Michèle Clément

Gender relations and risks of HIV transmission in South India: the discourse of female sex workers' clients

In South India, where the majority of the countrys cases of HIV are concentrated, transmission of infection occurs mainly within networks composed of female sex workers, their clients and the other sexual partners of the latter. This study aims to determine how gender relations affect the risks of HIV transmission in this region. Semi-structured interviews were carried out with 30 clients and analysed qualitatively. Results show that clients perceive sexual relations with female sex workers as a vice involving loss of control and contact with women at the bottom of the social ladder. Paradoxically, this sometimes allows them to conform to the masculine ideal, in giving sexual satisfaction to a woman, in a context of incompatibility between the idealised and actual masculine and feminine archetypes. Attitudes to condoms, affected by various facets of the client-female sex worker relationship, are indicators of the link between this relationship and the risks of contracting HIV. The results suggest that there is a need for expanding targeted HIV prevention towards clients and female sex workers alongside more general interventions on gender issues, particularly among young people, focusing on the structural elements moulding current relations between men and women, with particular consideration of local cultural characteristics.

Representations of Elderly with Mental Health Problems Held By Psychosocial Practitioners from Community and Institutional Settings

SUMMARY This article aims to clarify crucial issues pertaining to community and institution-based psychosocial care provided to elders suffering from mental health problems, and to the role of professional and lay systems of beliefs—i.e., representations—in this area of intervention. First, we review epidemiological, clinical, and evaluative data assessing the prevalence of mental health problems (both situational or transitional distress and severe mental health problems, with a special emphasis on the latter) among persons aged 65 and older, the specific situations and needs of this population, and the services provided to them. We then examine three promising and interrelated trends in psychosocial intervention aimed at seniors with mental health problems, that is, practices oriented toward recovery, empowerment, and social integration. Finally, we tackle the cumulative impacts of social representations of aging and the aged and of mental illness and the mentally ill, and how they can impede the implementation of interventions, services and programs based on recovery, empowerment and social integration approaches.

Speaking Out and Being Heard Residents’ Committees in Quebec’s Residential Long-Term Care Centre

Residents’ councils in Quebec’s residential and long-term care centres have the mandate to promote the improvement of living conditions for residents, to assess their level of satisfaction, and to defend their rights. Based on two studies on the autonomy of councils, we examined how committees can express themselves on topics other than those the management is already aware of, to reveal various previously unknown aspects of the services, and to voice unexpressed concerns. We are especially interested in what makes management receptive, or not, to what the committee members say. The councils’ ability to express them selves is, in fact, inseparable from its capacity to listen to the management teams, and we seek to determine the conditions required to perform this dual capacity.

Cheminements et situations de vie des personnes âgées présentant des troubles mentaux graves: perspectives d'intervenants psychosociaux

Services for elders with severe mental illness (SMI) have major deficiencies, among them a lack of adequate psychosocial services. Some analysts have attributed this situation to “double stigmatization” targeting both ageing and mental illness in our societies. Using qualitative methods (23 semi-directed interviews, theme-based content analysis), our exploratory research aims to understand better the perceptions of psychosocial practitioners working in community and institutional settings about the elderly with SMI and their living situations. Our informants evoke living situations marked by a lack of support (isolation), of resources (financial precariousness/poverty) and of power (learned passivity), traits that are related not only to mental illness per se, but also to long term psychiatric institutionalization. For them, the current situation of elders with SMI is the end product of biographies in which life-course, illness-course and life in services and/or institutions join and, sometimes, become indistinguishable. Implications for psychosocial practices are discussed.

The Québec Complaint Examination System: Stakeholder Perspectives on the Purpose and Intake of Complaints

Québecs complaint examination system has devoted considerable effort to supporting dissatisfied users who may wish to register complaints. It is open to question, however, whether this level of effort has, in fact, aided users in filing their complaints, and whether, once filed, the intake and processing of complaints has been rigorous and fair. Has the intake and handling of complaints at least improved? This is the question we shall attempt to answer here by presenting the results of our study concerning the impact of the Complaint Assistance and Support Centers (CAAPs) on the intake of complaints. The results show that the Québec complaint examination system and its Complaint Assistance and Support Centers help make complaints more admissible and ensure that each complaint is examined. However, the system is also hindered by differences and conflicting interpretations among the various stakeholders regarding the legitimacy of complaints, respect for users’ rights, and the mission of the system. Although complaint examination systems seek to encourage users to express their points of view, users’ voices are still only partly audible.