Violence conjugale et intervention féministe au Québec – les défis d’une pratique subversive dans un contexte de politiques néolibérales

Cet article propose une analyse des défis auxquels se confronte l’intervention féministe dans le champ de la violence conjugale, dans un contexte dominé par des politiques publiques néolibérales. Neuf focus groups ont été réalisés dans trois régions du Québec auprès de 32 intervenantes ayant recours à l’approche féministe en milieu communautaire et de 22 intervenant·e·s œuvrant dans des ressources institutionnelles et sociojudiciaires. L’analyse de contenu thématique a permis d’identifier cinq grand défis que les intervenantes féministes s’engagent à surmonter : 1) Défendre le fait que la violence conjugale est le produit de rapports de pouvoir asymétriques entre les hommes et les femmes ; 2) Déconstruire le double standard dans les réponses apportées aux comportements violents perpétrés par les femmes versus par les hommes ; 3) Définir et justifier l’intervention féministe ; 4) Faire face aux contraintes pour mettre en action les principes de l’intervention féministe ; 5) Dénoncer et lutter contre les politiques d’austérité. L’exemple des défis illustrés dans cet article montre comment le néolibéralisme et le patriarcat se nourrissent et s’enrichissent mutuellement pour étioler la légitimité et la portée de cette pratique sociale, subversive parce qu’elle critique et ébranle les fondements de ces systèmes. This article presents an analysis of the challenges encountered by feminist practitioners who work in the field of domestic violence within the context of neoliberal public policies. Nine focus groups were conducted in three regions of Quebec, with 32 feminist practitioners from community organizations and 32 practitioners from institutional or socio-judicial settings. Thematic content analysis identified five major challenges that feminist practitioners are committed to overcoming: 1) Defending the fact that domestic violence is produced by asymmetrical power relations between men and women; 2) Deconstructing the double standard in reactions to violent behavior perpetrated by women versus by men; 3) Defining and justifying a feminist approach and practice; 4) Overcoming constraints in implementing feminist approaches and practices; 5) Denouncing and fighting against austerity policies. The challenges illustrated in this article show that neoliberalism and patriarchy are intertwined and mutually enrich one another to diminish the legitimacy of this social practice, a practice that could be qualified as subversive to the extent that it criticizes and aims to undermine the foundations of these systems

Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment.

BACKGROUND: The recording of outcomes from large-scale, simplified HAART (highly active antiretroviral therapy) programmes in sub-Saharan Africa is critical. We aimed to assess the effectiveness of such a programme held by Médecins Sans Frontières (MSF) in the Chiradzulu district, Malawi. METHODS: We scaled up and simplified HAART in this programme since August, 2002. We analysed survival indicators, CD4 count evolution, virological response, and adherence to treatment. We included adults who all started HAART 6 months or more before the analysis. HIV-1 RNA plasma viral load and self-reported adherence were assessed on a subsample of patients, and antiretroviral resistance mutations were analysed in plasma with viral loads greater than 1000 copies per mL. Analysis was by intention to treat. FINDINGS: Of the 1308 patients who were eligible, 827 (64%) were female, the median age was 34.9 years (IQR 29.9-41.0), and 1023 (78%) received d4T/3TC/NVP (stavudine, lamivudine, and nevirapine) as a fixed-dose combination. At baseline, 1266 individuals (97%) were HAART-naive, 357 (27%) were at WHO stage IV, 311 (33%) had a body-mass index of less than 18.5 kg/m2, and 208 (21%) had a CD4 count lower than 50 cells per muL. At follow-up (median 8.3 months, IQR 5.5-13.1), 967 (74%) were still on HAART, 243 (19%) had died, 91 (7%) were lost to follow-up, and seven (0.5%) discontinued treatment. Low body-mass index, WHO stage IV, male sex, and baseline CD4 count lower than 50 cells per muL were independent determinants of death in the first 6 months. At 12 months, the probability of individuals still in care was 0.76 (95% CI 0.73-0.78) and the median CD4 gain was 165 (IQR 67-259) cells per muL. In the cross-sectional survey (n=398), 334 (84%) had a viral load of less than 400 copies per mL. Of several indicators measuring adherence, self-reported poor adherence (<80%) in the past 4 days was the best predictor of detectable viral load (odds ratio 5.4, 95% CI 1.9-15.6). INTERPRETATION: These data show that large numbers of people can rapidly benefit from antiretroviral therapy in rural resource-poor settings and strongly supports the implementation of such large-scale simplified programmes in Africa