Vulnérabilité sociale et accessibilité aux soins de santé chez les travailleuses de sexe séropositives dans la ville de Yaoundé

Abstract

HIV and AIDS still represent a real public health problem. Despite three decades of struggle for their eradication, they still constitute a real threat to the international community in general and to Cameroon in particular. Several programmes and projects have been implemented by public sector actors (Ministry of Public Health) and by private sector actors such as national and international bodies, non-governmental organisations and associations. The non-profit association Horizons Femmes, for example, through the "CHAMP" project, works in the care of sex workers who, according to the National AIDS Control Committee (NHCC), have a worrying seroprevalence rate of 36.7. Given that the activity in which this "high-risk" group engages puts them in permanent interaction with other social strata, the specific aim of this work is the analysis of the determinants that fuel their socio-sanitary vulnerability and health ‘care accessibility in Yaoundé City. Moscovici’s « social representation’s theory », Bourdon’s « methodological individualism (1965), Kleinman’s (1975), « explanatory model », Andresen (1995) and Adey’s (1998) « resort model » and Arrow’s (1963) « micro economy theory» were used as theoretical foundations to the study. Qualitative data’s collection methods and technics were used as well. As datas collection tools, the study focused on documentary observation, direct observation, semi direct interviews and life’s stories. As far as sampling technics are concerned, on-site sampling was the main sampling technic used in the study. To this effect, the study relied on one hundred and twenty (120) respondents among which were one hundred (100) HIV positive FSW, ten (10) from health ‘care structures and the other remaining were care staff workers from “Horizons Femmes” (10). There were personals as Community’s Mobilization Officers (CMO), Relay’s Advisors (RA) who works in sanitaria’s institutions, Pear leaders (PL), Psycho-socials ‘Advisors (PSA), the receptionist, the nurses, laboratory technicians, doctors who are in charge of HIV-positve female’s sex workers and « CHAMP »’s project responsible in « Horizons Femmes » notably the DIC Manager. Ethical aspects have been taken into consideration. In fact, ethical code document was obtained at the regional health delegation of center. In the field, confidentiality and anonymity’s principles have been used to protect HIV-positive female sex workers and health ‘care personal identities.The main results of the present sociological study conducted among 100 HIV-positive female’s sex workers was concerned firstly their socio-sanitary vulnerability factors and therapeutics’ choices. Then, the analysis informs about institutional arrangements that the health Ministry and Horizons Femmes’association put in place in the HIV-positive female sex workers’ take in charge. After this reflexion identifies HIV-positive female sex workers’ perceptions about health’s benefits given by the above bodies. Finally, the results show that their therapeutics’ choices do not always follow the guidelines prescribed by biomedical staff, due to factors related to both their social environment and structural constraints related to access to health care in hospital institutions in Cameroon.