Health Care Access Inequalities Among Pregnant HIV Positive Women

The aim of this paper is to analyse the production of some health care inequalities and the capacity of the health system to mitigate them.

In order to do so, it focuses upon the unequal social relations that decrease the adherence of some pregnant HIV women to antiretroviral medication.

It is based upon a study that was led in French Guyana (South America) in 2009: semi-directive interviews were led with 10 HIV positive women and 33 health care and social workers following them.

The study reveals that, although the French social system allows all pregnant HIV positive women to get free antiretroviral medication, the adherence of many of these women is far from optimal, leading to a relatively high rate of infection among their new-borns. These women suffer indeed from a diversity of unequal relations that make it difficult for them to achieve an optimal adherence to medication. Most of these women are altogether:

-        Immigrants without a residence permit : they are afraid of attending institutional health care centers because of the risk of permit control

-        Struggling with harsh living conditions that make medication not a priority

-        Concerned with the stigmatisation of their disease : they must hide infection, pills and hospital follow-up from sexual partners (from who they are economically dependent) and people around (to avoid social isolation)

-        Not familiar with biomedical conceptions of HIV infection and treatment : some misunderstand the principles of biomedical treatment

The paper presents health care professionals’ tips to help women with each of these difficulties and then improve their adherence. It suggests finally that professionals also enhance the self-dignity of the women when they offer them the possibility to give life and to actively preserve their child from prenatal infection (thanks to their adherence to medication).