introduce

Since the first case of AIDS was discovered in China in 1985, by the end of February 2003, there were 62 159 people infected with HIV, 8,742 AIDS patients and 2,359 deaths. According to the estimation of China Center for Disease Control and Prevention, by the end of 2003, there were about 840,000 people infected with HIV in China, including about 80,000 AIDS patients. The number of reported HIV infections and cases showed an obvious upward trend 2.

Generally speaking, in the fight against AIDS in the world, the elderly have not yet entered the mainstream vision and have almost become a neglected group. Only in recent years, some countries began to pay attention to the elderly and AIDS, and conducted some research and achieved certain results. In China, there is a lack of special investigations, reports and papers on the elderly infected with AIDS, and the research in this area is almost blank. With the development of aging population and the prevalence of AIDS, it is objectively necessary to investigate the impact of AIDS on the elderly from the perspective of the elderly, grasp the living conditions of the elderly affected by AIDS in China, understand the existing problems, and provide scientific basis for the decision-making of relevant government departments.

With the support of the United Nations Population Fund, the research group completed this research report by collecting and analyzing data based on national AIDS surveillance data and case surveys. The report reveals the epidemic situation of AIDS among the elderly in China and the influence of children infected with AIDS on their parents for the first time, which is of great significance for promoting the prevention and control of the spread of AIDS to the elderly, providing social help to the elderly affected by AIDS, and giving full play to the positive role of the elderly in the fight against AIDS. It has opened up a new field of AIDS research academically, and laid a theoretical foundation for implementing the care policy for the elderly affected by AIDS in the future.

The first part is the research background, research purpose and research method.

I. Research background

In the field of AIDS, the elderly have been rarely concerned by the world. In 1990s, some countries began to pay attention to the relationship between AIDS and the elderly, especially the United States, Zimbabwe, Tanzania, Nigeria and Thailand. , and conducted some investigation and research, and obtained some academic achievements and empirical experience. But generally speaking, there is little research on the impact of AIDS on the elderly in the world. According to foreign literature, the research on the influence of AIDS on the elderly includes two aspects: one is that the elderly themselves are infected with AIDS, and the other is the influence of their children infected with AIDS on their relatives.

In different countries and regions, due to the differences in political, cultural, socio-economic development level and the severity of AIDS epidemic, the ways and consequences of AIDS affecting the elderly are also different, and the research focus on this issue is also different. The focus of the United States is mainly on elderly AIDS patients and elderly people at risk of infection. The research content is detailed and covers a wide range, including the demographic profile of elderly AIDS patients, medical resources and service models, social discrimination, psychology, education and prevention plans, etc. Research conducted in some countries in Africa and Asia focuses on the economic, health and spiritual influence of elderly parents on their adult children with AIDS, and their role in caring for children with AIDS and raising AIDS orphans. Research shows that the influence of AIDS on elderly parents is closely related to the severity of their children's illness, and the content and ways of the influence are very different at different stages after their children are infected with AIDS. Studies from two continents show that a considerable number of adult children with AIDS will return to their parents' homes before they die, and their parents will provide care, economic and spiritual support. The understanding gained from these studies is that the elderly are also victims of AIDS, but also an important force to stop AIDS in developing countries, and they urgently need social attention and help. At present, the domestic research in this field is still blank, and it is urgent to carry out investigation and research in this field.

Second, the purpose of the study

The main purpose of this study is to grasp the current situation and trend of AIDS epidemic among the elderly in China through the age stratification of AIDS epidemic monitoring data, supplemented by the study of high-incidence communities and cases, to understand the living conditions, problems and needs of the elderly affected by AIDS, to explore ways of policy intervention, to promote and improve the living environment of elderly HIV-infected people and patients, to give play to the positive role of elderly relatives and to improve their quality of life.

Third, research methods and data sources.

(A) the concept of old age

The age definition of "old age" is the first premise to study the influence of AIDS on the elderly. At present, in the international AIDS statistics, people aged 50 and above are the elderly, while the elderly referred to in the elderly AIDS literature are mostly people aged 50 and above. In order to make the research results comparable, this study adopts 50 years old as the starting point of old age.

(B) the basic path of AIDS affecting the elderly

There are two basic ways for AIDS to affect the elderly: one is the direct impact, that is, the impact on their health and quality of life after being infected with HIV; The other is indirect influence, that is, through HIV-infected people and AIDS patients acting on their elderly relatives, bringing economic and health impact to the elderly. Therefore, there are two types of elderly people affected by AIDS, one is elderly people infected with HIV and AIDS patients, and the other is elderly relatives (mainly elderly parents) of children infected with HIV/AIDS.

The Impact of AIDS on the Elderly is analyzed in two levels: one is macro-research, which examines the epidemic situation and changing trend of AIDS in the elderly from the perspective of epidemiology and demography; The second is micro-research, which analyzes the living conditions and existing problems of elderly relatives of elderly people infected with HIV and children infected with AIDS from a sociological point of view.

(3) Research methods

In this study, the data collected by China STD/AIDS Prevention and Control Center through the AIDS surveillance network were used for quantitative analysis, and the data collected in typical areas with AIDS epidemic were analyzed qualitatively through case investigation. The field survey was obtained through qualitative data collection techniques such as case interviews, insider discussions and community surveys. For the policy implementation issues involved, this research report also consulted the opinions of relevant government departments and experts and scholars in the form of symposiums.

The survey plan consists of four kinds of questionnaires and outlines, including: (1) questionnaire for elderly relatives of children infected with AIDS; (2) Questionnaire for elderly HIV-infected persons and patients; (3) community questionnaire for the elderly affected by AIDS; (4) An outline of in-depth and public interviews in the communities where the elderly affected by AIDS live. In-depth public interviews include all kinds of key insiders related to the elderly in the community, including: close relatives of HIV-infected people/patients, community health workers, community administrative cadres, contacts of HIV-infected people, etc.

(four) the place and object of the case investigation.

The project team originally planned to select some people in urban and rural areas as samples, but during the operation, it was found that it was more difficult and difficult to carry out in-depth investigation in urban areas than in rural areas. Coupled with the limitation of time and funds, this project only selected one county in Shanxi Province for in-depth investigation. This county is a high epidemic area, and the infection route of local people is consistent with the main infection route of infected people in China in 2003, which is 1, which accords with the characteristics that infected people mainly occur in rural areas in China, so the survey results in this county are typical.

The investigation county, located in the south of Shanxi, is one of the poverty-stricken counties in China. 1985 Many farmers began to sell blood. 1995 The number of private blood stations increased, reaching a climax. Many people are infected with HIV because blood stations do not pay attention to the safety of blood collection. The village where many people sold blood in those years has now formed an AIDS village. Most of the interviewees in this project come from two villages. There are about 220 households 1000 people in a village, and HIV-infected people are found in 200 1 year. There are about 300 households 1500 people in village b, and HIV infection was found in 1995. In this survey, 44 of the 50 respondents or their children were infected with HIV when they frequently went to private blood stations to sell blood. Case study * * * interviewed 5 1 person, including 3 1 person for men and 20 women, the oldest being 75 years old, including 37 elderly relatives of children infected with AIDS and 4 elderly people infected with AIDS. A total of 7 people were interviewed in the two communities, including 2 village cadres, 2 village accountants 1 person, 2 contacts with HIV/AIDS, 2 medical workers 1 person, and relatives of HIV/AIDS 1 person.

In view of the fact that AIDS is a sensitive topic under the current national conditions, in order to protect personal privacy, this survey adopted a special organizational model, that is, the staff of the county epidemic prevention station informed the respondents to take a bus to the county town and conduct one-on-one investigation in a separate room arranged by the investigation team. All the information of the interviewees, including the names of their villages and relatives, is anonymous in the report.

The second part of the research results

I. Prevalence of AIDS among the elderly population

Accurately estimating the true scope of AIDS epidemic is the primary problem of this research topic.

(A) the national AIDS epidemic

1. The number of HIV-infected people in China is on the rise, and the number of patients continues to increase.

2 1 century, the number of HIV-infected people and patients in China has increased rapidly. In 2003, the total number of reported HIV-infected people in China reached 2 1 69 1, an increase of 122.9% over 2002. There were 6 120 AIDS patients, an increase of 495.3% over 2002. 1 147 people died (AIDS death110), an increase of 183.9% over 2002. Although the reported data are influenced by subjective and objective factors, it can still be seen that the number of HIV-infected people, especially AIDS patients, and the number of deaths have increased significantly in recent years.

2. Young adults are the main body of HIV-infected people.

In terms of age distribution, HIV-infected people reported in 2003 were mainly young adults, accounting for 25.9% in the age group of 20-29, 38.8% in the age group of 30-39 and 65,438+09.1%in the age group of 40-49. The combination of 20-49 years old reached 83.8%.

As mentioned above, there are 840,000 HIV-infected people in China. If calculated according to the proportion of 80%, there are 672,000 HIV-infected people and patients aged 20-49 in China. Assuming that the average number of parents of each infected person is 1.5, the number of elderly parents involved will reach 1 ten thousand. Young adults are the main age of AIDS epidemic, which determines that indirect ways are the main forms of AIDS' influence on the elderly. With the increase in the number of infected young adults, the number of elderly parents will continue to increase in the future.

A large number of young adults are infected with HIV, which means that a large number of elderly parents will lose their adult children in the future and become the targets of social assistance. In areas with high incidence of AIDS, the concentrated death of young and middle-aged AIDS patients will leave a large number of elderly parents in a short time, thus dramatically increasing the proportion of the local elderly population and bringing serious family and social problems.

3. Injecting drug use is the main route of infection, and the number of sexually transmitted people continues to increase.

By the end of 2003, there were 62,654,38+059 cases of HIV infection in China, mainly transmitted through blood, accounting for 74.654,38+0% of the total reported cases. Among them, injecting drug users accounted for the largest number, accounting for 5 1.2% of the total reported number, paid blood donation infection accounted for 2 1.0%, sexually transmitted infection accounted for 7.5%, mother-to-child transmission accounted for 0.4%, and the transmission route was unknown for 18.0%.

(b) The prevalence of AIDS among the elderly

1.50 years old and above, more than one in ten people are infected with HIV.

According to the data of case reports in 2003, HIV-infected people aged 50 and above accounted for 10.6% of the infected population, and the sex ratio was 108, which was lower than the overall level (179). The proportion of AIDS patients over 50 years old is high, reaching17.0%; Among the dead people, the proportion of people over 50 years old who died of AIDS also reached a high level of 16.6% 1. Many people over the age of 50 may be infected in middle age and get sick and die in old age. This is an important reason why the proportion of AIDS patients and deaths among people over 50 years old is higher than that of HIV-infected people.

According to the ratio of 200 1 accounting for 4. 1% of reported HIV-infected people and 10.5% of reported AIDS patients, it is conservatively estimated that among the above-mentioned 840,000 actual infected people in China, there will be 34,000 infected people aged 50 and above, and there will be 8,000 AIDS patients aged 50 and above in the country. For a long time, people have not considered that AIDS is related to the elderly. This result exceeded people's expectations, indicating that the proportion of middle-aged and elderly people infected with HIV has reached a fairly high level.

2. Past paid blood donation infection is the main route of infection.

According to the data reported in 2003, in the past, paid blood donation was the main infection channel for young people aged 65,438+05-49 (42.9%) and the main infection channel for the elderly, but the proportion of the elderly (72.5%) was much higher than that of young people. Sexually transmitted infection accounted for 4.6%, blood transfusion/blood products infection accounted for 3.7%, injecting drug abuse infection accounted for 1.3%, and the infection route was unknown for 17.9%.

Comparing the case reports in 2003 and 20001year, it is found that in recent years, the transmission route of HIV among people over 50 years old has changed significantly: the proportion of sexual transmission, drug injection, blood transfusion/blood product infection has decreased significantly, while the proportion of paid blood donation infection has increased significantly, from 30.7% to 72.5% in two years, more than doubling.

In recent years, the state has strengthened blood safety and management, and the spread of AIDS caused by paid blood donation in the past has been basically controlled. In the future, the possibility of HIV infection in the elderly will be weakened. It is expected that in a few years, the way of HIV infection among the elderly will gradually shift from paid blood donation to sexual contact and injecting drug use.

The proportion of infected people aged 3.50 and above has increased rapidly.

According to the national monitoring data, in 200 1 year, only 82 19 people were reported to be infected with HIV nationwide, which increased to 2 1 person and 69 1 person in 2003, 2.6 times of that in 20001year. However, in 20001year, there were only 339 HIV-infected people aged 50 and above, which increased to 2 283 in 2003, 6.7 times of that in 20001year. In 200 1 year, HIV-infected people aged 50 and above accounted for 4. 1% of all reported HIV-infected people. By 2003, this proportion had soared to 10.6%. 1990 or so, some places in the mainland do not pay attention to the health and safety of blood collection, and many middle-aged paid blood donors are infected with HIV, which is the main reason for the increase in this proportion in recent years.

Second, the impact of AIDS on the lives of the elderly

(1) Living conditions and problems faced by elderly people infected with HIV/AIDS

1. The health condition is deteriorating.

With the passage of time, the immunity of infected people gradually declined and their health status became worse and worse. In the two villages investigated, some infected people showed symptoms, some people started to get sick, and some patients died. Among the elderly infected people surveyed, 7. 1% have no obvious symptoms, and the remaining 92.9% have more than one symptom. 85.7% people are weak, 7 1.4% people have a fever, 7 1.4% people are emaciated, 64.3% people have thrush, 57. 1% people cough, 42.9% people have poor appetite and 42.9% people. The proportion of people with more than two symptoms at the same time reached 85.7%. 57. 1% of the respondents are receiving treatment for a certain disease, but have not received special treatment for AIDS; 14.3% people used to be treated for a certain disease, but now they don't; 28.6% people have never received any treatment. Reasons for not receiving treatment: 50% people mainly have no money, and 50% people have other reasons.

Life is becoming more and more difficult to maintain.

Fatigue is a common symptom after HIV infection, and the decline of health status seriously affects production and life. Among the elderly infected people surveyed, 78.6% still work in the fields or go out to work, and many of them are still the main labor force of the family. Being infected with HIV affects your work and you can't do heavy work. Some people can't work in the fields because of poor health, and usually do housework at home.

Local villagers are mainly engaged in agricultural production, and a considerable number of people's income is only enough to maintain their basic livelihood. According to the survey of 1 1 infected people, the average annual income of families last year was 900 yuan. 3 families without income, accounting for 27.3%; The average annual household income 100 yuan accounts for 27.3% in 300 yuan, and the two situations together account for 54.5%.

Most of the infected people interviewed are in good health, 14.3% of them have never spent medical expenses. 49.5% spent 1000 ~ 3000 yuan; 35.5% spent more than 3,000 yuan, and the most spent reached more than 30,000 yuan.

With the emergence of AIDS symptoms, patients pay more and more medical expenses. Debt treatment has become an inevitable means for HIV-infected people to maintain their health and life. 14 of the respondents, except 1 who didn't answer, 1 who didn't have debts, all others were due to AIDS or other reasons; 38.5% people have debts below 3,000 yuan, 53.8% people have debts above 3,000 yuan, and the largest amount of debts exceeds 20,000 yuan.

3. Long-term depression

After being infected with HIV, the road to life will come to an end. They suffer from pain and sadness that ordinary people can't understand, and their lives are like years. Older infected people are usually frightened by the threat of death. They want to live, but because they have no money, they lack medicine and necessary treatment. Some elderly people infected with HIV are resigned to their fate. Others have no hope. Long-term mental stress leads to psychological changes of elderly infected people. An interviewee is under great ideological pressure and loves to lose his temper and influence others.

4. Lack of relevant knowledge

The knowledge of AIDS prevention among the elderly is generally lacking. Some elderly infected people or patients actually did not take any preventive measures when they were in close contact with other family members or others.

Living conditions of elderly parents of children infected with HIV

Aids harms young people and affects the elderly. The impact of AIDS on the elderly is manifested in the following aspects:

1. The negative impact of children infected with HIV on elderly parents

1) Decline in living standards and increase in debts In the two villages surveyed, the living standards of elderly parents have obviously decreased because their children are infected with HIV. Most old people live a relatively poor life. After their children fell ill, in order to fully support their children's medical care and life, the old people cut back on food and clothing, mostly dressed simply, with thin faces and melancholy expressions. There are 55.6% and 36. 1% families with average and poor economic conditions respectively. A few poor households use steamed bread and boiled water to satisfy their hunger every day, and sometimes eat pickles. There are 200 days in a year. In order to treat the child, both parents borrow money. According to insiders' estimates, elderly people whose children died of AIDS generally have debts of 5000-6000 yuan.

2) There is no guarantee for old age. Among the 36 elderly parents interviewed in this survey, 29 mainly rely on their own labor income, accounting for 80.6%; The three are mainly supported by their children or grandchildren; Three people are supported by their wives (spouses). After a child is ill, he can't take care of himself, let alone his elderly parents. Once they die, they will leave the old people behind, leaving them without a reliable source of livelihood. Among the interviewees, five families have lost their sons, and the rest have at least 1 sick children. Thirty children of elderly parents survived, of whom 65,438+0 depended on their children or grandchildren, while five children of elderly parents died, and two of them depended on other children or grandchildren. Respondent No.36 has to support a family of six with his meager pension income, and the economic burden is extremely heavy. Many old people who have reached the age of stopping working have to find new jobs or continue to work in the fields in order to treat their children and bring up their grandchildren. An old woman had to find another job after her son died. Three brothers in a family died of AIDS, leaving five orphans to be temporarily raised by three daughters-in-law. After the daughter-in-law remarried, the living problems of the elderly could not be solved. In a village, after the child died of AIDS, there were more than a dozen elderly parents in need of support.

3) Children with great mental stress are infected with HIV, and elderly parents realize that their children will die before themselves. Some elderly people have experienced the death of their children. For them, the most painful thing in this life is to send white-haired people to dark-haired people. Economic embarrassment, confusion and despair about children's health and life are also the reasons for the ideological burden.

2. Elderly parents provide support to children infected with HIV/AIDS.

Surveys show that elderly parents provide all kinds of support to their children infected with HIV/AIDS.

1) Life care for children infected with HIV. For the convenience of care, most elderly people who live separately from their children change to live with their children, or live separately but eat together. Among the respondents in this survey, more than 60% accompanied them to see a doctor, 65% bought medicine and 65% helped with housework. Parents mainly take care of their grandchildren at the initial stage of infection or when there are no obvious symptoms. The help provided by elderly parents is mainly in daily life, nursing, treatment and spiritual comfort. In the late stage of the disease, the patient's immune system collapses rapidly and his condition deteriorates. At this time, the role of parents' caregivers is highlighted. Most of the deceased stayed in bed for 3-4 months before their death. At this time, most of the old people came to help, basically serving all day, with the focus on nursing, hospice care and other help. Mother plays a more important role than father in nursing and hospice care. Some elderly women's spouses are also infected with HIV, and their care burden is heavier.

2) Parents' financial support is very obvious, and there are various ways of support: providing part of living expenses and medical expenses, letting grandchildren eat at their own homes, paying tuition fees for grandchildren, buying toys, and helping children borrow money. Most elderly parents provide financial aid for 2-5 years, some as long as 10 years. Helping children financially for such a long time is tantamount to adding insult to injury to the elderly in rural areas who are not rich.

3) Spiritual Comfort Most AIDS patients live at home, and the spiritual comfort of elderly parents is very obvious, especially female elderly people. In the environment of external discrimination, their comfort makes children feel particularly warm, which greatly relieves their negative emotions caused by HIV infection.

4) Organizing funerals and caring for orphans When their children died of AIDS, many elderly parents undertook funeral arrangements. In this survey, the children of six interviewees died of AIDS, and three of them were the main undertakers of the children's funeral. In the past, 74 families of AIDS patients who took care of orphans died in Jia Cun had 14- 15 elderly people. They are old and weak. After the children leave, they have to bear the responsibility of raising the younger generation.

(3) Discrimination from outside.

Discrimination by villagers is widespread, and people are afraid of AIDS and avoid contact with infected people and their families. Some villagers no longer associate with infected people and their families as before. It is difficult for infected people to participate in group activities, and no one wants to participate in recreational activities with them. Considering the discrimination from outside, many elderly people are reluctant to disclose that they or their children are infected with HIV. In order to avoid discrimination from the outside world, elderly parents can't talk about their pain, so they can only bury it in their hearts and feel depressed.

(D) The wishes of the elderly

The needs of the elderly affected by AIDS are concentrated in the following aspects: First, there is an urgent need to obtain free drugs for the treatment of AIDS. Second, I hope to get financial support. Third, I hope to eliminate social discrimination. Fourth, I hope to solve the problems of orphans' life and study. Fifth, I hope that when I can't do it, I can have someone to support me when I am inconvenient to move.

Third, the socio-economic impact of AIDS on the elderly.

(A) AIDS has changed the family structure, and the elderly have lost their living security in their later years.

In developed countries, the elderly generally have pensions, self-reliance, developed social services, and low dependence on their children in life. In developing countries, especially in rural areas, the elderly have no social security and medical insurance, and can only rely on individuals and families for medical treatment and old-age care. AIDS has changed the family structure. Studies in Thailand show that adult children will move to or live with their parents in the later stages of illness.

The traditional family building for the aged is built on many children. When children have an accident and die before their elderly parents, the safety factor of seat belts decreases. For the only child infected with HIV, the problems faced by elderly parents are particularly severe. With the decline of fertility rate, the number of children of elderly parents will decrease in the future, and the influence of children infected with HIV or suffering from AIDS on elderly parents will become more and more prominent. Young people can get care and help from their parents after being infected with AIDS, while the elderly lose their sense of security in their later years. After their children are infected with HIV or suffer from AIDS, elderly parents in rural areas lose the only reliable and stable source of income in their later years. The spread of AIDS requires the society to assume the responsibility of supporting the elderly who were originally supported by their families. The epidemic of AIDS has brought more and more pressure to social security and social welfare.

(b) AIDS has deepened the poverty of the elderly.

AIDS puts elderly parents at high risk, and poverty is almost inevitable after their children are infected with HIV. Compared with other diseases, AIDS has a more serious impact on poor families, and its impact on female elderly relatives is higher than that of men, especially on the poor. AIDS has deepened poverty. As a vulnerable group, it is more difficult for the elderly who are trapped in poverty to get rid of poverty.

(c) AIDS causes social exclusion of the elderly.

Social exclusion is a problem that cannot be ignored. Aids-related stigma makes infected people lose self-esteem and fall into unavoidable fear, sadness, anger and depression. Out of fear of discrimination, many people are reluctant to go to the hospital/epidemic prevention station for examination even if they have some symptoms of AIDS, let alone disclose their illness. Many people go to epidemic prevention stations in neighboring counties to check, using fake names. It can be inferred that there is a big gap between the number of elderly HIV-infected people and patients reported in China and the actual number. The existence of social discrimination has also become a huge obstacle for the elderly affected by AIDS to obtain medical services and social assistance, which has increased the difficulty of work. If once the life and spiritual sustenance are cut off, the possibility of the infected person attacking and retaliating against the society exists and becomes a factor of social instability.

(D) AIDS makes the elderly on the edge of dual society.

When they enter old age, they lose their ability to work and become marginalized people in society. In the AIDS crisis, they have further become a double marginal group in society. Social and economic marginalization reduces their motivation and preventive ability to change risky behaviors, and reduces their positive attitude and behavior towards AIDS. Social and economic marginalization also makes the elderly HIV-infected people face many obstacles in obtaining medical services and insisting on treatment, including lack of fees and information, inconvenient transportation and mobility, fear of social discrimination, and distrust of the confidentiality of the medical care system. The situation of AIDS will inevitably aggravate the social and economic disadvantages of these marginalized people. As Jie Shen, director of China STD and AIDS Prevention and Control Center, pointed out: AIDS is not a simple medical problem, but a social challenge.

The role of elderly relatives has changed.

AIDS has reversed intergenerational relations and intergenerational support. Once again, elderly parents have changed from traditional dependents to caregivers, from caregivers to caregivers, and elderly women have become the main caregivers. With the passage of time, the number of adult AIDS deaths in China will gradually increase, and there will be more and more AIDS orphans, and the role of the elderly in helping AIDS orphans will become more and more significant. By helping children infected with HIV/AIDS, elderly parents have greatly reduced their social services and economic burden. From this perspective, the elderly not only continue to contribute to the family, but also indirectly contribute to the society.

Part III Social Support Environment and Suggestions

I. Policy support environment

In response to the AIDS epidemic, the China Municipal Government has strengthened the organizational construction of AIDS prevention and control work. 1986 the Ministry of health set up an AIDS prevention and control working group, 1990 set up a national AIDS prevention and control expert Committee, and in 2004 the State Council set up an AIDS prevention and control working Committee. In 2003, at the high-level meeting of the United Nations General Assembly on AIDS, the China government made five commitments, namely, strengthening government responsibility, providing free treatment drugs, intervening and preventing risky behaviors, and opposing social discrimination. Since 1988, the government of China has promulgated a series of policies and regulations related to AIDS, and has continuously increased its investment in AIDS prevention and control. In 2004, the state began to implement the "four exemptions and one care" policy for AIDS patients and infected people. The Ministry of Civil Affairs issued the Notice on Strengthening the Relief Work for AIDS Patients and Family Orphans with Living Difficulties. The country has carried out many project activities and achieved remarkable results. However, there is no national plan specifically for the elderly. The elderly population has its special problems, difficulties and needs, so it is necessary to strengthen the pertinence of policies. The elderly group is excluded from the scope of publicity and education and becomes a blind spot in work. Some HIV-infected people and their families have a strong sense of self-help in production and need outside encouragement. Some laws and regulations need to be refined. The Ministry of Civil Affairs has issued a policy to help AIDS family members who have difficulties in life, and it is necessary to implement financial allocation as soon as possible.

Second, social assistance and care activities.

At the end of the 20th century and the beginning of the 20th century, China launched various social assistance and AIDS care activities. Activities include: family care, neighborhood care, mutual non-discrimination, providing regular health services, helping families, etc. Many non-governmental organizations, institutions and associations have sprung up all over the country to actively participate in the fight against AIDS. Many HIV-infected people, AIDS patients and volunteers play a special role in solving all aspects of AIDS and have made great contributions. Most of the above social assistance and AIDS care activities have reference significance for helping the elderly affected by AIDS.

Third, foreign experience.