Marseille 2007
| Abstract #123 - Implication of expert patients in HIV programs in Cambodia | ||||
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Session: 43.7: Access and models of care (Parallel) on Tuesday @ 16.30-18.30 in CP Chaired by Joseph Okone, Martha Nthenge Authors: Presenting Author: Mrs Bureau Eve - IRD, France |
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| Aim: In southern countries, especially where HIV/AIDS epidemic is highly prevalent, care and support appear like standardized health policies implemented with uniformity throughout the world. This subject deals with one of this globalized initiatives, the implication of expert patients in HIV services. This initiative has acquired the value of an international norm and has been spread all over Cambodia. In this country, implication of people living with Aids is considered by development agencies as an unavoidable process, although that both explicit and implicit effects remain generally unforeseen and unexplored. This process encouraged by international agencies come from neither the patients not from Cambodian actors. Even if this contribution appears evident for institutions, the potential feedbacks have only been justified a priori by the latter. Patients in apparent good health propose their services or are directly requested in ever greater numbers to be trained as volunteers, drug educators, counsellors, peer educators, support group leaders. Those positions are very looked for by PLHA and well financed by international institutions. This anthropological research aims to emphasize the arising of the category of experts patients in order to clarify potential drawbacks, advantages and consequences of implementing this policy in care and support activities in Cambodia. It aims to highlight the nature and the scope of patient experts interventions in the dynamics of improving HIV support programs. Also, the purpose is to grasp perceptions and strategies of local stakeholders inherent to this policy, and to give light to this broader initiative implemented in the socio-cultural context of Cambodia. | ||||
| Method / Issue: This research is carried out in Phnom Penh, where HIV care programs are concentrated, and in three provinces (Battambang, Kandal, Siem Reap) where the dynamic of implication of expert patients is developed with provincial specificities. The researcher follows during a period of two years (2006-2007) different profiles of social actors linked to this initiative. Semi-directed interviews, open discussions and observations will be carried out with 1) patients involved in HIV care services 2) patients who are beneficiaries of those services 3) socio-medical staff who are in direct relations with patients and who are having their own vision and experience of the participation of PLHAs 4) health planers, deciders, project coordinators, local employees or expatriates, who are supposed to encourage this policy. | ||||
| Results / Comments: One year research brought out preliminary outcomes on this issue. Experts patients involvement appears like a part of a broader strategy consisting in mobilizing civil society to arouse a good governance in developing countries. This initiative, linked with northerns values, faces obstacles and resistances in its implementation in Cambodia. We identified gaps between motivations from public health officers and motivations from local bodies which illustrate malleability of worldwide concepts like expert, volonteer, participation and mobilisation. | ||||
| Discussion: We would like to put into questions the system of values implicitly spread through health decisions, and to question how a model like expert patients initiative can be efficient if its aroused by the upper level. | ||||
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