Abstracts
Résumé
Cet article présente une synthèse des principaux aspects traités par la littérature internationale de sciences humaines et sociales (SHS) depuis l’apparition des multithérapies antirétrovirales en 1996. Initialement sollicitées pour contribuer à l’observance de ces traitements, les SHS ont permis de dépasser l’approche «prédictive», jusque là dominante dans les disciplines biomédicales, qui visait à identifier sur la base d’un nombre limité de caractéristiques a priori les patients censés présenter un «haut risque» de non-observance. Elles ont montré que l’observance est un processus d’apprentissage dynamique qui dépend avant tout de l’expérience subjective vécue par les patients. La «chronicisation» de la maladie VIH a conduit les SHS à s’intéresser à l’impact des traitements sur tous les aspects de la vie quotidienne (de l’insertion professionnelle à la sexualité), en même temps qu’elles soulignent la contradiction entre les espoirs suscités par des multithérapies économiquement coût-efficaces d’une part, et la précarité sociale d’une proportion croissante de personnes atteintes, d’autre part. Ces recherches débouchent sur des recommandations visant à adapter les politiques publiques de lutte contre l’épidémie de sida tout en préservant le potentiel d’innovations qu’elles ont favorisé dans les systèmes de santé et de protection sociale, ainsi que dans les relations médecin/malade.
Summary
This article presents a synthesis of the main topics covered by social science research (SSR) on HIV/AIDS, since the advent of highly active antiretroviral therapies (HAART) in 1996. SSR has shown that non-adherence cannot be reliably «predicted» on the sole basis of a few a priori patient characteristics that clinicians could easily identify before initiation of HAART, and that a dynamic approach to adherence, continuously monitoring the impact of patients’ subjective experience with HAART is needed. In relationship with the evolution of HIV infection toward a «chronic disease», SSR has dealt with the impact of HAART on all aspects of patients’ daily lives (from employment and professional status to sexuality). It has also emphasised the potential contradictions between the hopes generated by these cost-effective therapeutic advances, on the one hand, and the high social vulnerability of a growing proportion of people living with HIV-AIDS, on the other hand. Finally, SSR suggests recommendations for «normalising» AIDS public policies without losing the potential for innovations that the fight against this epidemic has introduced in health care and «Social Security» systems, as well as physician-patient’s relationships.
Appendices
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