Khoudia Sow

Passer de la prévention de la transmission mère-enfant du VIH à son élimination avant 2015 : un objectif irréaliste ? Enjeux sociaux au Sénégal

In 2010, international agencies began to promote the elimination of mother-to-child HIV transmission (EMTCT) in 2015 by proposing a new preventive strategy based on the extensive use of antiretrovirals. For a country like Senegal where the epidemic is considered to be concentrated, since prevalence is beyond 1%, and where the prevention program was fully applied to only 7 to 15% of children exposed to HIV, the objective is ambitious. The pharmacological efficacy of antiretrovirals will not be sufficient if the experience of actors in the field about the social aspects and the acceptability of the program to women are not considered. The aim of this article is to describe the social issues on the basis of two studies conducted in the region of Dakar (an exploratory study of the effects of the new prevention strategies and a study of the experience of patients receiving antiretroviral treatment for 10 years). The results reveal the main issues: community prevention showed its limits at the stage of access to the program and test, which suggests the importance of strategies to promote awareness and prevention that are focused on women; retention depends highly on the attitudes of health workers and on the role of peer counselors, but the integration of HIV testing and treatment in reproductive health services is not fully established; ambivalent perceptions of antiretrovirals complicate adherence; and finally, the organization of health services hinders a family approach of prevention. These results are innovative, since most publications on this topic concern southern and east Africa.

Mobilising experience from Ebola to address plague in Madagascar and future epidemics

www.thelancet.com Published online November 28, 2017 http://dx.doi.org/10.1016/S0140-6736(17)33088-X 1 the rapid knowledge, attitudes, beliefs, and practices surveys proposed by many public health programmes; and adapting public health measures to local contexts. As the Madagascar plague epidemic expands, expert knowledge gained from the Ebola virus disease epidemic will be crucial to address topics that are relevant to both diseases—for example, avoidance of patients by health workers, hiding of the sick by their relatives, resistance to contact tracing and safe burials, over-reaction of the media, and discordance between the biomedical and lay representations of the illness. Anthropologists in Madagascar have been asked to examine burial practices, therapeutic itineraries, and the population’s relationship to (and fear of) global health interventions. Although the contexts are different from the west African Ebola virus disease epidemic, this previous experience is useful to help anthropologists face current situations. On Oct 22, 2017, an epidemic of Marburg virus disease was declared at the Uganda–Kenya border, and social scientists should be rapidly identi fied to join in emergency response efforts. As highlighted by anthropologists working on plague response in Madagascar, relevant connections with other scholars are essential. The contribution of anthropology to addressing the Marburg virus disease epidemic should include circulating relevant theoretical and practical knowledge within the social sciences, adapting findings to share with public health professionals and clinicians, developing appropriate research methodologies, and translating individual experience into collective knowledge and skills. Networks in medical anthropology should be supported to work toward this emergency epidemic preparedness, engage more anthropologists in rapid response efforts, and develop complementary in-depth studies related to haemorrhagic fevers, plague, and other epidemics. Mobilising experience from Ebola to address plague in Madagascar and future epidemics

Social and implementation research for ending AIDS in Africa

Authors Joseph Larmarange, Khoudia Sow, Christophe Broqua, Francis Akindes, Anne Bekelynck, Mariatou Kone Correspondence We need to do our utmost so that the benefits of the new treatments can…

[Ebola contacts' surveillance: social impact and ethical issues in Senegal].

RésuméLa surveillance des sujets contacts de personnes contaminées par le virus Ébola a pour objectif de contrôler les chaînes de transmission. Cette mesure soulève des questions d’éthique qui imposent de documenter ses modalités d’application et ses effets sociaux. L’étude a été menée au Sénégal sur la base d’entretiens approfondis auprès de 43 sujets contacts du cas survenu à Dakar d’une personne venue de Guinée contaminée par le virus Ébola, complétés par des observations. La surveillance avec confinement à domicile a été appliquée différemment aux co-résidents du malade et aux agents de santé. Les aides matérielles furent indispensables, la dimension relationnelle et la protection contre la stigmatisation étaient appréciées. Mais l’information a été insuffisante pour lever l’angoisse d’être contaminé ou de contaminer des proches, et certains ont éprouvé une souffrancemorale, la perte de leurs revenus et/ou de leur emploi. Les modalités de surveillance des sujets contacts devraient être plus acceptables et adaptées. Le rapport entre inconvénients et bénéfices reste à évaluer d’un point de vue de santé publique.AbstractQuarantine has been widely used during the Ebola outbreak in West Africa mainly to control transmission chains. This measure raises ethical issues that require documentation of the modalities of quarantine at the field level and its social effects for contact persons. In Senegal, 74 people were in contact with the Ebola case coming from Guinea in September 2014. Of these, 34 members of the case’s household were contained together at home and monitored by officers. The remaining 40 health care workers from two facilities were dispersed in their family households and monitored by telephone or during doctors’ visits. The study is based on in-depth interviews with 43 adult contacts about their experiences and perceptions, with additional observation for interpretation and contextualization.Containment at home was applied differently to contacts who lived with patient zero than to professional health care contacts. No coercion was used at first since all contacts adhered to surveillance, but some of them did not fully comply with movement restrictions. Contacts found biosafety precautions stigmatizing, especially during the first days when health workers and contacts were feeling an acute fear of contagion. The material support that was provided—food and money—was necessary since contacts could not work nor get resources, but it was too limited and delayed. The relational support they received was appreciated, as well as the protection from stigmatization by the police and follow-up workers. But the information delivered to contacts was insufficient, and some of them, including health workers, had little knowledge about EVD and Ebola transmission, which caused anxiety and emotional suffering. Some contacts experienced the loss of their jobs and loss of income; several could not easily or fully return to their previous living routines.Beyond its recommendations to enhance support measures, the study identifies the ethical stakes of quarantine in Senegal regarding informed consent and individual autonomy, non-maleficence and benevolence, and equity and adaptation to specific situations. Nevertheless, the balance between preventive benefits and individual inconveniences of quarantine should still be evaluated from a public health perspective.

La surveillance des personnes contacts pour Ébola : effets sociaux et enjeux éthiques au Sénégal@@@Ebola contacts’ surveillance: social impact and ethical issues in Senegal

RésuméLa surveillance des sujets contacts de personnes contaminées par le virus Ébola a pour objectif de contrôler les chaînes de transmission. Cette mesure soulève des questions d’éthique qui imposent de documenter ses modalités d’application et ses effets sociaux. L’étude a été menée au Sénégal sur la base d’entretiens approfondis auprès de 43 sujets contacts du cas survenu à Dakar d’une personne venue de Guinée contaminée par le virus Ébola, complétés par des observations. La surveillance avec confinement à domicile a été appliquée différemment aux co-résidents du malade et aux agents de santé. Les aides matérielles furent indispensables, la dimension relationnelle et la protection contre la stigmatisation étaient appréciées. Mais l’information a été insuffisante pour lever l’angoisse d’être contaminé ou de contaminer des proches, et certains ont éprouvé une souffrancemorale, la perte de leurs revenus et/ou de leur emploi. Les modalités de surveillance des sujets contacts devraient être plus acceptables et adaptées. Le rapport entre inconvénients et bénéfices reste à évaluer d’un point de vue de santé publique.AbstractQuarantine has been widely used during the Ebola outbreak in West Africa mainly to control transmission chains. This measure raises ethical issues that require documentation of the modalities of quarantine at the field level and its social effects for contact persons. In Senegal, 74 people were in contact with the Ebola case coming from Guinea in September 2014. Of these, 34 members of the case’s household were contained together at home and monitored by officers. The remaining 40 health care workers from two facilities were dispersed in their family households and monitored by telephone or during doctors’ visits. The study is based on in-depth interviews with 43 adult contacts about their experiences and perceptions, with additional observation for interpretation and contextualization.Containment at home was applied differently to contacts who lived with patient zero than to professional health care contacts. No coercion was used at first since all contacts adhered to surveillance, but some of them did not fully comply with movement restrictions. Contacts found biosafety precautions stigmatizing, especially during the first days when health workers and contacts were feeling an acute fear of contagion. The material support that was provided—food and money—was necessary since contacts could not work nor get resources, but it was too limited and delayed. The relational support they received was appreciated, as well as the protection from stigmatization by the police and follow-up workers. But the information delivered to contacts was insufficient, and some of them, including health workers, had little knowledge about EVD and Ebola transmission, which caused anxiety and emotional suffering. Some contacts experienced the loss of their jobs and loss of income; several could not easily or fully return to their previous living routines.Beyond its recommendations to enhance support measures, the study identifies the ethical stakes of quarantine in Senegal regarding informed consent and individual autonomy, non-maleficence and benevolence, and equity and adaptation to specific situations. Nevertheless, the balance between preventive benefits and individual inconveniences of quarantine should still be evaluated from a public health perspective.

La surveillance des personnes contacts pour Ébola : effets sociaux et enjeux éthiques au Sénégal

RésuméLa surveillance des sujets contacts de personnes contaminées par le virus Ébola a pour objectif de contrôler les chaînes de transmission. Cette mesure soulève des questions d’éthique qui imposent de documenter ses modalités d’application et ses effets sociaux. L’étude a été menée au Sénégal sur la base d’entretiens approfondis auprès de 43 sujets contacts du cas survenu à Dakar d’une personne venue de Guinée contaminée par le virus Ébola, complétés par des observations. La surveillance avec confinement à domicile a été appliquée différemment aux co-résidents du malade et aux agents de santé. Les aides matérielles furent indispensables, la dimension relationnelle et la protection contre la stigmatisation étaient appréciées. Mais l’information a été insuffisante pour lever l’angoisse d’être contaminé ou de contaminer des proches, et certains ont éprouvé une souffrancemorale, la perte de leurs revenus et/ou de leur emploi. Les modalités de surveillance des sujets contacts devraient être plus acceptables et adaptées. Le rapport entre inconvénients et bénéfices reste à évaluer d’un point de vue de santé publique.AbstractQuarantine has been widely used during the Ebola outbreak in West Africa mainly to control transmission chains. This measure raises ethical issues that require documentation of the modalities of quarantine at the field level and its social effects for contact persons. In Senegal, 74 people were in contact with the Ebola case coming from Guinea in September 2014. Of these, 34 members of the case’s household were contained together at home and monitored by officers. The remaining 40 health care workers from two facilities were dispersed in their family households and monitored by telephone or during doctors’ visits. The study is based on in-depth interviews with 43 adult contacts about their experiences and perceptions, with additional observation for interpretation and contextualization.Containment at home was applied differently to contacts who lived with patient zero than to professional health care contacts. No coercion was used at first since all contacts adhered to surveillance, but some of them did not fully comply with movement restrictions. Contacts found biosafety precautions stigmatizing, especially during the first days when health workers and contacts were feeling an acute fear of contagion. The material support that was provided—food and money—was necessary since contacts could not work nor get resources, but it was too limited and delayed. The relational support they received was appreciated, as well as the protection from stigmatization by the police and follow-up workers. But the information delivered to contacts was insufficient, and some of them, including health workers, had little knowledge about EVD and Ebola transmission, which caused anxiety and emotional suffering. Some contacts experienced the loss of their jobs and loss of income; several could not easily or fully return to their previous living routines.Beyond its recommendations to enhance support measures, the study identifies the ethical stakes of quarantine in Senegal regarding informed consent and individual autonomy, non-maleficence and benevolence, and equity and adaptation to specific situations. Nevertheless, the balance between preventive benefits and individual inconveniences of quarantine should still be evaluated from a public health perspective.