Lorsque la réduction des risques devient une histoire africaine

Céline Debaulieu, coordinatrice de la mission Médecins du Monde en Tanzanie jusqu’en septembre 2011, dresse le portrait du programme de réduction des risques mis en place à Dar-es-salam. Cette démarche qui a fait ses preuves sur d’autres continents est une première en Afrique

Opinion of health professionals and drug users before the forthcoming opening of the first drug consumption room in Paris: a quantitative cross-sectional study

Abstract Background On the brink of the opening of the first French drug consumption room in Paris, the general opinion of the local involved health care professionals and drug users was not known. The objective of this study was to determine their expectations and to search for influencing factors. Method We carried out a quantitative cross-sectional study. A multiple choice questionnaire was proposed to the surrounding willing general practitioners (GPs) and pharmacists, to the emergency doctors of Lariboisière hospital, and to the professionals of the harm reduction facilities and their drug users (PWUD). For each question, there was a choice between seven answers, from “− 3” (very negative impact) to “+ 3” (very positive impact). The influence of the characteristics of each group on its mean answers was explored by Mann-Whitney, Kruskal-Wallis, and Spearman’s tests. Results The median expectations among the groups of responding GPs (N = 62), other health care professionals (N = 82), and PWUD (N = 57) were mainly positive. They thought that the drug consumption room (DCR) would improve the health of PWUD, reduce their at-risk behaviors, would not increase drug use or drug dealing in the neighborhood, and would reduce nuisance in the public space. Only the group of GPs expressed that the DCR could decrease the quietness of the neighborhood, and only the group of PWUD had higher expectations that the DCR would decrease the number of arrests and the number of violent behavior. GPs’ expectations were significantly better in terms of health improvement of PWUD and reducing their precariousness if they had a previous experience in addiction medicine (Mann-Whitney, p = 0.004 and p = 0.019), with a longer practice (Spearman’s rho, p = 0.021 and p = 0.009), and if they were currently prescribing opioid substitution treatments (Mann-Whitney, p = 0.030 and p = 0.002). Among non-GPs, those who were working in addiction medicine centers had significantly better expectations than pharmacists, and the professionals of the local emergency department had intermediate expectations. Conclusions Health care professionals and drug users had a positive opinion of the to-be-created Parisian drug consumption room. Experience in addiction medicine influenced positively health professionals’ expectations

KRACH SANITAIRE : la crise, à quel prix ?

Aujourd’hui, notre système de protection sociale est malade. Ce ne sont plus seulement les populations auxquelles une association comme Médecins du Monde apporte assistance chaque jour qui sont concernées. A côté des migrants, des sans-logements, des travailleurs du sexe ou encore des usagers de drogues, c’est de plus en plus la population générale qui rencontre des difficultés d’accès aux soins. Prendre la mesure de l’évolution de la précarité chez certaines populations, décrire les tensions et difficultés actuelles auxquelles sont exposés certains dispositifs, comme l’Aide médicale d’Etat ou le Droit au séjour pour maladie, tels sont les objectifs de ce numéro. Il réunit les représentants de structures qui assurent aujourd’hui le « filet de sécurité sociale », des observateurs de cette exclusion sanitaire montante et des acteurs qui innovent au quotidien. Avec eux, dans le contexte de crise économique et financière que nous connaissons, et alors que se dessine une tendance à l’individualisation des risques, il s’agit d’obtenir des éléments de réponse à la question qui surplombe ces problématiques : quel système de santé solidaire souhaitons-nous construire