Ebola en Guinée : formes de la stigmatisation des acteurs de santé survivants
Ebola in Guinea: Experience of Stigma among Health Professional Survivors
L’objectif de cet article est de décrire les formes de stigmatisation que rencontrent les professionnels de santé survivant à la maladie à virus Ebola. Une étude, reposant sur des entretiens approfondis auprès de vingt survivants, réalisée à Conakry dans le cadre du programme PostEboGui (Revivre après Ebola), montre que les formes de stigmatisation comprennent principalement l’évitement, le rejet, le refus de réintégration au poste de travail, le déni de la maladie. Cette stigmatisation semble due à la peur de la contagion et à des conceptions divergentes de la maladie, sources de conflits. Elle est le plus souvent limitée, du fait des attitudes solidaires, et transitoire, car les survivants mettent en place des stratégies pour éviter le stigmate. Cette recherche montre que le milieu médical perpétue le stigmate vis-à-vis d’agents qui ont été exposés dans le cadre de leur rôle professionnel.
This article aims to describe the various forms of stigma faced by Ebola health professional survivors. A study based on in-depth interviews with 20 survivors was conducted in Conakry as part of PostEboGui multidisciplinary cohort research Program (Life after Ebola) in July–August 2015. Participants were health professionals, male and female, mostly with precarious positions in the health system. The results show that stigmatization is mainly expressed through avoidance, rejection, or being refused to be reinstated in the position at work and non-acceptance of the disease by third parties. This stigmatization appears to be rooted in fear of contagion and in diverging conceptions of the disease aetiology that may engender conflict. Being health workers did not protect them against stigma and some of them faced rejection in their own health care facility. This stigmatization was not based on moral grounds, contrary to the one experienced by people living with HIV, and attitudes of solidarity were encountered in family and confessional networks. Responders found support within an association of survivors (Association des personnes guéries et affectées d’Ebola en Guinée, APEGUAEG) that was created in early 2015. Stigmatization was temporary and disappeared for most responders owing to strategies implemented by survivors and because the fear of contagion had vanished: interviews were conducted when the notion of persistence of Ebola virus in the semen was not spread in the population. This research study shows that stigma is perpetuated among health agents, towards workers who were exposed by their professional role. This observation should be considered for specific measures towards behavioural change. Finally, the very notion of “stigmatization”, widely used by public health institutions, is challenged by the diversity of individual experiences that are particular to Ebola virus disease regarding their expression and evolution. Studies on stigma related to Ebola should be held in other populations and contexts for comparison.
S. SOW, A. DESCLAUX, B. TAVERNE
Reçu le 11 décembre 2015.
Accepté le 19 mai 2016.
Ebola, Agents de santé, Survivants, Stigmatisation, Programme PostEboGui, Guinée, Afrique intertropicale
Ebola, Health agents, Survivors, Stigma, PostEboGui Program, Guinea, Sub-Saharan Africa