Mark VanLandingham

Two views of risky sexual practices among northern Thai males: the health belief model and the theory of reasoned action.

We apply the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA) to an analysis of unsafe sexual practices (inconsistent condom use with commercial sex workers) among men living in a high HIV-prevalence area. The empirical analysis is based primarily on a survey of sexual practices that was conducted by the authors during the fall of 1991. The survey sample includes university undergraduates, soldiers, clerks, and laborers living in Chiang Mai, Thailand. There is much overlap between the two theories, and both provide useful frameworks for examining condom use in this population. However, the Bayes Information Criterion (BIC) approach provides very strong evidence that TRA is the more plausible model, given the data. The success of TRA appears to be due to its more adequate incorporation of peer group effects. Other covariates positively associated with consistent condom use in the multivariate models include knowledge about the consequences of HIV infection, knowledge about the benefits of condom use for preventing infection, and positive attitudes about condoms.

Older people and AIDS : quantitative evidence of the impact in Thailand

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.

AIDS and older persons: an international perspective.

Summary: The impact of the worldwide AIDS epidemic on persons aged 50 years or older has received relatively little consideration except in the United States, where interest has focused almost exclusively on older persons living with AIDS or at risk for infection. The place of older persons in the epidemic deserves international attention because their lives are being significantly affected in a variety of ways. Because most of the epidemic occurs in the developing regions of the world, especially in Africa and Asia, efforts to understand and deal with the concerns of older persons in relation to AIDS in those settings need expansion. Although older persons represent a nonnegligible minority of the reported global caseload, a far larger number of older persons are affected through the illness and death of their adult children and younger generation relatives who contract AIDS. From a global perspective, a broader concern encompassing those who are affected through the infection of others rather than a narrow concern with those who are at risk or infected themselves is called for if the needs of the large majority of older persons adversely affected by the epidemic are to be addressed.

Sexual activity among never-married men in northern Thailand

We use data collected in 1991 to investigate sexual activity among never-married men in Thailand, with a focus on age at first intercourse, characteristics of sexual partners, and conditions under which men visit prostitutes. We sampled men from a broad spectrum of northern Thai society, including university undergraduates, soldiers, and semiskilled/unskilled workers. We found that except for the students, the majority of each subsample is sexually experienced; prostitutes are the most common type of sexual partner for all groups. Alcohol consumption is associated with several measures of sexual activity. Condom use with prostitutes varies among the subsamples. Among men who have both prostitute and nonprostitute partners, the majority of those who do not use condoms with prostitutes also do not use condoms with their nonprostitute partners. We consider the implications of these results for the AIDS epidemic in Thailand.

Return Migration in the Context of Parental Assistance in the AIDS Epidemic: The Thai Experience

Most persons with AIDS (PWAs) eventually require demanding caregiving. This can prompt changes in living arrangements during the course of the illness. Few studies have attempted to examine the potential links between AIDS and migration from this perspective. The present study uses both direct and indirect approaches to examine the extent of return migration of adults with AIDS in Thailand and explores how this is linked to residence with and care by older aged parents. Methodological challenges and various approaches to the study of this phenomenon are discussed. Despite differences in the nature of information available from our samples and in basic sample characteristics, the findings show a consistent pattern suggestive of extensive return migration among PWAs. The fact that most return migrants die within a few months of their return indicates that they are seeking parental caregiving during the final stages of the illness. The vast majority of PWAs who returned home after becoming ill did so because of their illness, particularly due to a need for care.

One Year Later: Mental Illness Prevalence and Disparities Among New Orleans Residents Displaced by Hurricane Katrina

OBJECTIVES We examined whether there were high levels of mental illness among displaced New Orleans, LA, residents in the fall of 2006, 1 year after Hurricane Katrina. METHODS We used data from the Displaced New Orleans Residents Pilot Study, which measured the prevalence of probable mild or moderate and serious mental illness among a representative sample of people who resided in New Orleans at the time of the hurricane, including people who evacuated the city and did not return. We also analyzed disparities in mental illness by race, education, and income. RESULTS We found high rates of mental illness in our sample and major disparities in mental illness by race, education, and income. Severe damage to or destruction of an individuals home was a major covariate of mental illness. CONCLUSIONS The prevalence of mental illness remained high in the year following Hurricane Katrina, in contrast to the pattern found after other disasters. Economic losses and displacement may account for this finding as well as the disparity in mental illness between Blacks and Whites.

PTSD in Vietnamese Americans following Hurricane Katrina: prevalence, patterns, and predictors.

One year after Hurricane Katrina devastated New Orleans, we assessed 82 adults from a population-based sample of the Vietnamese American community who had participated in a larger study of immigration weeks before the disaster. Although 21% met criteria for partial posttraumatic stress disorder (PTSD), only 5% of the sample met all PTSD criteria. Avoidance/numbing symptoms did not form a coherent cluster and were seldom confirmed, but intrusion, arousal, and interference were common. Severity of exposure to the floodwaters, property loss, and subjective trauma were independently related to PTSD symptoms. Symptoms were highest among participants who were low in acculturation or who had high Katrina exposure in combination with prolonged stays in transition camps during emigration.

In the company of friends: Peer influence on Thai male extramarital sex

We explore some of the key social dynamics underlying patterns of male extramarital heterosexual behavior in Thailand. We analyze transcripts of focus group discussions and focused individual interviews conducted during 1993 and 1994 with married men and women living in both urban and rural areas of central Thailand. We discern several pathways of peer influence on extramarital commercial sex patronage that are common across our sites and interpret these peer effects in light of contemporary theories of social influence and sexual behavior.

Aids and the elderly of thailand: projecting familial impacts

We apply aggregate demographic analysis and computer microsimulation to project the number of older Thais who will lose children to AIDS during their own lifetimes and to assess their involvement with ill children through caregiving and coresidence. Parental bereavements from AIDS are predicted to peak at around 80,000 per year between 2003 and 2007. Despite an HIV prevalence of only 2%, 13% of Thais who were over age 50 as of 1995 are likely to experience the loss of at least one adult child to AIDS, and 12% of them will lose multiple children. The chance of losing an adult child during onés lifetime will be 70% higher than if there were no AIDS epidemic.

The impact of the AIDS epidemic on older persons.

The impact of the worldwide HIV/AIDS epidemic extends well beyond persons with HIV or AIDS. Noninfected family members are especially vulnerable. Much attention is being directed to the plight of AIDS orphans, the children of persons with AIDS, and rightly so.Yet most adults who die of AIDS have parents who survive them and who are often affected by their son’s or daughter’s illness and death in profound and consequential ways. Since adults with AIDS are typically in their 20s and 30s, their parents tend to be in their 50s, 60s and 70s, and they constitute a substantial population of older persons who are very directly impacted by the epidemic.