Access to treatment and care associated with HIV infection among members of AIDS support groups in Thailand

Abstract

To examine the types and distributions of treatment received among persons living with HIV and AIDS (PLWHAs) in Thailand, we analyzed data collected during 2000 from 412 members of PLWHA support organizations in Bangkok and three upcountry northern provinces. Most (74%) of the respondents report ever receiving modern medical care for their HIV-related symptoms; 31% report ever using herbal treatments. Small proportions of those experiencing severe symptoms related to activity limitations report treatments with anti-retroviral medication, treatment for opportunistic infections or treatment for pain. Multivariate analysis suggests that the government's health card system plays an important role in keeping treatment costs down for PLWHAs and their families, that being open about one's HIV status to one's community is positively associated with receiving modern treatment for HIV-related ailments, that being female is negatively associated with receiving modern treatment and that living upcountry (as opposed to living in Bangkok) is associated with using herbal remedies. Policy implications of the findings are discussed.

Acknowledgments

This research is supported by grants by the United States National Institutes on Aging (Grants AG15983 and AG18648). The authors thank Somboon Suprasert and the Thai Red Cross for their assistance in the field; Hongyun Fu for research assistance; Jiraporn Kespichayawattana for help with fieldwork logistics and the interpretation of the results and Chanpen Saengtienchai for help with the content and translation of the instrument. John Knodel provided valuable guidance and advice at all stages. Comments from the two anonymous reviewers were very helpful.

Notes

1. A few (five or fewer) mentioned exercise, rest, mental support from relatives and meditation.

2. This is changing rapidly. About half of new infections in 2000 were expected to be female (World Bank 2000).

3. This proportion is higher than we found for the women PHAs in the other samples we included as part of our more general investigation of the impact of AIDS on Thai families. For example, a sample based on reports of local key informants results in about half of all women PHAs having children. Women PHAs with children may be more likely to join support groups than are women who are childless.

4. Only 11 cases (2.8%) reported a healthcare provider as their main care provider.

5. These relationships are explored in a multivariate framework in Table V.

6. Men are, on average, more ill than are women in this sample.

7. Because differentials in treatment varied mostly between Bangkok and the provinces, we collapsed the three provincial locations into one column for this table and subsequent tables.

8. Likewise, those with more education may be less likely to combine these two approaches but the difference only approaches statistical significance (p=0.11).

9. For more information on treatment expenditures, see a related report that includes expenditure payments as reported by parents of PHAs who have died (Knodel & Im-em, 2004).

10. Splitting the amount spent into a dichotomy (less than $120 versus $120 or more) resulted in only one significant difference: those reporting serious symptoms were significantly more likely to have spent more (p<0.05, results not shown). Gross National Income in purchasing power parity (GNI PPP) for Thailand in 2002 is $6,890 (World Bank 2003).

11. This is a natural break point in our categorical expenditure data, equal to approximately $120.

12. We collapse this variable into two categories: low to medium versus the high category. This is because it is the high category that appears to be the outlier in the bivariate tables.

13. See Table III notes for definitions. We feel that ever-experienced severe symptoms is conceptually our best control factor for severity of illness, since it should capture best whether symptoms are affecting one's ability to function effectively.

14. Substituting length of symptoms as an alternate control factor also did not result in any significant findings.

15. In bivariate analysis, the health card variable did not distinguish at a statistically significant level between those who did and did not receive modern treatment among those receiving any treatment.

16. This is because they won't benefit from the organizational advantages of the PLWHA support group for leveraging care. On the other hand, since it is often the affluent PLWHA s who seem disinclined to disclose their HIV status (a prerequisite for joining), such individuals may be able to leverage such care using their own resources.

17. This is likely due in part to women in this sample having much better experience with community reaction than the men had. Also, since many of our female respondents have been widowed by HIV, it may seem pointless to them to try to conceal their own infection. See VanLandingham et al. (2005) for more discussion on community reaction and stigma related to HIV in Thailand.