Acteurs et agents, points de vue géographiques au sein des sciences sociales

En guise d’avant-propos introductif Dans son texte de présentation, Jean-Pierre Gaudin brasse de façon succincte mais très efficace la problématique de l’acteur. S’interroger sur ce que c’est qu’un acteur revient à ouvrir un éventail de questions qui sont au cœur de toute problématique scientifique dans les sciences sociales, et notamment à mettre le doigt sur l’arbitraire de toute une série d’oppositions qui jouissent néanmoins encore d’une fortune incontestée : individu contre société, subj..

Towards Multidisciplinary HIV-Cure Research: Integrating Social Science with Biomedical Research

The quest for a cure for HIV remains a timely and key challenge for the HIV research community. Despite significant scientific advances, current HIV therapy regimens do not completely eliminate the negative impact of HIV on the immune system; and the economic impact of treating all people infected with HIV globally, for the duration of their lifetimes, presents significant challenges. This article discusses, from a multi-disciplinary approach, critical social, behavioral, ethical, and economic issues permeating the HIV cure research agenda. As part of a search for an HIV cure, both the perspective of patients/participants and clinical researchers should be taken into account. In addition, continued efforts should be made to involve and educate the broader community

Investigating and Improving Access to Reproductive Healthcare for Vulnerable Migrant Women in France

Background: Homelessness and housing instability in the host countries are central features of the experience of migration to the EU. Although migrant women across the EU encounter obstacles in accessing healthcare services, little is known on the health and access to healthcare services for unstably housed migrant women. The DSAFHIR project aims to better describe the risks faced by migrant women in situations of administrative and social vulnerability, to analyze the barriers to access healthcare and to test specific health interventions. Methods: The DSAFHIR project consists of a two-wave mixed-method survey and the implementation of two tailored sexual health interventions. 474 migrant women aged 18 to 77 years housed in social hotels were surveyed at inclusion. After the implementation of sexual health interventions, respondents were contacted for the follow-up survey (n=284). Discussion: The project provides needed data on migrant women’s health and healthcare access, including non-French speakers. It allows to draw lessons on feasibility and acceptability of quantitative and qualitative surveys on this hard-to-reach population. A high response rate in both waves of the survey (84% and 85%) suggests good acceptability. The attrition is comparable to other migrant longitudinal surveys (60% of the original sample completed the follow-up survey, or 40% of attrition), suggesting that relying on cell phones is possible for follow-up even in contexts of housing instability

PrEP in Europe - expectations, opportunities and barriers

INTRODUCTION: In contrast to the global trend showing a decline in new HIV infections, the number reported in the World Health Organization (WHO) region of Europe is increasing. Health systems are disparate, but even countries with free access to screening and treatment observe continuing high rates of new infections in key populations, notably men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is only available in France. This commentary describes the European epidemics and healthcare settings where PrEP could be delivered, how need might be estimated for MSM and the residual barriers to access. DISCUSSION: Health systems and government commitment to HIV prevention and care, both financial and political, differ considerably between the countries that make up Europe. A common feature is that funds for prevention are a small fraction of funds for care. Although care is generally good, access is limited in the middle-income countries of Eastern Europe and central Asia, and only 19% of people living with HIV received antiretroviral therapy in 2014. It is challenging to motivate governments or civil society to implement PrEP in the context of this unmet treatment need, which is driven by limited national health budgets and diminishing assistance from foreign aid. The high-income countries of Western Europe have hesitated to embrace PrEP for different reasons, initially due to key gaps in the evidence. Now that PrEP has been shown to be highly effective in European MSM in two randomized controlled trials, it is clear that the major barrier is the cost of the drug which is still on patent, although inadequate health systems and diminishing investment in civil society are also key challenges to overcome. CONCLUSIONS: The momentum to implement PrEP in European countries is increasing and provides a welcome opportunity to expand and improve clinical services and civil society support focused on HIV and related infections including other sexually transmitted and blood-borne infections

Parcours migratoire, violences déclarées, et santé perçue des femmes migrantes hébergées en hôtel en Île-de-France. Enquête Dsafhir.

International audienceAccommodation in emergency hotels is a particularly precarious form of emergency sheltering. Confronted with violence, migrant women accommodated in emergency hotels are characterised by several types of vulnerabilities. This has a negative impact on their health status and exacerbates their difficulties of access to healthcare.The Dsafhir survey, conducted in 2017 among 469 migrant women accommodated in emergency hotels, mainly describes the perceived health status of these women and the variety of forms of violence they have experienced (physical, psychological, sexual, economic, administrative), the relationships they have (or used to have) with perpetrators (spouse, relatives, representatives of the state authority), as well as the temporality of the acts incriminated (violence ocurring before migration, during their migratory journey, or in France).By processing the quantitative (n=469) and the qualitative (n=30) Dsafhir data, this article describes the health status and violence that accommodated migrant women were exposed to, by characterising the types of violence, the links with the perpetrators, and by placing them in the temporality of migration routes. Sexual violence, moreover is dealt with specific attention.Our results show that these women are particularly vulnerable to experiencing violence in their lifetime.By questioning respondents in « ordinary households », the largest statistical surveys on violence usually and considerably under-represent these marginalised women. In addition, these women often do not have access to healthcare, even though this situation has a proven negative impact on their health.La « mise à l’abri » à l’hôtel est une forme particulièrement précaire d’hébergement d’urgence. Les femmes migrantes hébergées à l’hôtel cumulent des facteurs de vulnérabilité face aux violences. Ce contexte a un effet délétère sur leur état de santé et renforce leurs difficultés d’accès aux soins de santé.L’enquête Droits, santé et accès aux soins des femmes hébergées immigrées et réfugiées en Île-de-France (Dsafhir), menée auprès de 469 femmes migrantes vivant à l’hôtel en 2017, permet notamment de décrire l’état de santé perçu de ces femmes et la diversité des formes de violence qu’elles ont subies (physiques, psychologiques, sexuelles, économiques et administratives), les liens qui les unissent (ou les unissaient) aux auteurs des violences (conjoint, membre de la famille, représentant de l’autorité, etc.), ainsi que la temporalité des actes incriminés (violences survenant avant la migration, pendant le trajet migratoire, en France).En mobilisant les données quantitatives (n=469) et qualitatives (n=30) de cette enquête, cet article décrit les états de santé et les violences auxquelles ont été exposées les femmes migrantes mises à l’abri en les caractérisant (types de violence, lien avec l’auteur) et en les plaçant dans la temporalité des parcours migratoires. Les violences sexuelles font l’objet d’une attention spécifique.Les résultats montrent que ces femmes sont particulièrement exposées au fait de subir des violences au cours de leur vie.Les grandes enquêtes statistiques sur les violences, parce qu’elles interrogent des répondants dans des « ménages ordinaires », sous-représentent largement cette population de femmes marginalisées. En outre, elles sont rarement prises en charge, sur le plan médico-psycho-social, alors que ces expériences ont un impact négatif avéré sur leur état de santé

Investigating and Improving Access to Reproductive Healthcare for Vulnerable Migrant Women in France

International audienceBackground: Homelessness and housing instability in the host countries are central features of the experience of migration to the EU. Although migrant women across the EU encounter obstacles in accessing healthcare services, little is known on the health and access to healthcare services for unstably housed migrant women. The DSAFHIR project aims to better describe the risks faced by migrant women in situations of administrative and social vulnerability, to analyze the barriers to access healthcare and to test specific health interventions. Methods: The DSAFHIR project consists of a two-wave mixed-method survey and the implementation of two tailored sexual health interventions. 474 migrant women aged 18 to 77 years housed in social hotels were surveyed at inclusion. After the implementation of sexual health interventions, respondents were contacted for the follow-up survey (n=284). Discussion: The project provides needed data on migrant women’s health and healthcare access, including non-French speakers. It allows to draw lessons on feasibility and acceptability of quantitative and qualitative surveys on this hard-to-reach population. A high response rate in both waves of the survey (84% and 85%) suggests good acceptability. The attrition is comparable to other migrant longitudinal surveys (60% of the original sample completed the follow-up survey, or 40% of attrition), suggesting that relying on cell phones is possible for follow-up even in contexts of housing instability