV: the joint association of sexual identity and gender

This study examines the association of sexual identity and gender among older clients with HIV at an AIDS service organization using the Andersen Model. Data confirm those aging with HIV exhibit high rates of age-associated illnesses 10 to 20 years before expected. They have fragile social networks that cannot supply the informal supports needed. This aging population will need to increasingly access community-based services. Sexual identity and gender were weak covariates of service utilization. Although heterosexual men used more services, utilization was largely predicted by service needs and the use of case management. Implications for service delivery and policy are discussed.

Defying all odds: coping with the challenges of volunteer caregiving for patients with AIDS in South Africa

AIM

This paper is a report of a study to explore the challenges experienced by volunteer caregivers of people living with HIV/AIDS and the strategies employed in coping with these challenges.

BACKGROUND

Informal caregiving is associated with stresses that often results in poor health outcomes for caregivers. In South Africa, volunteers play a major role in the provision of care for people living with HIV/AIDS and have been shown to experience burdens as a result of caring. However, little is known about stress and coping among volunteer caregivers.

METHODS

An ethnographic study was conducted, using observation and in-depth interviews, to collect data with 20 volunteers and other stakeholders in two semi-rural communities in South Africa over a 19-month period in 2002/2003.

FINDINGS

'Defying all odds' emerged as the central theme that encompassed the various ways in which volunteer caregivers dealt with the many practical challenges confronting them. These challenges initially posed a threat to volunteering work but were gradually appraised by volunteers as challenges that could be dealt with using various strategies in order to continue providing care. Eight themes highlighting these challenges and the coping strategies employed by volunteers were identified.

CONCLUSION

A clear understanding of how volunteers deal with challenges of caring for people living with HIV/AIDS can give insight into their weaknesses and strengths and can inform the design of interventions aimed at providing support. Studies are needed to facilitate better understanding of the processes of appraisal of challenges by volunteers and the effectiveness of coping strategies, and to track coping strategies over time.

Home care needs of patients with long-term conditions: literature review

BACKGROUND

There is a widely felt need to improve the match between long-term patients' care needs and actual use of home care. As this match is not always adequate, it is important to know what factors influence it.

AIM

The aim of this paper is to provide insight into long-term patients' need and actual use of home care, and the factors influencing these.

METHOD

A literature review was carried out, based on database searches in PubMed, CINAHL and the Nivel online library catalogue. A total of 114 papers were retrieved, but only 13 clearly dealt with use of professional home care (rather than informal home care or residential care) by people with long-term conditions.

RESULTS

There is a dearth of publications on factors influencing the match between care need and actual use of professional home care among people with long-term conditions. Most of the 13 publications reviewed concerned determinants of professional home care use, rather than the match between patients' felt needs and the home care delivered. From these studies, a profile of people with long-term conditions who used home care emerged. In general, older, non-white women, with multiple chronic diseases and impairments, and who had recently had inpatient care, tended to make more use of professional home care.

CONCLUSION

Future research in this field is recommended, particularly into system- and patient-related characteristics that may be responsible for the mismatch between care need and use.

Effects of Coresidence and Caregiving on Health of Thai Parents of Adult Children with AIDS

PURPOSE

To explore potential effects on the health of older parents living with and caring for people infected with HIV.

DESIGN

Comparison of health outcomes between affected parents and matched nonaffected parents, and between principal caregivers and nonprincipal caregivers in Thailand.

METHODS

Survey data from 394 affected households and 376 nonaffected households; qualitative data from 18 interviews of affected older parents.

RESULTS

A large proportion of older people with HIV-infected children provided time-consuming and strenuous caregiving services to them. Mothers shouldered most of this burden. Mothers who had a child die from AIDS reported lower levels of overall happiness than did mothers who had not. Mothers and fathers of PHAs (persons with HIV/AIDS) who died reported lower levels of overall happiness compared to 3 years previously (before the time of the death of their child) and compared to parents from households that did not experience an adult child's death. Many parents of children with AIDS experienced anxiety, insomnia, fatigue, muscle strain, and head and stomach aches during the time they cared for their ill children.

CONCLUSIONS

Many older people suffered adverse health outcomes related to living with and caring for their children with AIDS. Recommendations indicate a variety of programs that might help such older parents.