La gestion d’un risque insaisissable entre expertise scientifique et vécu intime : la prophylaxie des accidents d’exposition sexuelle au VIH

La question des décisions politiques ayant trait à des problèmes scientifiques ou techniques est envisagée sous l’angle des controverses auxquelles elles donnent lieu, notamment celles qui renvoient à des conceptions opposées du risque, ainsi que celles motivées par des intérêts contradictoires. Acteurs centraux, les associations mettent en cause les pratiques traditionnelles d’expertise. La complexité du sida a favorisé l’entrée en scène d’une grande variété d’experts et d’acteurs, avec des revendications concurrentes de légitimité. Les procédures scientifiques habituelles ont alors été mises en question. Une forme spécifique d’action collective se développe, et sa fin ultime consiste à transformer les points de vue des profanes en expertise légitime par le biais de l’action des associations qui les représentent. En France, la mise en place de la prophylaxie des accidents d’exposition sexuelle au VIH constitue un très bon exemple de ces phénomènes. Elle éclaire les questions de la définition du risque et de la pertinence des indicateurs pour les différents acteurs sociaux. Elle montre comment symboles et valeurs président aux décisions et influent sur la légitimité des expertises. Elle permet de mettre en évidence la distance entre une définition abstraite du risque et les situations concrètes d’exposition individuelle.The question of political decisions concerning scientific or technical problems is examined from the viewpoint of the disputes to which they give rise, particularly those concerning differing concepts of risk, as well as those motivated by conflicting interests. As major players, the associations question traditional practices of expertise. The complexity of AIDS has led to the emergence of a wide variety of experts and actors, with concurrent claims to legitimacy. Current scientific procedures have thus been challenged. A specific form of collective action develops, its final result being to transform the opinions of the profane into legitimate expertise through the action of the associations that represent them. In France, the implementation of prophylactic measures as regards sexual exposure to HIV constitutes an excellent example of these phenomena. It clarifies questions of risk definition and the pertinence of indicators for the various social actors. It shows the importance of symbols and values in decision-making and their influence on the legitimacy of expertise. It highlights the distance between an abstract definition of risk and concrete situations of individual exposure. (1)(1) The French agency, Agence Nationale de Recherche sur le Sida et les Hépatites (ANRS), has contributed funding for this research.La cuestión de las decisiones políticas relativas a problemas científicos o técnicos se prevé desde el punto de vista de las controversias a las cuales dan lugar, en particular, las que se refieren a concepciones opuestas del riesgo, así como las que son justificadas por intereses contradictorios. Protagonistas centrales, las asociaciones cuestionan las prácticas tradicionales de peritaje. La complejidad del SIDA favoreció la entrada en escena de una gran variedad de expertos y protagonistas, con pretensiones competidoras de legitimidad. Los procedimientos científicos habituales se pusieron entonces en duda. Una forma específica de acción colectiva se desarrolla, y su fin último consiste en transformar las opiniones de los profanos en peritaje legítimo por medio de la acción de las asociaciones que los representan. En Francia, la instauración de la profilaxia de los accidentes de exposición sexual al VIH constituye un muy bueno ejemplo de estos fenómenos. Aclara las preguntas de la definición del riesgo y la pertinencia de los indicadores para los distintos protagonistas sociales. Muestra cómo símbolos y valores presiden a las decisiones e influyen sobre la legitimidad de los peritajes. Permite poner de relieve la distancia entre una definición abstracta del riesgo y las situaciones concretas de exposición individual (1).(1) La agencia Nacional de investigación sobre el Sida y las hepatitis (ANRS) dió un apoyo financiero a la realización de esta investigación

Male circumcision as HIV prevention in Africa: Debates and resistance

While the practice of male circumcision (MC) is declining in Western countries, its promotion in order to prevent HIV/AIDS is currently implemented in Eastern and Southern Africa, where it is not frequently carried out and where the HIV epidemic is very widespread. However, in spite of the scientific demonstration of MC's efficacy, its advocacy as a method to prevent HIV/AIDS has generated controversy, with its most extreme opponents denouncing a conspiracy by an occult organisation of powerful "circumcisers". Drawing on an analysis of scientific papers and the responses they have elicited in the journals where they are published and on Internet sites, this article sheds light on this opposition and its connotations. It situates the distorted vision of Africans and of their sexuality - as expressed through these publications and reactions - in a post-colonial context where the ex-colonisers' domination over ex-colonised populations is perpetuated under different forms. Finally, it analyses the action designed in Western countries and exerted on African bodies as an instance of biopower involving medical experimentation transfers to Southern countries. When deprived of any symbolic dimension and practised with a prophylactic objective, MC appears emblematic of such biopower

The Impact of Activist Organisations on Political Action: AIDS National Prevention Campaigns in France

This paper analyses the implementation of a French public AIDS prevention policy through campaigns targeting the general population. More precisely, it is aimed at understanding how the political authorities dealt with the emergence of an epidemic through mass media campaigns. First, I argue that activist organisations a leading role on the implementation of that policy. Second, I contend that political uncertainties and destabilisation paved the way for organisations to lead the debates and impose their framing. This political situation was enabled by two main factors: the HIV-tainted blood scandal and the political instability generated by the successive political "cohabitations" in which a left-wing president coexisted with a right-wing parliament, prime minister and prime minister's appointed officials. The actors and arenas are presented and the process of political action is analysed. Then three noteworthy stages of state-run communication are discussed. They represent major steps in the evolution of the political agenda marked by the influence of activist organization

Decreased motivation in the use of insecticide-treated nets in a malaria endemic area in Burkina Faso

<p>Abstract</p> <p>Background</p> <p>The use of insecticide-treated nets (ITN) is an important tool in the Roll Back Malaria (RBM) strategy. For ITNs to be effective they need to be used correctly. Previous studies have shown that many factors, such as wealth, access to health care, education, ethnicity and gender, determine the ownership and use of ITNs. Some studies showed that free distribution and public awareness campaigns increased the rate of use. However, there have been no evaluations of the short- and long-term impact of such motivation campaigns. A study carried out in a malaria endemic area in south-western Burkina Faso indicated that this increased use declined after several months. The reasons were a combination of the community representation of malaria, the perception of the effectiveness and usefulness of ITNs and also the manner in which households are organized by day and by night.</p> <p>Methods</p> <p>PermaNet 2.0^®and Olyset^®were distributed in 455 compounds at the beginning of the rainy season. The community was educated on the effectiveness of nets in reducing malaria and on how to use them. To assess motivation, qualitative tools were used: one hundred people were interviewed, two hundred houses were observed directly and two houses were monitored monthly throughout one year.</p> <p>Results</p> <p>The motivation for the use of bednets decreased after less than a year. Inhabitants' conception of malaria and the inconvenience of using bednets in small houses were the major reasons. Acceptance that ITNs were useful in reducing malaria was moderated by the fact that mosquitoes were considered to be only one of several factors which caused malaria. The appropriate and routine use of ITNs was adversely affected by the functional organization of the houses, which changed as between day and night. Bednets were not used when the perceived benefits of reduction in mosquito nuisance and of malaria were considered not to be worth the inconvenience of daily use.</p> <p>Conclusion</p> <p>In order to bridge the gap between possession and use of bednets, concerted efforts are required to change behaviour by providing accurate information, most particularly by convincing people that mosquitoes are the only source of malaria, whilst recognising that there are other diseases with similar symptoms, caused in other ways. The medical message must underline the seriousness of malaria and the presence of the malaria vector in the dry season as well as the wet, in order to encourage the use of bednets whenever transmission can occur. Communities would benefit from impregnated bednets and other vector control measures being better adapted to their homes, thus reducing the inconvenience of their use.</p