Escolar Documentos
Profissional Documentos
Cultura Documentos
2009
Hancart Petitet Pascale., “They only have to use condoms!” Social aspects of
contraceptives use amongst ARV users in Cambodia. Research perspectives.
International workshop on The Impact of HIV/AIDS and its Treatment in Asia Chiang
Mai, Thailand, 19-21 February 2009
Aim: According to WHO's Medical Eligibility Criteria for Contraceptive Use, most of
contraceptive methods are considered to be safe and effective for HIV positive
women. However, in Cambodia, we found that it is generally assumed by caregivers
and PLWA representatives that people leaving with HIV/Aids only have to use
condoms. The aim of this paper is to describe firstly, caregivers and PLHWA’s reason
for not considering other contraceptive options for people on ART. Secondly, we will
investigate various social factors that lead people under ART to use other birth
spacing methods like contraceptives pills, Depo-Provera injection, contraceptive and
abortive “Chinese pills” as well as abortion.
Results: The analysis shows various factors that lead caregivers and representatives
of PLHWA not to consider methods different from condom for birth spacing practices
amongst people under ART. Those factors are related to the consensus about the
need of dual protection for people living with HIV, to medical assumptions that are
not validated anymore in the scientific community (drugs interaction leading to
decrease efficacy of ARV treatment) and to social categorizations of patients
(condoms user described as the good ART patient, reproductive health care refusal
for PLHWA). Our data suggest also that many other factors lead people under ART
not to use condom. Those factors are related to the discomfort with male condoms
expressed by people and to women difficulties to negotiate safer sex. Various
common social representations on contraceptives secondary effects or lack of
knowledge on contraceptives drugs lead also some women to go for abortion. Finally,
the fear to talk about such subject with caregivers appears also to be an important
Discussion: From a theoretical point of view, this study suggests relevant hypotheses
for the anthropology of reproductive health. For example, we may consider why, how
and to which extend social norms in the field of reproduction are build and
interpreted in the Cambodian context of AIDS. From the perspective of applied
research, those findings demonstrate the necessity to consider seriously the need of
contraception for people undertaking ART. This issue raises a problem for public
health, as many women go for unsafe abortions or other treatments like
contraceptive and abortive “Chinese pills” (whose effects on ARV treatment have not
yet been documented). From an ethical point of view, there is a need for people
under ART, as for everybody, to receive accurate information on contraceptive
methods and to get benefit from counseling sessions that will help them choosing
the best adapted one.
2007
Hancart Petitet P, Samuel NM, Desclaux A, Pragathi « Missed opportunities for HIV
PMTCT: A case study in South India . Abstract n°61 International Conference Aids
Impact Marseille 1-4th July.
Aim: In India, PMTCT programs are available at tertiary hospital level and numerous
women, particularly, when living in remote areas do not have access to those
services. Others, living in cities are not receiving the correct information about
PMTCT, or are not able to follow the entire protocol required by caregivers. For
various reasons some women are lost of for follow up. The aim of this paper is to
describe the various social factors that do contribute to missed opportunities for
PMTCT.
Results: The analysis of factors for transmission shows the intricacy of various social
factors that limit women’s access to PMTCT. For example: social categorization of
patients done by health care givers when deciding whom to test or not; economical
factors that limit the possibility of women to follow the rules required by protocols;
social factors that shape discrimination and stigma of HIV infected people;
inadequacy of ethical norms edited by international health institutions that are
sometimes difficult to implement in some contexts. Some factors are related to the
poor living conditions of women in rural areas, others are related to relationships
between pregnant women and the health system, mainly through their interactions
with health workers.
Results: The analysis of factors for transmission shows the intricacy between
biological and social factors, such as the length of labour due to poor management of
delivery in some health services for women from low social status. In each setting,
some factors are specially related to HIV (such as women’s low level of knowledge
about AIDS or unavaibility of HIV testing), when others are not (such as high
frequency of C-sections in hospitals and private clinics). Most factors are related to
relationships between pregnant women and the health system, mainly through their
interactions with health workers.
Discussion: These data are relevant for the on-going debate about the involvement
of Traditional Birth Attendants in decentralization of PMTCT, which meets the issue of
changes in women’s roles in the time of AIDS. They are also relevant when
considering the consequences of delivery for women’s health, including iatrogenic
transmission and opportunities for HIV care, a topic that has often been neglected.
Aujourd’hui en Inde, pour de nombreuses femmes des zones rurales le sida reste
une maladie peu connue. La plupart ont entendu parler de cette maladie. Cependant
peu connaissent les modes de transmission du VIH et les moyens de s’en protéger.
Par ailleurs, les personnes infectées par le VIH sont souvent victimes de
stigmatisation et d’actes de discrimination. La faible réponse initiale du
gouvernement face à l’épidémie, sa résistance face aux mises en garde des
institutions internationales quant à la diffusion d’une épidémie indienne à VIH et le
maintien de son discours moralisateur et conservateur sur l’épidémie auraient retardé
la mise place des actions nécessaires. La position gouvernementale est peu claire.
L’étendue de l’épidémie ne fait pas non plus consensus. Je propose de rendre
compte de certains aspects conflictuels autour de la lutte contre le sida en Inde du
Sud ; d’abord selon du point de vues des femmes d’un village des environs de
Pondichéry, puis selon une perspective plus large, à l’échelle nationale. Enfin nous
verrons comment l’accès à un programme de réduction de la transmission mère-
enfant du VIH est aussi une source de conflits divers pour les patients et pour les
soignants chargés de sa mise en œuvre. Cette ethnographie des conflits propose
donc une lecture des normes, des valeurs, des règles éthiques et des intérêts divers
que l’épidémie de sida, « réformateur social », vient révéler.
2006
« Rencontre des savoirs autour de la naissance, les cas des matrones au Tamil
Nadu ». séminaire organisé par l’Association des Jeunes Etudes Indiennes, Savoirs et
Dans les pays du Sud, les matrones sont la cible de programmes de développement
variés et l’objet de nombreuses recherches dans le domaine des sciences sociales.
L’Inde ne fait pas exception comme en témoigne l’abondante littérature scientifique
et/ou militante à leur sujet. Les matrones sont l’objet de discours opposés et
contradictoires. Ces derniers conduisent grossièrement à distinguer les « pro-
matrones », persuadés de la nécessité de ces praticiennes dans le champ de la santé
de la reproduction, et les « anti-matrones » convaincus de la nuisance de leurs
pratiques. En adoptant un point de vue émique, je propose de montrer l’impact de
ces formations, ou de leur absence, sur les pratiques des matrones en Inde du Sud.
En effet, face aux pressions exercées par les représentants locaux du système
biomédical et afin de répondre à la demande des patientes pour des soins
« modernes » de l’accouchement, les pratiques des matrones sont transformées. Ce
sont des pratiques variées et syncrétiques agencées pour tenter de satisfaire les
exigences des nouveaux contextes. Certaines matrones, revendiquent la spécificité
de leurs pratiques comme une variation et une recomposition de celles
recommandées et pratiquées en milieu biomédical. D’autres matrones, voient leur
statut de praticienne et leurs soins dévalorisés. Entravées dans leurs activités
d’accoucheuses, le manque de pouvoir social et d'opportunité de ces dernières
paralysent la réadaptation de leurs pratiques aux nouvelles demandes de soin. Ainsi,
cette communication vise à décrire les causes, la mise en œuvre et les effets des
transformations contemporaines des savoirs et des pratiques des matrones dans le
contexte de la bio médicalisation de l’accouchement.
« State of the Art: PMTCT and Counselling », Second Annual IS-Academy Expert
Meeting on HIV/AIDS, Rethinking HIV/AIDS Preventive Counselling.13-14 November.
ASSR, Amsterdam.
Objective: Today, there is a common assessment that broadly 15% of HIV infected
pregnant women involved in HIV Prevention of Mother to Child Transmission
(PMTCT) protocol escape at the time of delivery. They give birth at home with
Traditional Birth Attendants (TBAs). In some part of India, women of remote rural
areas also deliver at home with TBAs, without any PMTCT care, as such programs
are only available in few health care services. In such context it is highly relevant to
explore the possibility to provide HIV PMTCT care during home delivery. Methods:
This paper presents results of a research Project « HIV Transmission amongst
birthing practices in Southern India, anthropological approach » which aim was to
study delivery practices in various system of birth (from biomedical to traditional
setting) in the context of HIV/Aids. Results: The study of birthing practices in rural
areas points out the lack of awareness of TBAs as well as rural women on HIV/AIDS.
It also shows TBAs practices that may increase (such as late cut of the cord) or
decrease (such as the absence of artificial rupture of membrane) the HIV MTCT.
Conclusions: Women delivering at home should also benefit of HIV PMTCT.
Prevention should then be adapted to local contexts and cultures to reach as many
women as possible. Relevant activities can be done in order to provide HIV PMTCT in
home delivery care.
Birth Practices Today. The Popular Representation of the Rise of Caesarean Section
In India Healing Today Soundings in the contemporary fashions of Indian medicines
International Seminar. 28.10.2005. French Institute Pondicherry.
Les données présentées ont été recueillies dans le cadre du projet de recherche
« Transmission du VIH et pratiques d’accouchement en Inde du sud, approche
anthropologique » initié par Centre de Recherche Cultures, Santé, L’objectif général
de ce projet est d’éclairer la façon dont les facteurs sociaux et culturels relatifs à la
conception, la grossesse et l’accouchement, au sein d’un contexte donné, accroissent
ou non la vulnérabilité de l’enfant à naître à l’infection par le VIH. J'ai choisi de vous
parler des matrones parce qu'en tant qu'institution sociale elles représentent un
prisme à l'étude des représentations et pratiques autour de la naissance. Dans un
premier temps de cet exposé, je présenterai les enjeux des formations des matrones
en Inde. Dans un deuxième temps nous nous intéresserons au cas particulier de
Satchadie une matrone de Pondichéry et aux transformations contemporaines de ses
savoirs et pratiques. L'objectif de cette présentation est de montrer comment des
approches théoriques diverses de l'anthropologie de la reproduction permettent de
mettre en évidence certaines logiques culturelles, sociales et politiques, individuelles
et collectives, en œuvre lors de l'événement de la naissance.
HIV Transmission and Delivery Care in South India: Theoretical approach and
practical issues. SSR-WISER seminar Risks and realities of HIV-AIDS in everyday
lives: Ethnographic insights and implications for Policy. October 6th & 7th 2004,
Amsterdam
In Southern India, HIV MTCT programs have been started in some governmental
hospitals and by some NGOs but it exist neither in private clinics nor in rural areas
where deliveries are conducted at home by the so called “Traditional birth
Attendants”. In such context, the distance that separates HIV MTCT
recommendations of International Health Organizations from the actual delivery
practices at home may be viewed as an extremely fertile field of study of the diverse
social factors which condition the actual implementation of the envisaged safeguards.
This paper presents the main preliminary results of a research Project “HIV
Transmission amongst birthing practices in Southern India, anthropological
approach”. The specific objectives are to: 1) set up an ethnography of child-birth
practices for studying the underlying causes of HIV MTCT 2) analyze the variations
in the practices in various systems of birth (traditional, semi traditional and
biomedical) 3) evaluate the applicability of the preventive measures recommended to
health care providers as well as to TBAs. I will consider the question of MTCT from
the point of view of public health and then suggest research perspectives in four fold
approach of anthropology of reproduction presented by the problematic of MTCT and
HIV: “socio-cultural”, “medical”, “social change” and “political” approach. In using
the frame given by the four fold approach, I will present the problematic of HIV
PMTCT from the perspective of the Home Delivery Practices of TBAs.
Notes on the sanitary, social and political stakes of Traditional Birth Attendant’s
training in India International Workshop Mirrored Views on Healing Systems in
India : Merging Policies, Politics and Practices, 19th and 20th of April 2004, French
Institute of Pondicherry. India.