HIV/AIDS in France in relation to the country's history of politics, public health and ideology

Contents

1. Introduction
1.1 HIV/AIDS in France today
1.2 Ideology

2. Politics surrounding Public Health

3. Measures against HIV
3.1 The Magic Bullet Approach
3.2 Condom Use
3.3 Screening

4. Culture & Language

5. Stigmatization
5.1 MSM and HIV/AIDS
5.2 Immigration and HIV/AIDS

6. Recommendations

7. Conclusion

Appendix: Timeline of HIV/AIDS in France

References

1.Introduction

This essay will provide a basis for a thick description of the AIDS issue in France. We describe the history of politics surrounding AIDS, the conception of Public Health in France, French ideologies and the relationship to stigma and language. All of these are of particular salience when addressing an issue like AIDS, which is a non-linear issue in that it and cannot be attributed to any one cause.

1.1 HIV/AIDS in France today

France has the highest number of HIV-positives in all Europe. The number of people living with HIV/AIDS in France has steadily increased in the last decade from 120,000 in 2005 to about 150.000 in 2015 (indexmundi, 2015). Its prevalence rate, 0.4%, is also relatively high compared to the rest of Europe, e.g. 0.2% in the UK and 0.1% in Germany. Every year between 1500-2000 people die of HIV/AIDS in France (Ibid). This is only about 1% of the total number of HIV-positives, showing that France does reasonably well in providing ART (anti-retroviral treatment). Rather they have been facing difficulties regarding prevention. The rate of newly diagnosed HIV infections has been decreasing, but only slowly, from 9.5 per 100 000 in 2005 to 6.3 per 100 000 in 2011 (WHO, 2011). It is striking that more than a third of seropositives remain undiagnosed in France (Supervie et al., 2014).

15% of men who have sex with men (MSM) are seropositive, a relatively high proportion compared to 0.4% among the general population (UNAIDS, 2012). MSM represent 42% of all HIV-positives in France, slightly less than the European average (ECSC, 2013). While HIV-infected MSM are mostly located in Paris and its suburbs, an area that by itself amounts for 50% of urban cases in France (Galien, 2011), HIV-infected drug users tend to live in the south of France (Baldwin, 2005). However, intravenous drug users make up only 10% of HIV-positives in France (UNAIDS, 2013). About half of France’s seropositives are migrants, although the European average is only 35% (ECSC, 2013). Men generally represent two thirds of seropositives in France (Ibid). More than a third of deaths among French people with HIV actually are due to cancer, suggesting a strong relationship between the virus and cancer (Vandenhende et al., 2015). Very recently the French government has acted progressively by approving PreP (no-expense pre-exposure prophylaxis) for people who need it as the first European country (Cairns, 2015). The French national AIDS research agency (ANRS) has exercised two large studies on HIV/AIDS in France, Vespa (2003) and Vespa 2 (2011), on which many of our empirical data is based.

1.2 Ideology

France’s core ideology is Republican Egalitarianism (Baldwin, 2005, p. 148). It is heavily influenced by the ideals of the French revolution in 1789, notably Liberté, égalité, fraternité (freedom, equality, brotherhood). French citizenship can be described as “a contract resulting from a political will, from the convergence of free, individual decisions to live together according to a core of basic universal principles“ (Caron, 2001, p. 151). It is a rather conservative country where people have a strong sense of nationalism and unity. Strict neoliberal ideas such as individual autonomy are seen as opposed to the nation. Conservatism is also emphasized by the dominating Catholic religion in France. The Church had a large influence on the perception of AIDS, which was linked to impious issues like homosexuality and polygamy (Caron, 2001). Ideology in France served to create and sustain vulnerabilities among those who do not fit French notions of the typical citizen.

2. Politics surrounding Public Health

The AIDS epidemic in France was formally recognized in 1986, but it would not be until 1992 that the general public would become hyperaware of AIDS (Bergeron et al., 2012). In the early part of the 1990s, it was discovered that France’s supply of donor blood was contaminated with HIV, and had been so for two years (Ibid). This ultimately resulted in half of all hemophiliacs acquiring HIV within France (Ibid). This event has become referred to as the “blood crises”, and the general public responded by searching for who was to blame.

It is primarily the blood crises of the early 90s that lead to the explosive relevance of public health in French politics (Bergeron et al., 2012). Increasingly throughout the 90s and early 2000s, public health began to be perceived as a solution to all areas in which France’s health care system falls short (Ibid). However, public health came to be driven by political forces in France, and decisions surrounding public health were made along partisan lines, drawn in light of political strategies instead of public health failures (Ibid).

The “left” party politician Bernard Kouchner served repeated terms as in France’s health system in the 1990s (Bergeron et al., 2012). These new actors developed key policies that served to develop and support France’s idea of public health: “sécurité sanitaire”, which gave connotations to public health being a matter of national security (Ibid). In 2002, Kouchner’s boys had developed a policy which effectively gave citizens the right to know their own health information, something which had been contested on the grounds of maintain France’s version of patient privacy information (Ibid).

As a signifier of the politicization of Public Health, Jean-François Mattei, a minister from 2002-2003, aimed at “reinventing” the idea of public health during his term, and it is widely considered that he did so to assert his and his parties ownership of public health in France (Bergeron et al., 2012). And though Mattei failed at doing, he played a large part in asserting that public health should serve to not simply guarantee the rights of citizens to health, but to assess the responsibilities of individuals themselves (Ibid). This responsibilization of individuals within France took place alongside a widespread adoption of neoliberal ideologies in Europe, which were proposed in order to promote overall economic wellbeing for nations (Ibid). Debates over the roles and responsibilities of patients continue to exist in France’s public health arena, but do impact the mental and physical health of said patients (Barbot, 2006; Bergeron et al., 2012; Douab et al., 2014).

Amongst those most in line with Mattei’s responsibilization of individuals is France’s Nation Front party. Marine Le Pen of France’s most extreme right-wing party, National Front, was nearly second in France’s last presidential election (Belmonte, 2012). Le Pen’s campaign emphasized its promises to tighten France’s borders against immigration, and Le Pen’s relative success represents the immense importance of immigration in France’s politics (Ibid).

The National Front played a large part in spreading fear of the epidemic, and promoting the idea that it was a threat to the entire population (Baldwin, 2005). Though attention to the epidemic was a necessary step in addressing the issue, perspectives on how to address the issue were warped by political nationalism. France’s political-left wielded nationalism to assert that groups should not identify by traits, and that to do so was inherently reductionist (Ibid). Opposition to reductionism was largely created by French post-modernist philosophers, such as Michel Foucault (Baldwin, 2005). This attitude was shared amongst groups such as homosexuals and immigrants, and so their political mobilizations were relatively weak because they would not self-identify (Ibid). It makes sense that such groups would share the left’s interpretation, as it is the left, socialist party that shares solidarity with disenfranchised groups (Baldwin, 2005; Caron 2001). At the same time, France’s political right interpreted nationalism as excluding traditionally disenfranchised groups, who are the ones most afflicted by HIV (Dray-Spira, 2007). The right’s interpretation of nationalism led them to proclaim isolating seropositive individuals, and to close borders to at-risk groups (Belmonte, 2012). These actions did not consider the environments that confine marginalized people’s decision regarding “risky behavior”, but simply identified individuals irresponsibility as the main driver of susceptibility. Identifying groups on the basis of things such as country of origin or sexual orientation was inherently tied to the reductionism, which much of France was ideologically opposed to (Baldwin, 2005).

3. Measures against HIV

3.1 The Magic Bullet Approach

No other European country spent more resources on research for an HIV solution than France (Baldwin, 2005).^[1] On the one hand, this can be linked to its weak public health system. A biomedical magic bullet solution was particularly attractive to the French, as it would have spared the public health system to deal with a socially complex disease; the magic bullet solution could have prevented the difficult discourses about homosexuals and immigrants. On the other hand, the focus on research was also influenced by strong Enlightenment values in France. A classic Enlightenment idea was that nature could be tamed. Further, the French themselves explained their emphasis on research by seeking “a cure for all mankind”, reaffirming Enlightenment traditions (Baldwin, 2005).

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^[1] Still, the Americans dominated the research on HIV/AIDS, having spent about 30 times more on it than France (Baldwin, 2005).