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| Abstract #219 - Post-carceral treatment interruption : biographical time vs institutional time | ||||
| Authors: Presenting Author: Ms Meoďn Hagčge - Ecole des Hautes Etudes | ||||
| Additional Authors: | ||||
| Aim: Hypothesis and Problem. The primary hypothesis of this research is that considering conceptions of time in patients' relations to healthcare is crucial to understanding the issue of treatment interruption in the population of HIV-positive, recently released inmates (or 'exmates'). More specifically, gaps between patients' and professionals’ conceptions of what constitutes a significant life event, or of what activities take priority after release (and upon re-entry in the social milieu), can shed light on the crucial public health issue of why and how HIV-positive inmates undergoing treatment delay reintegrating the healthcare system after release. Objectives. The primary objective of this research is to build a comprehensive view of the health trajectories of HIV-positive exmates, that includes patients’ and professionals’ perspectives, and approaches in sociology and epidemiology. | ||||
| Method / Issue: Materials and methods. The mixed methods approach used, combined qualitative (observation, interviews) and quantitative (statistical analysis of medical records) techniques. Biographical interviews of inmates and exmates living with HIV were collected, using interactionist and phenomenological approaches, to look at the power dynamics behind how time is spent, valued, and more specifically, the role of race, gender and class in the recourse to healthcare. This data was then confronted to the statistical analysis of the medical records of a healthcare center for recently released prisoners, to ground and situate this data, while establishing patterns and relationships between life events. | ||||
| Results / Comments: Results. The interviews showed how biographies shape experiences of embodiment : in the French hospital setting, these can be seen as counter-intuitive by healthcare professionals and hinder adequate relations with patients. Chaotic biograhies are common place among the exmates : they have lived through multiples incarcerations, migration, precarious employment and housing, discrimination, lack of social insurance and familial instability. They have also been treated by a variety of doctors, with periodic interruptions and little communication between healthcare centers. These obstacles relegate the body and disease to the background of priorities and activities. Investigating the place of the infection, its discovery, and the doctor-patient relationship in biographies reveals that, to these exmates, these are not considered life events. How they manage and prioritize activities shows that their HIV status is one among many preoccupations - while, in the patient-doctor relationship, it takes primacy. For these men, the behavioral change needed to endorse the patient role required by the healthcare institution is in dissonance with their conception of disease as a life event -a and renders prevention and public health messages inadequate. These results can contribute to explain the high “lost to follow up” rate and low observance of the patients, contrasted by a high prevalence and low treatment rate. | ||||
| Discussion: Perspectives. This study was conceived and made possible by the collaboration with medical professionals and epidemiologists, in a critical social sciences and humanities research perspective. It stays true to a bottom-up approach and focuses both on agents' experiences and on how they are shaped by broader socio-economic, political and cultural forces. Including exmates and professionals in the production of knowledge, or practising “co-construction of research”, and questioning taken-for-granted assumptions about the social world and theoretical frameworks, encourages the use of this research for progressive social change. | ||||
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