Back to basics in HIV prevention: need for a systemic approach
Editor – The paper by Pisani et al reports that a commonsense
approach based on simple country by country analyses could improve the
efforts to prevent HIV infection.1
Therefore as public health doctors, we find that this approach is always
too limited and we venture to say "we have never been modern". The
partition of knowledges and expertises compels us, contempories, to
redesign our modernity in front of constraints imposed to changes and
innovations by man and society. New knowledges are emerging to fill the
gap between theory and process to knowledge, between knowledge and psycho-
social reality of individuals and societies.2
With AIDS, the question is to put our questioning in centre of the
thinking. The AIDS problem puts forward the ambivalence of a systemic
approach and different nets with individual training identities,
specialisations, expertises, institutions. It is indeed a public health
questioning : how far are we prepared to understand our systems and nets
though such a complicated problem, AIDS.
And now we have this opportunity. Before analysing the situation or
proposing strategies of action, we must first understand. Understand the
individual, drug addict person, prostitute person, young person, person in
the street, married person, the person him(her)self. The understanding of
the personal and temporal vulnerability multiplies endlessly specific
situations.3 To understand this individual within his group, a closed or
open system reflection of his society and his own context. To understand
the intricate net of micro, meso and macro systems of organisation in
which behaviours and attitudes leading to the development of the disease
get into place.
There appears to be a disproportion in competences capacities in the
health system against a much wider problem. First step is to ascertain it.
Then one must question oneself on the part the health system must play in
this intricate net. How far is the health system capable of adapting
itself to the needs of this disease and these patients. But above all how
far can the health system improve the well-being of the persons, their
family and friends confronted with the risk of sero-positivity and the
disease.
Part of a wider net, the health system can now consider his own concepts
of "integration" and "globality". Confronted to the individual or to the
system in its whole, these concepts have to be reconsidered when
approaching AIDS in health. How far will a program approach of a health
problem like AIDS lead to the development of a net of competences and
capacities able to respond to the demand of a multidisciplinary vision in
order to install necessary "global" strategies?
How far is the decentralised health system more capable to adopt social
and environmental dimensions needed for this approach? What are the
different mechanisms that the health system can install in order to better
understand the answer given to AIDS within the associative, social and
family net. How can we add the technical answer to the sociological,
psychological and economical answer?
Surely the health system can give a coherent technical, integrated and
global answer. In public health, some "verticalist" have adopted a
systematic tendency integrating more the health system, others have gone
further in imposing a systemic approach to all their actions in public
health, be it AIDS related problems. With AIDS, an additional dimension
is put forward, which includes the idea of net, superior to the system and
favourable to the emergence of a dual way of thinking, cross-roads to
sociological, epidemiological, medical, psychological, anthropological,
political, philosophical sciences.
References
1. Pisani E, ,Garnett GP, Grassly NC, Brown T, Stover J, Hankins C, Walker
N, Ghys PD. Back to basics in HIV prevention: focus on exposure. BMJ
2003;326:1384-87.
2. Delor F, Hubert M. Revisiting the concept of 'vulnerability'. Social
Science & Medicine 2000;50 (11):1557-70.
3. Groupe Thématique ONUSIDA Maroc. L'approche culturelle dans la lutte
contre le VIH/SIDA. Regional Conference, Fès (Maroco), 2001.
Rapid Response:
Back to basics in HIV prevention: need for a systemic approach
Editor – The paper by Pisani et al reports that a commonsense
approach based on simple country by country analyses could improve the
efforts to prevent HIV infection.1
Therefore as public health doctors, we find that this approach is always
too limited and we venture to say "we have never been modern". The
partition of knowledges and expertises compels us, contempories, to
redesign our modernity in front of constraints imposed to changes and
innovations by man and society. New knowledges are emerging to fill the
gap between theory and process to knowledge, between knowledge and psycho-
social reality of individuals and societies.2
With AIDS, the question is to put our questioning in centre of the
thinking. The AIDS problem puts forward the ambivalence of a systemic
approach and different nets with individual training identities,
specialisations, expertises, institutions. It is indeed a public health
questioning : how far are we prepared to understand our systems and nets
though such a complicated problem, AIDS.
And now we have this opportunity. Before analysing the situation or
proposing strategies of action, we must first understand. Understand the
individual, drug addict person, prostitute person, young person, person in
the street, married person, the person him(her)self. The understanding of
the personal and temporal vulnerability multiplies endlessly specific
situations.3 To understand this individual within his group, a closed or
open system reflection of his society and his own context. To understand
the intricate net of micro, meso and macro systems of organisation in
which behaviours and attitudes leading to the development of the disease
get into place.
There appears to be a disproportion in competences capacities in the
health system against a much wider problem. First step is to ascertain it.
Then one must question oneself on the part the health system must play in
this intricate net. How far is the health system capable of adapting
itself to the needs of this disease and these patients. But above all how
far can the health system improve the well-being of the persons, their
family and friends confronted with the risk of sero-positivity and the
disease.
Part of a wider net, the health system can now consider his own concepts
of "integration" and "globality". Confronted to the individual or to the
system in its whole, these concepts have to be reconsidered when
approaching AIDS in health. How far will a program approach of a health
problem like AIDS lead to the development of a net of competences and
capacities able to respond to the demand of a multidisciplinary vision in
order to install necessary "global" strategies?
How far is the decentralised health system more capable to adopt social
and environmental dimensions needed for this approach? What are the
different mechanisms that the health system can install in order to better
understand the answer given to AIDS within the associative, social and
family net. How can we add the technical answer to the sociological,
psychological and economical answer?
Surely the health system can give a coherent technical, integrated and
global answer. In public health, some "verticalist" have adopted a
systematic tendency integrating more the health system, others have gone
further in imposing a systemic approach to all their actions in public
health, be it AIDS related problems. With AIDS, an additional dimension
is put forward, which includes the idea of net, superior to the system and
favourable to the emergence of a dual way of thinking, cross-roads to
sociological, epidemiological, medical, psychological, anthropological,
political, philosophical sciences.
References
1. Pisani E, ,Garnett GP, Grassly NC, Brown T, Stover J, Hankins C, Walker
N, Ghys PD. Back to basics in HIV prevention: focus on exposure. BMJ
2003;326:1384-87.
2. Delor F, Hubert M. Revisiting the concept of 'vulnerability'. Social
Science & Medicine 2000;50 (11):1557-70.
3. Groupe Thématique ONUSIDA Maroc. L'approche culturelle dans la lutte
contre le VIH/SIDA. Regional Conference, Fès (Maroco), 2001.
Competing interests:
None declared
Competing interests: No competing interests