THAILAND: Coping with HIV/AIDS Takes Toll on Elderly

   By Bhanubet Mahareankwan

CHIANG MAI, Thailand (Asia Media Forum) - A framed black-and-white photograph of a young man stares down on two ageing parents seated outside their bamboo hut in Sankampaeng district here in this northern Thai province.

   The man is playing a tune on his flute while his partner, seated nearby, is staring into space, as if waiting for someone to come home.

   It has been 10 years since the family lost three people to HIV/AIDS, but the parents have yet to overcome their loss.

   Some memories are hard to erase and deaths caused by AIDS fall under that category. Sixty-year-old Mae Ou (not her real name) still weeps when she narrates how AIDS shattered her family a decade ago.
      
   "I still miss all of my three children, always," she says. "I spent several months caring for two of them who were in great pain before they died."

   Mae Ou's daughter had helped her care for her sons, until she passed away a few months later. She came to know of her own infection only after her brothers died.

   "Sometimes, the two boys cried out at the same time and I had to rush to their side to try to comfort them," says Mae Ou, who is now raising three grandchildren -- children of the sons she lost to AIDS.

   "Sometimes, they ask for new toys. But I have no money," she says.

   Mae Ou's family is one of a growing number of Thai households where grandparents are being forced to shoulder a new responsibility -- caring for children with AIDS or grandchildren whose parents died of AIDS.

   According to official estimates, almost 70 percent of Thai people living with AIDS are being cared for by their parents or elderly relatives. In absolute terms, this added up to about 240,000 elderly caretakers (in 2001-2004) and their numbers are projected to reach 550,000 in 2010.

   Seventy-year-old Poh Ad (not his real name) of Mae On district is raising a nine-year-old left behind by a daughter who died of AIDS. He spent all his money on trying to get medical help for her, but could not save her life.

   "I cannot work anymore, my wife helps to harvest peanuts or rice to earn money," he says. "She has a bad eye and I'm sorry that she has to work at this age but we have no choice," he adds.

   The daughter who died was the family breadwinner. That responsibility has now shifted to the grandparents who do not have the means or the physical strength to work to earn a living.

   Some days Poh Ad collects and sells firewood-and sells it for two baht (five U.S. cents) a bundle -- and does whatever odd jobs come his way. He also visits the health centre regularly to fetch anti-retroviral (ARV) medicines, which slow down the spread of HIV/AIDS, for his grandson. 

   "I have to keep close watch to make sure that he takes the medicines on time," says Poh Ad. "There have been times when he forgets his medicines, especially when he is playing, and I have had to tell him of possible death."

   Poh Ad has another daughter who is a nurse. Between tears, he says he hopes she will adopt her nephew after they die. The couple has not spoken to their daughter about the adoption and is unsure if she would agree to their request.

   In Muang district, two pre-schools refused to enroll the three-year-old grandson of Mae Eat, because the child's parents had died of AIDS.

   "I managed to enroll him at the third school I took him to but I did not disclose the family history," says Mae Eat. The boy's mother died three years ago, leaving behind two children, one three and the other, nine.

   Mae Eat's husband has been paralysed since eight months ago, leaving her solely responsible for making ends meet, in addition to caring for her two grandchildren.  She earns 120 baht a day (3 dollars) by polishing lacquer-ware at a nearby workshop.   "It is hard work but I have no choice," she says. "If I don't work a day, I will have no money."

   Mae Eat's hands appear tired but she spends all day polishing lacquer-ware, often returning home late in the evening with fine red dusts stain over her cloths and grey hair.

   "Everyone has to work for himself or herself. Even if they want to help, the people here don't have the means to do so," she said, keeping her eyes fixed on the jar she was polishing. "I have just paid the tuition fee for the youngest grandson, but I still owe the school about 900 baht (22 dollars)".

   Survival remains a constant struggle for Mae Eat but the satisfaction of being able to raise her two grandsons gives her the urge to carry on. She says, "I will not give up until the end". 

   The challenge the elderly in urban and semi-urban households face in taking care of people with HIV/AIDS is personal because "modernisation" has changed social values and broken down the community support systems. However, in the rural areas -- such as nearby Doi Saket district -- there are some mechanisms that help families to cope with AIDS.

   "My wife and I can no longer work," says 70-year-old Poh Od.  "We have to depend on food provided by our neighbours."

   Many of Thailand's elderly do not only have to cope with relatives living with HIV/AIDS or orphaned by the pandemic, but also live with AIDS themselves. According to official statistics, about 5.4 percent of all people living with HIV/AIDS or 50,000 are seniors. The real numbers could be still higher because there is high non-reporting due to the fear of stigmatisation.

   "I don't feel ashamed about disclosing the infection (of my grandson) and I will look after him," says Poh Ad. "I have to remind him to take medicines everyday. I still have no idea what AIDS is, what I know is that it kills people," he adds.

   The lack of information on HIV/AIDS in rural Thailand -- despite the high prevalence -- remains a major challenge in preventing the spread of the pandemic.

   Even Mae Ou, who lost three children to the virus, has little idea about how to monitor the infection, antiretroviral medicines and opportunistic infections.

   "I only know that AIDS kills and we can get it from having sex and through blood," says Mae Ou. "The doctor tried to explain many things, but I hardly remember them. I am too old."

   But it has been difficult for her to forget the despising looks from people around her. "People looked at me with disgust. It was fine for me," she adds. "But it made very sad that they gave the same looks to my daughter."

   The society's response had at times caused her to wish that she was infected in place of her daughter.

   Today, a number of NGOs are trying to help Thailand's elderly organise and cope with HIV/AIDS by training them to become good caretakers and disseminators of correct information about the pandemic.

   "As the elderly with AIDS organise, they can get more access to information, ARV treatment and legal assistance," says Usa Khiewrod, regional project manager of HelpAge International (HAI). "As a group, they have greater bargaining power and courage to ask for information and access to services."

   By organising the elderly with HIV/AIDS, HelpAge hopes to help protect their rights. It also helps in advocacy and lobbying for policies to address the needs of the ageing population that now has the added burden of raising grandchildren with HIV/AIDS. (END/AMF/IPSAP/1205)