Marseille 2007
| Abstract #305 - The representation of risks and the use of health care services within prisons: the case of HIV and tuberculosis in the prisons of Rio | ||||
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Session: 43.3: Access and models of care (Parallel) on Tuesday @ 16.30-18.30 in CP Chaired by Joseph Okone, Martha Nthenge Authors: Presenting Author: Prof LHUILIER Dominique - CNAM, France |
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| Additional Authors: Prof Lhuilier Dominique, Mrs Diuana Vilma, Prof Amado Gilles, Mrs Sanchez Alexandra, | ||||
| Aim: The available epidemiological data about the sanitary conditions of the prisoners in the state of Rio de Janeiro are alarming (HIV and tuberculosis) and preventive measures strike against the lack of knowledge about the prisoners representations of illness, contagiousness of practices considered as risky, as well about the barriers encountered as regards the access to care. This research tries to overcome some of these difficulties. | ||||
| Method / Issue: On this basis, an action-research has been undertaken within three prisons and two prisons hospitals with two main focuses: the representations of health risks in prison, and the prints of the prisons context and culture on the relationship to health and on the use of health care devices. Well present here the data collected from prisoners through individual and collective interviews | ||||
| Results / Comments: The representations of contagious/transmissible illness are relegated behind other risks: domination, stigmatization, aggression, murders. The hierarchy of risks, subordinated to the double dependence of the prisoner on the penitentiary order (and its agents) and to the inner prisons order (and its leaders), act as a filter to the reception of informative and preventive messages and as an obstacle of the health care services access. The representations of diseases single out these which belong to the category of the dirty from those which are linked to the devil. HIV appears as a relative risk in spite of its image of death: it is limited to the stigmatized homosexual relationship. Whereas tuberculosis, an invisible evil within confined spaces, indifferently threatens both the prisoners and the guards. Within such a context, always characterized by a necessity to belong and the status (places) precariousness, the disease is firstly a synonym of risk of a loss: loss of the support found in the group, of the access to illicit (clandestine) resources. The use of health care services contains strategic purposes which have no direct link with the disease but open the way to special advantages. The access to these services requires overcoming a double filter: the one controlled by the guards (their power of sorting out the request on the basis of criteria which are more concerned with security than with health), and the other one dependent on the social organisation of the prisoners. Two criteria facilitate such an access: the conformity to the role of the cooperative prisoner and the position within the hierarchical system of the groups of prisoners. | ||||
| Discussion: The investigation of the homology between the social relationships organization and that of the beliefs and representations therefore appears to be a condition for the improvement of health care in prisons. But is it really possible irrespective of the acknowledgment of the social and political context ? | ||||
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