Marseille 2007
| Abstract #237 - Involvement of expert patients in HIV programs in Cambodia | ||||
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Session: 26.33: Posters B (Poster) on Tuesday in Chaired by Authors: Presenting Author: Mrs Bureau Eve - IRD, France |
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| Additional Authors: | ||||
| Aim: The high spread of HIV/AIDS in southern countries has led to an international mobilization to fight the epidemic. Models and norms underlying by international health policies are spread throughout the world. Our study is focussed on a specific public health approach which is the involvement of expert patient. Recently, patients skills are taken into account by health planers so as to improve quality of care. Due to their experience of the disease, people living with AIDS may facilitate understanding of the disease and improve communication between patients and health providers. This new approach has acquired the value of an international norm and has been spread all over Cambodia. PLHAs propose their services and are directly requested to work as volunteers, drug educators, counsellors, peer educators, support group leaders. However, its a top-down process and health implementers consider contribution of PLHAs as an unavoidable process, although explicit and implicit effects remain generally unforeseen and unexplored. Contribution of PLHAs comes neither from the patients nor from Cambodian actors decision and feedbacks have only been justified a priori by international organisations. In order to grasp perceptions and strategies of local stakeholders inherent to expert patients model, we undertook an anthropological study focused on the arising of this new category of care givers. Our aim is to highlight the nature and the scope of expert patients contribution in the dynamics of improving HIV programs, in the socio-cultural context of Cambodia. | ||||
| Method / Issue: An anthropological investigation is carried out in Phnom Penh and in three provinces (Battambang, Kandal, Siem Reap) where the expert patients s dynamic of implication gets some particularities due to provincial specificities. During a period of two years (2006-2007), various profiles of social actors linked to this initiative are followed. Semi-directed interviews, open discussions and observations are carried out with 1) expert patients involved in HIV 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 and expatriates, who are supposed to encourage this policy. | ||||
| Results / Comments: Preliminary gaps were identified between health officers expectations and local bodies motivations. This model is attractive for donors owing to subsequent ideology spread through this initiative: it rises civil society mobilisation and it gives to the grass-root level the opportunity to express ideas and participate to the decision. Nevertheless, this process promotes PLHAs in a country where civil society is emerging and awaken by western organisations. Moreover, Cambodia is managed by a general top-down decision making process which disrupts involvement of expert patients. Actions of this new stakeholders are bound to be limited at the grassroot level. | ||||
| Discussion: If this model promotes PLHAs, the latter mainly execute orders, strategies and principles from the top level. Expert patients activities are restricted by their professionnal circle given the fact they are often considered as forces of opposition or troublemakers. By drawing our attention on reinterpretations of this model by local bodies, we highlight how this model is anchoring into cambodian health policies. | ||||
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