Tensions Between Identities and Roles : When Sub-Saharan African Women Living with HIV Become Health Mediators in France

Between 2000 and 2005, an experimental training program for « new health actors » was lead in France, to improve access to HIV prevention and healthcare for populations in condition of vulnerability. This program trained more than 150 health mediators from the targeted social groups and it included many Sub-Saharan African women living with HIV in France, recruited from communitarian associations. Through their interventions in the Infectious Disease Wards of the Hospitals, the peer health mediators have turned key players in the relationship between patients and professionals.

This paper proposes to explore the specific interactions between HIV-positive health mediators and institutional healthcare professionals, in particular physicians and social workers. This reflection is based on a socio-ethnographic field research led from October 2011 to July 2013, by conducting 18 months of direct observations in HIV communitarian associations and 85 interviews with HIV-positive patients, health mediators, physicians and social workers. The roles that health mediators are asked to play to improve patients' quality of care will be examined. It will highlight the tensions that they experiment between the double identity of being an HIV-positive patient and an healthcare professional. A special attention will be given to their specific position within a set of unbalanced relationships with physicians and social workers. Thus, this paper aims at showing that the professional participation of those patient-expert has inexorably improve patients and professionals interactions, by helping reconfigure the hierarchical position of physicians and the states of patienthood. Nevertheless, their intermediary status (between being a patient and an healthcare professional) reveals serious social issues, especially because they are included in an intertwining of unequal power relationships.