Adapter les pratiques médicales au terrain : maternité et VIH en Guyane et à Saint-Martin

Abstract

Because of its high prevalence, HIV in pregnancy is a major public health issue in French Guyana and Saint Martin, particularly since the risk of transmission to the child can be significantly reduced through pharmacological treatment. Most of the HIV-infected women in these areas are immigrants living in highly precarious circumstances. This study examines the capacity of the healthcare system to adapt to the specific social characteristics of overseas regions, focusing in particular on perceptions of the risks associated with pregnancy among HIV-infected women and the social inequalities affecting adherence to HIV treatment. Semi-structured interviews were conducted in Cayenne, Saint-Laurent du Maroni and Saint-Martin with 19 HIV-infected women and 54 social and health care professionals. Observations (medical consultations, therapeutic education consultations, discussion groups, medical meetings) were also conducted to complete the data set. The results show that professionals tend to use the most significant concern expressed by HIV-infected women - i.e. the risk of transmitting their infection to their child - as an opportunity to promote the active involvement of patients in their own care and the health care of their children by encouraging them to adhere to their treatment. The study found that professionals seek to lessen the impact of social inequalities on patient adherence to the treatment in a context of social stigmatization linked to the particular status of their patients as HIV-infected women, undocumented migrants, and ethnic minority members. The example of HIV in pregnancy illustrates the capacity of the healthcare system to reduce the impact of social inequalities on health and highlights the significant negative impact that a reduced commitment to this issue would have.