L'altérité de l'épidémie. Les politiques du sida à l'épreuve de l'immigration

Abstract

The Diversity of Epidemic. The Politics of Aids and the Experience of Immigration. Didier Fassin. After two decades of silence from the health information system and the inaction of the public health agency, the relation between AIDS and immigration is beginning to emerge from beneath a regime of restrictions. If this is the case, it is because new manners of thinking about this relationship are beginning to see the light of day. Firstly, the themes of risk and of epidemically dangerous populations have been replaced by the problem of inequality and sociologically fragile categories. Secondly, the attention that had formerly been almost exclusively placed on the culture, the representations and the resistances has been enlarged to an examination in terms of social conditions, integrating historical and material dimensions in the double experience of the illness and migration. While at the same time, two new stakes appear. One is the redefinition of the contours of the immigration question under the double effect of its crystallization around foreigners in irregular situations and its dissolution in the original groups of migrants, these two groups are particularly exposed to the material disparities related to health and care. The second stake is the development of legitimacy of the foreigner which is increasingly founded upon the suffering or sick body, which is relevant therefore to bio-politics in which AIDS take a symbolic role.

Sick and Vulnerable Migrants in French Public Hospitals. The Administrative and Budgetary Dimension of Un/Deservingness

“…For patients 'without potential entitlement'those for whom the hospital has to bear the costs itselfthe bios worthy of protection tends to be reduced generating undercategories of patients. Also, the limits set by the bio-legitimacy principle (Fassin et al, 2001), which supposes to place the protection of the biological life above all, seems to be questioned, especially when the costs of treatment are high (as it is often the case for therapeutic migrants). The more patients belong to categories of migrants that have been kept away from the healthcare protection system, the more their condition tends to require expensive treatment, and the less these patients are morally read as deserving of benefiting from the protection of PASS.…”

“…Although the reality of everyday praxis is blurrier as we will see below, the lower end of this stratified healthcare coverage system seems to draw two red lines which are not supposed to be crossed: a) a principle of bio-legitimacy (which acknowledges a sacred and universal dimension of the human life, see Fassin et al, 2001); and b) the protection of the public from infectious diseases such as HIV or tuberculosis (Geeraert, 2018). These narrow criteria for healthcare coverage act as government toolsone can say as bio-powers ('that make live and let die', Foucault, 1997: 214)fulfilling public health and human rights obligations, while simultaneously curbing social inclusion.…”

“…Would the patient experience a loss of opportunities if he/she did not receive the treatment? These questions reveal the tensions between budgetary concerns and 'biolegitimacy', a principle that attributes a superior value to biological life and its protection (Fassin et al, 2001). Parting from a minimum understanding of life as biologicaland not as containing social and political dimensionsthe negotiation tends to delineate what is the minimum necessary to respect the biological integrity of the vulnerable migrants which is measured in terms of 'consequences of rare gravity' or 'urgent treatments'.…”

La prise en charge par l’hôpital des populations à la marge du système de santé en France : l’exemple des Permanences d’accès aux soins de santé

“…La France entérine à partir de 1946 un véritable « droit au soin » qui fait écho à la nouvelle définition de la santé portée dans le monde occidental et qu'on peut résumer par « un état de complet bien-être physique, mental et social », et ne consiste pas seulement « en une absence de maladie ou d'infirmité » (OMS, 1946, p. 16). Plus important encore pour notre propos, ce nouveau droit au soin est le fruit d'un combat social qui tend à protéger la vie elle-même et reconnaît chez tous les individus une « bio-légitimité », c'està-dire une « reconnaissance supérieure donnée au principe de maintien en vie » Costa-Lascoux;Hily, 2001, p. 146). Ce droit dépasse le seul calcul biopolitique évoqué dans l'introduction pour entrer dans le champ de la morale.…”

La santé des immigrés en France : controverses autour d’un paradigme

“…Il est désormais traversé par la mécanique du vivant et sert de support aux processus biologiques : prolifération, augmentation de la population, lutte contre la maladie et la souffrance biologique. Alors que pendant la période des Trente Glorieuses, les immigrés malades étaient systématiquement mis à l'écart, depuis la fin des années quatre-vingt-dix, la mobilisation autour du sida a permis aux étrangers malades qui avaient perdu leur force de travail, et en même temps toutes les autres formes de reconnaissance sociale, de bénéficier d'une légitimité nouvelle et immuable, celle du corps souffrant (10) . Aujourd'hui, dans un contexte national et international marqué par une internationalisation et un transfert des normes (11) (12) ."…”