Precarious Populations Research Articles

HYPERTENSION AND DIABETES DUAL SCREENING ACTION BY A TERRITORIAL PROFESSIONAL HEALTHCARE COMMUNITY (CPTS) USING MAY MEASUREMENT MONTH (MMM) 2023 PROTOCOL: THE FUTURE?

Objective: In France, there are 17 million hypertensive (25.5% of the population) and 3.6 million diabetics (5.4% of the population). This prevalence is higher in precarious populations such as those in Seine-Saint-Denis. In response to these findings, the Bobigny-Bondy CPTS, in collaboration with our ESH center, has set up a 7-stage screening program (one of which incorporates MMM protocol adapted in French by the French Society of Hypertension (SFHTA)) for these two chronic diseases. The aim of our study is to disseminate data obtained from a sample of adults in Seine-Saint-Denis during joint ’Hypertension and diabetes’ screening actions in 2023. Design and method: Seven stages of action with our population were carried out (reception, biometry, nurse interview, dietetic interview, associative interview, medical interview) (1. Diagram). The MMM protocol, adapted in French by the SFHTA, was also proposed to each participant. Results: General anonymous data for this population of 469 subjects (including 275 F) are summarize in Table (2). In this population, 38.6% declared hypertension. Of the non-hypertensive sample (n=279), 24.4% of participants presented with averages above 140/90 mmHg and 10.4% with grade 2 hypertension. As for diabetes, 18.8% of the sample claimed to be diabetic, and 8.3% of fasting participants presented with blood glucose levels suggestive of diabetes. This joint city/hospital screening program, initiated by a CPTS, confirms the high prevalence of these pathologies in our population, with more than half the participants screened concerned with hypertension and more than a quarter concerned with diabetes. Conclusions: Developing prevention and screening actions according to the needs of a population is a priority mission for CPTSs. In the case of hypertension, the MMM kit proposed by the SFHTA has helped to establish part of the framework for action. Ministerial health authorities will need to provide more resources to encourage screening not only for diabetes, but also for frequent cardiovascular diseases such as hypertension, since their association can be ’explosive’, as in the case of COVID.

Migration in French Guiana: Implications in health and infectious diseases

In French Guiana, more than a third of the population, and nearly half of the adults, are of foreign origin. This immigration is explained by the French standard of living, which is attractive to nationals of surrounding countries. Infectious diseases remain in the top 10 causes of premature death, often in the most precarious populations. In this context we aimed to synthesize the state of the knowledge regarding immigration and infectious diseases in French Guiana and the general implications that follow this diagnosis.For HIV, although the majority of patients are of foreign origin, estimates of the presumed date of infection based on CD4 erosion modelling and from molecular analyses suggest that the majority of transmissions in foreign-born individuals occur in French Guiana and that the Guiana shield has been a crossroad between Latin America and the Caribbean. Among key populations bridging these regions illegal gold miners are very mobile and have the greatest proportion B Caribbean HIV viruses. Gold miners have been a key vulnerable population for falciparum malaria and other tropical diseases such as leishmaniasis, leprosy, or leptospirosis. The complex history of migrations in French Guiana and on the Guiana Shield is also reflected in the fingerprinting of mycobacterium tuberculosis and the high incidence of tuberculosis in French Guiana, notably in immigrants, reflects the incidences in the countries of origin of patients. The high burden of infectious diseases in immigrants in French Guiana is first and foremost a reflection of the precarious living conditions within French Guiana and suggests that community-based proactive interventions are crucial to reduce transmission, morbidity, and mortality from infectious diseases.

Dear food: Yuca’s relational role in sustaining precarious populations in Ecuador

In this article, we argue that communities’ relationship to food helps to shape their experiences of crises. The French term la vie chère – dear life – simultaneously invokes affective relations, collective valuations, and high prices, pointing to the importance of all these dimensions in understanding experiences and responses to rising costs of living. In this sense, the ways through which people apprehend and experience the cultivation and consumption of food influence their possibilities for material sustenance. The study compares the role of yuca, a regional word for cassava, in a coastal and in an Amazonian province of Ecuador, in order to shed light on trajectories of social reproduction in contexts of scarcity. Key to the divergent experiences of cassava in these two sites are histories of colonization and exploitation of land and people that shape social and human–nature relations, as well as expert studies that define and reinforce the tuber’s relational role in diverse ecologies.

An Archipelago of Aid

Community pantries proliferated in the Philippines to address the corporeal hungers debilitating Filipino bodies and the Philippine body politic at the height of the COVID-19 pandemic in 2021. These initiatives saw Filipinos contributing their physical labour, material resources and cultural capital to the widely celebrated cause and demonstrating expanded notions of compassion and community spirit in the face of bureaucratic mismanagement and government neglect. Many have since lauded this socio-civic phenomenon, calling it ‘a silent revolution’, ‘a ray of sunshine amidst the stories of gloom’ and an indicator of the Filipino people’s generous ‘will to give’. Examining an array of materials such as interviews, photographs, news features, video recordings and other online resources that lay bare the bodily, visual, and discursive components of these civic engagements, I show in this article how community pantries constituted a scattered and spontaneous yet coordinated network of action that mirrored the archipelagic formation of the Philippines. This ‘archipelagic effect’ involved differently stationed Filipinos who formed autonomous or interconnected collectives and engaged in improvised and shape-shifting mechanisms with the view of not only extending immediate aid to the hungry, the homeless, and the unemployed but also reworking existing socio-political structures. Such an effect also included an unprecedented convergence and circulation of goods, bodies, talents, ideas, images, creative and critical initiatives, cultural practices, and ideological commitments from across the country. I argue that this mode of doing politics, activism, and social work deviated from the ‘patronizing logics of philanthropy’, countered statist efforts of controlling the Filipino people, and accentuated a type of expressive resilience and embodied resistance that was, indeed, central to a vernacular formulation of action hunger. I conclude the article with reflections on the importance of performative solidarities – how people come together, share their resources and provide nourishment to others – in foregrounding the usefulness of the arts and other embodied acts in establishing a liveable life for precarious populations caught up in tense political climates.

Major depressive disorder in post-secondary students attending foodbanks in France.

Poor mental health among youth is a major public health issue that has risen to the forefront since the COVID-19 crisis, especially among post-secondary students and precarious populations. The objectives of this work were to evaluate the rate of major depressive disorder (MDD) among precarious post-secondary students in the greater Paris region, to describe its risk factors, and to identify determinants for not seeking care. We conducted a multi-site, cross-sectional survey of post-secondary students attending a selection of 13 student foodbanks in the greater Paris region (France) between 30 November 2021 and 27 January 2022. This study had two complementary epidemiological and sociological components: a quantitative description of MDD through completion of a questionnaire performed through face-to-face or telephone interviews, and a qualitative assessment of the factors underlying MDD through in-depth follow-up interviews conducted among a sub-selection of students who participated in the first phase. Among 456 students who participated in our survey, 35.7% presented with MDD. The risk of suffering from MDD was higher among women, students housed by third-parties, students reporting moderately to severely hungry and/or poor physical health. Students receiving material and/or social support were less likely to present with MDD. Among students who reported needing health care in the last year or since their arrival in France, 51.4% did not seek care. To address poor mental health among precarious students, policy action must jointly consider financial precarity, administrative barriers, housing, food security, physical health, and access to health services, especially mental health.

On the Edge: Straddling (Anti)normativity in Queer Performance

In Living a Feminist Life, Sara Ahmed explains that precarity is akin to a vase on the mantelpiece. If it were pushed even slightly, it would fall off the edge. Existence on that edge, Ahmed explains, is what we allude to when we discuss precarious populations. Patriarchy, racism, ableism, homophobia, and transphobia are violent forces. They threaten to push us over the edge. Queer performance often begins in this in-between state on the mantelpiece, not quite fallen, not quite stable, negotiating, and straddling a balance between holding on to a fragile state and falling off the mantle entirely. In this article, I analyze the Queer Pride Inside Cabaret (June 2020), the first official partnership between Buddies in Bad Times Theatre, the largest and longest running queer theatre in the world, and the CBC, a Canadian federal Crown corporation and national public broadcaster. In considering the mainstream producers and the radical queer artists showcased, I refuse a simplistic antinormative/normative binary in queer performance in Canada and make space for accessing resources from the mainstream, while rejecting inequitable systems of oppression. If queer theatre is intended to break down ingrained static and naturalized assumptions of everyday practices, how do we understand queer performance through contradictions and incoherence? Can we simultaneously fuck the system and accept our complicity within it? Complicating the unique and diverse ways artists opt-in and out of mainstream queer presence, this article looks at creative practices that challenge and promote continuing legacies and failures of queer performance in Canada.

Municipal socialism and the impact of urban decay: the case of Nevers, a mid-sized town in Central France (1971–2020)

Nevers, a medium-sized city of 33,000 inhabitants in the centre of France, has long been regarded as a laboratory for municipal socialism as well as for the union of the left. The socialist party has dominated the local political scene for more than four decades. In 2014, however, a list without any party label put an end to this hegemony by winning the election. The 2020 municipal election confirmed the changeover: the outgoing list won the election, this time in the first round. How to explain this lasting change in a city that has long been a socialist city, in favour of an "apolitical" list that does not benefit from partisan resources? If this change is part of a more general movement, characterized by the decline of the “Parti socialiste” (PS) and the “Parti communiste Français” (PCF), we will show that it is also rooted in the socio-demographic transformations that the city has undergone in recent decades. Such as many medium-sized French cities, Nevers is indeed confronted with a long-standing phenomenon of urban decline, particularly marked in the central districts. The departure of managers and middle-level professions and the arrival of precarious populations has contributed to the transformation of the electorate, while the theme of decline has become one of the main issues of the last elections. This article thus proposes to examine the evolution of the local political field in the light of the social, economic, and demographic transformations of the territory. To do so, several databases are used in order to quantify and map these transformations: the results of municipal elections since 1971 and census data at municipal level since 1968 and at the neighbourhood level (Iris) since 1990. These data will be put into perspective with archives relating to municipal elections from 1971 to 2020 as well as interviews and observations conducted during the 2014 and 2020 campaigns. In conclusion, the urban decline, in the case of Nevers, has contributed to bring down municipal socialism in two ways: (1) by weakening its electoral base, (2) by imposing a political agenda that the socialist municipal team cannot keep, which will be blamed on them in 2014.

Holding on

What resources do people facing great difficulties linked to the increase in social inequalities between territories use daily? Why do some people in precarious situations move from one region to another and not others? How do these relocations, endured or chosen, contribute to locking them in or giving them back control over their lives? A loss of income or the hope of an easier life may lead to residential relocation to areas where the cost of living is lower (rent, food), where relatives are available to share domestic tasks in the broadest sense. Staying put when neighbors leave, having to leave a neighborhood where the cost of living has risen sharply, seeing one's neighborhood become impoverished, empty, collapsed, seeing adjacent neighborhoods get richer: all these factors obfuscate attitudes towards the future and lead to emotions such as anger, shame, or sadness. These questions are raised by a collaborative social science study that examines the role of economic dynamics and public authorities in the selective collapse of portions of the French territory. The photographic investigation conducted in Tonnerre between 2017 and 2022 is the first unit implemented by this collective research. It focuses on the conditions necessary for photography to be an effective heuristic tool in the service of scientific knowledge. Formally, the work is part of a lineage partially interrupted during the second half of the twentieth century, that of alliances between photography and social sciences forged a century earlier in Europe (Thomson and Smith), in Australia (Gillen and Spencer), and in the United States (Boas and Hastings). The project advocates the notion of photographic and ethnographic practice closer to a craft rather than an art form, a profession rather than an artistic gesture, for production of knowledge at the service of accretion of understanding and interdisciplinary cooperation rather than the competitive search for innovation. On the zoom.able platform, the visual essay unfolds on three levels. The first layer presents a map of the city of Tonnerre that highlights the important structures for the survey: pictograms indicate the entry points to the territory, the caring institutions that allow people to survive, the vacant places that play a key role in the arrival of precarious populations, and the shelters that provide protection from the cold and rain. The second layer shows a selection of portraits, with captions providing information on the different ways in which people have settled in Tonnerre over the past ten years. The framework engages the people photographed at several stages of the production. They have chosen the places where the pictures were taken. They have also chosen the places to which their portraits are linked on the map, either because they spend time there, or because they have in those locations an emotional connection, related to their hopes and doubts. And they have also coauthored the captions accompanying the photographs, to explain their singular relationship to the area. The third layer follows two rationales: the places identified on the map refer to photographic documentation of the territory, while each portrait refers to the resources mobilized to deal with daily life as well as photographic situations. From an epistemological perspective, this is about restoring the gap between the observed world and its photographic representation, a reminder that photographic materials, in order to be usable, must be related to the singular context of their production: the distance between photographer and subject; monochromatic effects; and things that are out-of-frame, such as the photographer's body language during the shoot.

The Impact of the COVID-19 Crisis on the Practices and Mental Health of Psychologists in Belgium: Between Exhaustion and Resilience.

While the COVID-19 pandemic has created psychological distress in the general population and increased the need for psychological care, little research has been done on how mental health practitioners (MHP) have been affected by the pandemic, and these health professionals have received little attention from public authorities. In this article, we focus on psychologists and the impact that the pandemic has had on their mental health and practices by exploring the adaptive and innovative responses generated. This study is based on an online survey (including multiple choice questions, several validated scales, and eight free text items) completed by 187 psychologists (86% female) one year after the beginning of the COVID-19 pandemic in Belgium (February-April 2021). Most participants considered that the crisis had an impact on their well-being and mental health. However, the prevalence of symptoms of depression and anxiety was relatively low (17%; 12%). On the other hand, the majority of psychologists (72%) suffered from a medium level of burnout (BO), 7% suffered from a high level of BO, and only 21% had low levels of BO. Psychologists working in face-to-face settings had the highest scores on the "exhaustion" subscale of the BO, and those working primarily with patients in precarious situations had significantly higher scores of BO and exhaustion. Qualitative analysis of free text items showed that MHP were resilience and developed new frameworks and modes for proactive interventions in order to reach their patients, meet the psychological and social population's needs, and maintain their relationships with the network. In a crisis or pandemic context, public policies should take into account the psychological and social needs of the most socially precarious populations in reinforcing and supporting mental health professionals working in this sector.

Creating Financial Enclosures: The Confluence of Displacement, Aid, and Narcoparamilitary Credit in Colombia

ABSTRACT This article examines the relationship between aid programmes and the expansion of credit and debt in the lives of displaced people who have relocated to Cartagena, Colombia over the last three decades. The article argues that state and NGO-organized aid programmes have contributed to the emergence of urban spaces for financial exploitation in which narcoparamilitary creditors extract interest to profit from displaced populations, spaces I define as ‘financial enclosures.’ In them, faulty aid programmes purportedly created to provide economic stability to displaced people have instead further entrenched their dependency on credit. Financial enclosures are geographic and socioeconomic spaces where people continue to experience the repercussions of displacement as subjects of aid and as indebted precarious workers. The case of Colombia offers important insight into how aid programmes for displaced people contribute to the creation of fertile ground for new forms of financial exploitation of precarious populations. In doing so, it sheds light on how capitalism expands and reproduces to extract profit from people who struggle to subsist in contexts of long-term displacement.

Homelessness during the Coronavirus Pandemic. Exploratory Study in Switzerland

ABSTRACT The coronavirus pandemic has negatively affected people of all social strata, and continues to do so, but its effect has been the most severe on members of the most precarious populations. In this exploratory study conducted in Switzerland, the specific situation of homeless people, a particularly vulnerable population, is examined from a criminological perspective. In total, we surveyed 32 homeless individuals: 14 during the first wave of the pandemic (March-September 2020) and 18 during the second wave (December 2020-March 2021). Results corroborate that the pandemic has had adverse effects on the respondents – both socioeconomic and psychological. Most of the participants do not use drugs and, overall, those who reported drug use did not report an increase during the epidemic. The occurrence of both victimization and offending is low among the participants. Ethical and methodological considerations such as the minimization of social desirability bias, satisficing, as well as the recruitment of difficult-to-reach participants and data collection more broadly during a pandemic are discussed.

Exposure to High Precariousness Prevalence Negatively Impacts Drug Prescriptions of General Practitioners to Precarious and Non-Precarious Populations: A Retrospective Pharmaco-Epidemiological Study.

(1) Background: Precarious patients are more difficult to care for due to low literacy rates and poor adherence to treatment and hospitalization. These difficulties have detrimental effects on general practitioners (GPs), deteriorating medical communication, advice, diagnoses, and drug prescriptions. To better understand how precariousness affects primary care, we tested whether, among GPs, exposure to high precariousness prevalence more severely impacts drug prescriptions to precarious and non-precarious populations compared to low precariousness prevalence. Materials and methods: This pharmaco-epidemiological study, using linear regression analyses, compared the defined daily dose of 20 drugs prescribed by GPs to precarious and non-precarious patients in four French regions with low and high precariousness prevalence in 2015. (2) Findings: Exposure to high precariousness prevalence significantly impacted the prescriptions of nine medications to precarious patients and two medications to non-precarious patients, and distributed into three interaction patterns. (3) Interpretation: The selective over-prescription of drugs with easy intake modalities to precarious patients probably reflects GPs’ attempts to compensate for poor patient compliance. In contrast, the under-prescription of drugs targeting fungal infections in precarious populations and diabetes and cardiovascular diseases in non-precarious populations was seemingly due to a breakdown of empathy and professional exhaustion, causing medical neglect.

TEST AND CURE Towards hepatitis C Micro Elimination by Increase Outreach Linkage to Care by use of HCV Viral Load Real Time Measure and Same Day Treatment

Introduction and objective: HCV treatment for all was effective in France since 2017. HCV testing, diagnosis and treatment of drugs users and precarious people remain low. Lost follow-up was too important since several stages are necessary. Pangenotypic direct antiviral agents were available. Point-of-care HCV RNA testing offers advantage over antibody testing, enabling diagnosis of active infection with real time measure in a single visit. It is missing link between HCV RDT, liver fibrosis evaluation by FIBROSCAN and treatment. Validated Xpert HCV Viral Load assay CEPHEID, fast training technique, allow developing projects of diagnosis to treatment session. Our objective was to evaluate test to cure session allowing the access in 5 hours to an antiviral treatment to vulnerable and precarious populations (drug users, migrants, psychiatric patients). Materials and methods: Eligible patients had to have known positive serology or risk behavior, an unknown or unchecked viral load after antiviral treatment; 5 to 7 patients were recruited per each session by social or nursing interview. Between 9 am and 2 pm these patients had access to measure of the hepatic fibrosis by FIBROSCAN, HCV viral load in real time by CEPHEID Xpert HCV Viral load finger-stick samples, social interview, shared educational evaluation, collective workshops, especially harm reduction, depiction of results by hepatologist and prescription of DAA (sofosbuvir velpastasvir combination) allowed delivery of 1st month of treatment. Specific social and nursing follow-up was made during and after treatment. Compliance and sustained virological rate were determinate at week 12. Results: From October 2019 to December 2021, 223 sessions were realized on 27 sites: 9 drug units, one prison, 17 social units; 1602 patients with drug using history were screened; 427 patients had HCV positive serology and 24 patients did not come; 403 FIBROSCAN measures and 403 measures of viral load in real time were realized. Mean value of liver stiffness was 8.2 and 29% of patients were F3 or F4: 229 patients were HCV RNA positive (56.8%), 57 declared knew their HCV status; 228 treatments began same day, only 1 was delayed due to default social rights; 120 patients had a negative viral load spontaneously and 54 following prior treatment; 399 social interviews and 405 collective workshops were realized. On 31st January 2022, 207 antiviral treatments were completed and 199 patients were cured; 12 patients interrupted treatment; 3 patients relapsed and 5 reinfections; 89% of patients were satisfied with this program. Conclusions: Despite 3 months interruption by COVID 19 pandemic lockdown and sanitary restrictions, 94% of positive participants were linked to care and cure with this mobile clinic model, by screening and RNA real time measure in unity of place adapted to precarious public, patients distant from system of care had access immediately to treatment.

Gabapentinoid use in French most precarious populations: Insight from Lyon Permanent Access to Healthcare (PASS) units, 2016-1Q2021.

Gabapentinoids (i.e., gabapentin and pregabalin) are medications approved for epilepsy, chronic pain, or generalized anxiety disorder. Recently, there have been regular reports of misuse of pregabalin, and to a lesser extent, gabapentin, in particular among opioid and polydrug users. To longitudinally explore the amounts of gabapentinoids dispensed in Lyon's Permanent Access to Healthcare (PASS) units, which offer permanent and free healthcare to precarious populations with no healthcare insurance coverage. We collected the amounts of pregabalin and gabapentin dispensed in the three PASS units of Lyon and calculated the average doses dispensed monthly between 2016 and the first quarter of 2021 (1Q2021), with and without adjustment for the number of dispensing visits. The total doses of gabapentinoid dispensed every month in Lyon's PASS units displayed a 1233% increase for pregabalin, and a 1185% increase for gabapentin, between 2016 and 1Q2021. When adjusted for the number of visits, this increase reached a factor of 8.5 for pregabalin and 8.3 for gabapentin, respectively. However, while the increase in pregabalin dispensing was constant throughout the study period, gabapentin total dispensed doses were more fluctuating over time, and the rise of dispensations was thus less straightforward. Our study reveals a local but substantial increase in gabapentinoid use in populations with no social insurance. These findings should be confirmed more widely and plead for the systematic collection of anonymous patient data in free healthcare centers in France.

SARS-CoV-2 screening among people living in homeless shelters in Brussels, Belgium.

BackgroundSubgroups of precarious populations such as homeless people are more exposed to infection and at higher risk of developing severe forms of COVID-19 compared to the general population. Many of the recommended prevention measures, such as social distancing and self-isolation, are not feasible for a population living in shelters characterised by physical proximity and a high population density. The objective of the study was to describe SARS-CoV-2 infection prevalence in homeless shelters in Brussels (Belgium), and to identify risk factors and infection control practices associated with SARS-CoV-2 positivity rates.MethodsA total of 1994 adults were tested by quantitative PCR tests in 52 shelters in Brussels (Belgium) between April and June, 2020, in collaboration with Doctors of the World. SARS-CoV-2 prevalence is here described site by site, and we identify risk factors associated with SARS-CoV-2 positivity rates. We also investigate associations between seropositivity and reported symptoms.ResultsWe found an overall prevalence of 4.6% for the period, and a cluster of high rates of SARS-CoV-2 positivity (20–30% in two shelters). Among homeless people, being under 40 years of age (OR (CI95%) 2.3 (1.2–4.4), p = 0.02), having access to urgent medical care (AMU) (OR(CI95%): 2.4 (1.4–4.4)], p = 0.02), and sharing a room with someone who tested positive (OR(CI95%): 5.3 (2.9–9.9), p<0.0001) were factors associated with SARS-CoV-2 positivity rates. 93% of those who tested positive were asymptomatic.ConclusionThis study shows high rates of SARS-COV-2 infection positive tests in some shelters, with a high proportion of asymptomatic cases. The survey reveals how important testing and isolation measures are, together with actions taken by medical and social workers during the outbreak.

L’application du droit à l’hébergement comme enjeu sanitaire et économique : étude sociologique de l’accès à l’hébergement à Marseille

L’accueil inconditionnel dans les centres d’hébergement pour les personnes sans abri ainsi que la continuité de leur prise en charge dans des structures adaptées constituent deux éléments essentiels du Code de l’action sociale et des familles en matière de protection des personnes sans logement. Pourtant, il arrive que des consignes officieuses, émanant des services décentralisés de l’État, viennent faire obstacle à l’application du droit inconditionnel à l’hébergement. Cet article analyse la façon dont les obstacles rencontrés par les travailleurs sociaux dans l’application du droit saturent artificiellement les dispositifs d’hébergement des populations les plus précaires et la façon dont ils y font face en pratique.

The Characteristics of Care Provided to Population(s) in Precarious Situations in 2015. A Preliminary Study on the Universal Health Cover in France.

Background: The French Universal Health Cover (CMU) aims to compensate for inequalities between precarious and non-precarious populations, enabling the former to access to free healthcare. These measures rely on the principle that precarious populations’ health improves if healthcare is free. We designed a study to examine whether CMU fails to compensate for inequalities in reimbursed drugs prescriptions in precarious populations. Material and method: This retrospective pharmaco-epidemiological study compared the Defined Daily Dose relative to different reimbursed drugs prescribed by general practitioners (GPs) to precarious and non-precarious patients in France in 2015. Data were analysed using Mann–Whitney tests. Findings: 6 out of 20 molecules were significantly under-reimbursed in precarious populations. 2 were over-reimbursed. The 12 remaining molecules did not differ between groups. Interpretation: The under-reimbursement of atorvastatin, rosuvastatin, tamsulosine and timolol reflects well-documented epidemiological differences between these populations. In contrast, the equal reimbursement of amoxicillin, pyostacine, ivermectin, salbutamol and tiopropium is likely an effect of lack of compensation for inequalities. Precarious patients are more affected by diseases that these molecules target (e.g., chronic bronchitis, bacterial pneumonia, cutaneous infections). This could also be the case for the equal and under-reimbursement of insulin glargine and metformin (targeting diabetes), respectively, although this has to be considered with caution. In conclusion, the French free healthcare cover does not fail to compensate for all but only for some selective inequalities in access to reimbursed drugs prescriptions. These results are discussed with respect to the interaction of the doctor–patient relationship and the holistic nature of primary care, potentially triggering burnout and empathy decrease and negatively impacting the quality of care in precarious populations.

'Known and Feeling Sorrows': Disabled Knowledge and King Lear

This essay argues that King Lear presents a version of disability determined not by bodily authenticity but by bodily knowledge. By staging multiple forms and experiences of disability, the play defies the drive to authenticate and control non-standard bodies that flourished in early modern England. King Lear’s insistence on embodied knowledge both recognizes the unique perspective afforded to disability and resists disability exceptionalism through its attention to populations made vulnerable to impairment. King Lear specifically dramatizes the way disabled knowledge extended to precarious populations by granting Edgar disabled knowledge even though his disability is fraudulent.

Accessibility to oral health care of precarious and non precarious populations in Côte d’Ivoire

Abstract Introduction The purpose of any health system is to guarantee access to care for the entire population served. However, the socio-economic insecurity situation of people in precarious situations, raises the problem of their access to oral health care considered to be expensive. The objective of this study was to compare the dental status and modalities of oral health care use by people in precarious situations to group of non-precarious population in Abidjan, in Côte d’Ivoire. Methods The cross-sectional study was conducted at the University Hospital Center of Treichville. It concerned all users of the dental office of this hospital. Subjects in precarious situations were identified using a screening tool. Was considered to be in a precarious situation, a person living with less than 1.5 USD/day, having no fixed address, looking for a job, having no health insurance or having difficulties in dealing with medical and pharmaceutical costs. We have identified variables for the modalities of oral health care use and follow-up. The frequencies of these variables were calculated and comparisons were made between subjects in precarious and non- precarious situations using the Chi2 test. Results 256 people participated in the study. The tool for identifying precariousness made it possible to distinguish 128 subjects classified in precarious situations and 128 others in non- precarious situations. The number of missing teeth in people in precarious situations was twice as high as in non-precarious subjects. Renunciation of dental care was more common in the precarious group (46%) than in the non- precarious group (32%). Absenteeism rates at the first two appointments were higher among the precarious (54%) than among the not precarious (46%). Conclusions These results show the need to sensitize the population on the importance of oral health and the establishment of social protection mechanisms to ensure greater accessibility to care for people in precarious situations. Key messages Improving the oral health of populations, especially vulnerable population groups, requires the establishment of social protection mechanisms to remove the financial barrier to access to care. Educating the public about the importance of oral health for overall good health is essential to improving the use of dental care.

La prévention du VIH chez les personnes sourdes au Burundi : état des lieux et perspectives

This article presents the various aspects of HIV/AIDS care for deaf people in Burundi to assess social inequalities in health especially the access to preventive care. Our work is particularly focused on identifying the factors that hinder the access of deaf people to HIV/AIDS care in developing countries such as Burundi. The study is based on a literature review and a qualitative study with stakeholders and beneficiaries. The literature review was conducted on reports or other official documents that were made by various stakeholders involved in the fight against HIV/AIDS. A qualitative approach was made of interviews with deaf people and different implied actors in the fight against AIDS. The informations on HIV/AIDS prevention and education is not readily available to the deaf people. They must depend on a third person to access HIV/AIDS prevention and education campaigns. Faced with communication difficulties, deaf people go to health professionals with support from a member of the family, which raises questions of ethics and respect for privacy. They face unequal access to HIV/AIDS prevention and education and then fall into the category of precarious populations. This work opens new avenues for research on the state of access to health care in general and the prevention of HIV/AIDS among deaf people in particular.