Psychosocial issues in community health : The example of the Malian Gundo-So program with women living with HIV

Abstract

HIV infection still affects 38.4 million people worldwide. Most people living with HIV are women. Because of their gender, they face biological and social challenges. Mali is confronted with this health and social challenge, since in 2021 there were 110,000 people living with HIV, including 53,000 women. By living with HIV, Malian women are confronted with several psychosocial issues such as discrimination linked to social representations of HIV which referred to immoral practices. Faced with this stigma, people living with HIV must make the choice of whether or not to disclose their HIV status. The disclosure by people living with HIV of their serostatus can be synonymous of positive manifestations, but can also lead to negative manifestations. For Malian women, it can mean being rejected by their peers, being repudiated by their husbands or being subjected to violence. It is in this context that Gundo-So, a community-based programme that aims to support women living with HIV on the question of whether or not to share their serological status, was developed. The ANRS 12373 Gundo-So study aims to study the effect of the programme in the short and medium term. Through the ecological model and the empowerment notion developed by community psychology, three objectives are investigated in this thesis. Firstly, to explore the psychosocial experience of participation in this community programme, and secondly, to trace how the experience of Gundo-So fits into the life trajectory of the participants and facilitators. Thirdly, to identify the psychosocial factors that promote the empowerment of participants in this community programme. To this end, individual interviews were conducted with participants in the programme (n=13) on three occasions. The facilitators (n=8) were also interviewed twice. An interpreter was needed for the interviews. Thematic reflective and trajectory analyses were conducted on all interviews. Quantitative analyses were conducted on the