Today over 1.1 million people are living with HIV/AIDS in the United States; over the last 4 decades mortality rates have decreased largely made in part because of advancement in awareness and treatment options. Treatment adherence has long been considered a vital component in decreasing HIV/AIDS related mortality and has proven to reduce the risk of transmission. However not all patients take their medicine as prescribed. This research study, sponsored by The North Central Texas HIV Planning Council explored how Patient and Provider communication impacted treatment adherence. By utilizing a mixed-methods approach survey data and semi-structured interviews were used to collect insights from both Patients and Providers. Data gleaned through the interview process provided a perspective that could not be captured by using quantitative methods alone. The results from this research yielded multiple themes related to patient and provider communication with recommendations as to how The North Central Texas HIV Planning Council could address treatment adherence, such as Providers focus on Patients perceived severity based on their understanding of disease and illness; that side-effects remain a concern for patients and should not be dismissed; and finally that the word AIDS is perceived to be more stigmatized and as such organizations providing HIV/AIDS related services should explore alternative names where the word AIDS in not included.

In 2019, a major academic medical center released a public health research report on life expectancies in Texas organized by zip code. The study revealed that the 76104-zip code, part of the central area of the city of Fort Worth, has the lowest life expectancy in the entire state. Concerned about the life expectancy study statistics, New Mount Rose Baptist Church, affiliated churches, and other community members sought to understand better why the life expectancy in their area was so low. This exploratory study uses a mixed-methods approach that incorporates interviews, a survey, and participant observation to help understand (i) how community members in the area feel, think about, and relate to their community, (ii) what the major social determinants of health are for them, and (iii) what health-related infrastructures in the area are lacking or need improvement. This study unearths perceptions of health and community from the various communities in the area and social and structural determinants of health in 76104.

This thesis is about food practices and change among Mexican migrants living in West Queens, New York City. Public health research suggests that Mexican migration to the US has a negative impact on food practices, with diets being less nutritious over a migrant’s stay in the United States and obesity being more common among longer-term than more recently-arrived individuals. Through ethnography, I explore how migration shapes food practices and examine the nuanced process of nutritional change that is often obscured in large-scale epidemiological studies. Food practices are important not just because they shape vulnerabilities to chronic diseases but also because they serve as prisms by which to examine migrants’ lives, pressures and aspirations. The three aims of this ethnography are to explore the food practices that Mexicans engage in after migration; to examine the social, temporal and political-economic contexts shaping food practices and change; and to describe how migrants themselves makes sense of nutritional change. I explore these themes using the approach of structural vulnerability, which views health practices and outcomes as influenced by social structures, relationships and inequalities. In so doing, I provide a critique of the public health literature’s use of the concept of acculturation to explain food practices, which largely obscures the role played by structural contexts and constraints. Through participant observation, conversations and interviews with Mexican migrants in West Queens, NYC, I have identified three contexts shaping food practices and change after migration: household dynamics and labour division; time constraints and work schedules; and the ‘food environment’, referring to the availability of food items and weight loss products. Gender dynamics, documentation status and class modified the way in which these contexts were perceived and negotiated by informants, which had further consequences on food practices. In these settings, informants were often encouraged to consume high-energy foods and large portions, to replace meals with snacks, to eat prepared or convenience foods, and to experiment with weight loss products. To rationalize nutritional change and body size disparities, informants employed multiple discourses. Some discourses emphasized the role of structural contexts and constraints related to time, money and documentation status, while others emphasized the role played by cultural beliefs, habits and acculturation. An ethnographic approach informed by structural vulnerability serves to articulate how the everyday lives and social contexts in which Mexican migrants are embedded, shape experiences of nutritional change. This thesis exposes a disconnect between the way in which the public health literature conceptualizes nutritional change and how it is lived ‘on the ground’.

The objective of this thesis is to examine which socio-economic, structural and cultural factors may influence Indian women’s propensity to contract HIV and later their ability to access the relevant healthcare services for their condition. The research draws on two theoretical frameworks, the first being Barnett and Whiteside’s (2002) concept of social structural factors of disease transmission. Second, Anderson and Aday’s (1981) model of access examines how a variety of structural and resource-based factors, e.g. area of residence, can influence usage of healthcare facilities. Two stages of data analysis were undertaken, the first being secondary statistical analysis of the National Family Health Survey III. The survey provided state level estimates on the HIV sero-status of the general population in India and data on demographic and socio-economic determinants for family planning, nutrition, utilization of healthcare and emerging health issues. The second stage of analysis consisted of a set of qualitative interviews conducted in Andhra Pradesh, India. Thirty-three interviews were conducted with female sero-positive patients and ten with HIV-infected women who were providing social services to others with the same condition. Statistical results on social structural determinants of HIV transmission illustrated that Indian women who were formerly married (OR=5.27, CI=3.07-9.04), lived in higher prevalence states (OR=3.48, CI=2.19-5.54), had a low level of education (OR=2.27, CI=1.40-3.68) and were employed (OR=1.45, CI=0.96-2.18) had significantly (<.05) higher odds of being HIV-positive in comparison to those who were not. Findings in the qualitative phase of analysis were similar but participants’ narratives illustrated that their risk of contracting HIV begun before they even had the opportunity to seek a match as they seemed to live in communities with a high level of HIV prevalence. Many of the participants commented that there were factors outside of their sphere of control, e.g. lack of education, which resulted in them having a narrow choice of potential partners. Additionally, statistical results on female participants’ access to healthcare services indicated the vast majority of HIV-positive respondents were almost certainly not aware of their sero-status as they had not undertaken an HIV test prior to the survey. As the sample of female HIV infected respondents was relatively small, it was difficult to ascertain which social factors had an impact on these participants utilisation of HIV testing services. On the other hand, respondents’ narratives from the qualitative stage of research highlighted on social structural factors which could potentially influence WLHA’s continual utilisation of HIV-related healthcare services. It was found that participants experienced the most barriers to accessing healthcare facilities in the initial phases of their treatment. These barriers were mediated by the structure of healthcare services, culturally sanctioned medical practices (e.g. physicians refusal to inform the patient of their sero-status) and quality of services.

L’intervention psychosociale auprès des jeunes vivant en Centre jeunesse est régie par la Loi sur la protection de la jeunesse (LPJ). La posture professionnelle des intervenants s’inscrit à la fois dans une relation d’autorité, renforcée par le cadre institutionnel et les obligations légales, et dans une relation d’aide. Ce mémoire s’est attardé à ce double mandat (réadaptation sociale et relation d'aide) et à son impact sur le lien jeune-éducateur. Le terrain de cette recherche s’est déroulé pendant trois mois dans une unité de réadaptation de Montréal (CJM-IU). L’analyse s’est faite à partir de la rencontre des corpus de données; les récits des jeunes et des éducateurs (entretiens semi-directifs) et l'observation de ce milieu de vie. L’approche utilisée, puisant à la fois dans la tradition ethnographique et dans la phénoménologie, nous a permis de faire émerger l’interprétation et les perceptions qu’ont les jeunes et leurs intervenants sur la question de la relation d’aide et de la relation d’autorité. Les résultats de recherche portent sur les conditions qui favorisent la conciliation ou la polarisation de ces mandats qui peuvent parfois sembler antagonistes. Il a ainsi été possible d’identifier les éléments qui fragilisent l’établissement de liens significatifs et de confiance entre les jeunes et leurs éducateurs ou au contraire les éléments qui les renforcent. Ultimement, les résultats ont permis d’illustrer les embûches à la création d’une alliance thérapeutique en centre de réadaptation pour mineurs et l’impossibilité de sa réalisation dans le contexte actuel. / Psychosocial intervention with children living in Youth Centers is legislated by the Youth Protection Act (YPA). The professional position of the youth workers is characterised by a relationship of authority, reinforced by an institutional framework and numerous legal obligations, and a counselling relationship. This research paper focuses on this double mandate and its impacts on building a connection between the children and their youth workers. The research’s fieldwork took place in a unit of a Youth Center of Montreal (YCM). The analysis is mostly based on a corpus of data, from living environment observations to the protagonist’s very own narratives throughout semi-directive interviews. The present approach combines the ethnographic and phenomenological traditions, enabling the interpretation of the children and youth workers’ perceptions on the questions of the relationships of authority and counselling. The research results pertain to the conditions supporting the conciliation and polarisation of these sometimes antagonistic mandates. Elements weakening the construction of meaningful bonds between the parties, or, to the opposite reinforcing them, were highlighted. Conclusively, this research illustrates the obstacles in creating a therapeutic alliance and its impossible concrete fulfilment within the context of Youth Centers.

This thesis gives an experiential account of notions of the home in contemporary rural China. Based on a year of fieldwork in a mountain village in rural Shanxi Province, the thesis explores everyday and ritual practices to investigate how people make themselves at home under conditions of political economic transformation. Villagers accommodate and resist conflicts of interest by negotiating boundaries of insiders and outsiders through the home. Differences of gender and generation come to the fore as people compromise between aspiration and pragmatism within the home under conditions of resurgent market competition. The theoretical concern of the thesis lies in connecting wider social processes to personal life projects through the intimate sphere of the home. The rhythm of the seasons patterns the thesis into spring, summer, autumn and winter chapters, as the seasons were pivotal in ordering people’s everyday practices and ritual activities within a shared social and ecological environment. The opening chapter on the autumn harvest coincided with my arrival in the village. The chapter explores how labour, and particularly women’s labour, transforms the earth into affective belonging, and how women negotiate conflicts over food consumption between the agricultural and market economy. The winter chapter parallels tales of personal life history with wider kinship networks across various generations, while simultaneously tracing bodily pathways from the domain of the hot stove in the home to the cold grave in the fields. The next chapter begins with the celebratory periods of springtime during the New Year Festival, a time of ritual renewal in the home when women partook in a local domestic ritual of propitiating the little spirits of the house. At Qingming Festival villagers’ practices of worshipping the ancestors in the fields were juxtaposed with a tour company’s staging of an elaborate ritual revival of star worship in the village. Conflicting aspirations over the future of the past thereby tore fissures into the emerging ritual terrain between outside spectacle and inside convergence. The last ethnographic chapter looks at the summer as a time for regenerating life, particularly through marriage and children. Reciprocal caring cycles between different generations of women are central to balancing domestic and occupational aspirations in negotiation with the local implementation of the family planning policy. House-based rituals at children’s birthday parties and bridal farewell ceremonies formally celebrate the roles of matrilateral relatives.

Confrontée à des familles devant faire face à des questions reliées à l'honneur, l'ethnopsychiatrie ne peut faire l'économie de s'interroger sur cette notion. C'est l'un des objectifs de cette thèse qui se donne pour mission, non seulement de réaliser une revue de la littérature sur ce thème, mais aussi de dégager l'intérêt de ce concept pour cette discipline. / The notion of honor in psychotherapy and ethnopsychiatry: Interviews conducted with psychotherapists and ethnotherapists in Montreal and Paris. Having to treat families with honor related issues, ethnopsychiatry cannot afford to ignore this notion. The objectives of this thesis are to review the literature on the theme of honor and to impress the importance of the notion of honor in the field of ethnopsychiatry.

L’intervention psychosociale auprès des jeunes vivant en Centre jeunesse est régie par la Loi sur la protection de la jeunesse (LPJ). La posture professionnelle des intervenants s’inscrit à la fois dans une relation d’autorité, renforcée par le cadre institutionnel et les obligations légales, et dans une relation d’aide. Ce mémoire s’est attardé à ce double mandat (réadaptation sociale et relation d'aide) et à son impact sur le lien jeune-éducateur. Le terrain de cette recherche s’est déroulé pendant trois mois dans une unité de réadaptation de Montréal (CJM-IU). L’analyse s’est faite à partir de la rencontre des corpus de données; les récits des jeunes et des éducateurs (entretiens semi-directifs) et l'observation de ce milieu de vie. L’approche utilisée, puisant à la fois dans la tradition ethnographique et dans la phénoménologie, nous a permis de faire émerger l’interprétation et les perceptions qu’ont les jeunes et leurs intervenants sur la question de la relation d’aide et de la relation d’autorité. Les résultats de recherche portent sur les conditions qui favorisent la conciliation ou la polarisation de ces mandats qui peuvent parfois sembler antagonistes. Il a ainsi été possible d’identifier les éléments qui fragilisent l’établissement de liens significatifs et de confiance entre les jeunes et leurs éducateurs ou au contraire les éléments qui les renforcent. Ultimement, les résultats ont permis d’illustrer les embûches à la création d’une alliance thérapeutique en centre de réadaptation pour mineurs et l’impossibilité de sa réalisation dans le contexte actuel. / Psychosocial intervention with children living in Youth Centers is legislated by the Youth Protection Act (YPA). The professional position of the youth workers is characterised by a relationship of authority, reinforced by an institutional framework and numerous legal obligations, and a counselling relationship. This research paper focuses on this double mandate and its impacts on building a connection between the children and their youth workers. The research’s fieldwork took place in a unit of a Youth Center of Montreal (YCM). The analysis is mostly based on a corpus of data, from living environment observations to the protagonist’s very own narratives throughout semi-directive interviews. The present approach combines the ethnographic and phenomenological traditions, enabling the interpretation of the children and youth workers’ perceptions on the questions of the relationships of authority and counselling. The research results pertain to the conditions supporting the conciliation and polarisation of these sometimes antagonistic mandates. Elements weakening the construction of meaningful bonds between the parties, or, to the opposite reinforcing them, were highlighted. Conclusively, this research illustrates the obstacles in creating a therapeutic alliance and its impossible concrete fulfilment within the context of Youth Centers.

Si hier les guérisseurs revendiquaient uniquement le besoin de reconnaissance, aujourd’hui, ils se battent plutôt pour que la reconnaissance qui leur a été accordée par l’État soit capable d’intégrer les conceptions africaines de la maladie et des thérapies ; de les protéger au même titre que les biomédecins dans l’exercice de leur profession ; de protéger les malades en cas de préjudices moral et physique. Ils craignent que la reconnaissance [accordée] ne soit pas reconnue juridiquement par une loi camerounaise qui régule leurs pratiques de soins. Dans la mesure où, sans une reconnaissance juridique et institutionnelle, il leur est impossible de se maintenir dans l’espace [public] de sociabilité thérapeutique ; de changer, à partir de la position illégitime, leurs conditions de praticiens précaires, et surtout leur relation aux usagers de soins [les mères] et aux biomédecins. Dans cette perspective, on se demande quelles sont les modalités d’intéressement ou de désintéressement mutuel qui permettent aux guérisseurs – affaiblis institutionnellement – et aux biomédecins – fortement reconnus – d’évoluer vers une réciprocité de perspectives. L’étude cherche à identifier les modes d’arrachement à l’affaiblissement institutionnel, en s’intéressant, d’un côté, aux processus de capacitation et de renforcement de la légitimité ; et de l’autre, à l’impact de ce renforcement, d’abord, sur la redéfinition des objets et figures de la rencontre et de la reconnaissance, et ensuite, sur la reconfiguration de l’espace de soins et du profil du thérapeute camerounais contemporain. Pour répondre à cet objectif, nous avons sollicité le cadre théorique de la sociologie des épreuves d’inspiration pragmatiste [Thévenot, Boltanski, Gennard et Cantelli] et de l’anthropologie capacitaire [Ricœur]. Les observations de consultations en Maisons de Soins [chez les guérisseurs] et au Centre Mère et Enfant [Hôpital pédiatrique] et les entretiens individuels effectués à Yaoundé [Cameroun] ont engendré une réflexion sur le sens que donnent les mères, guérisseurs et biomédecins au fait de rencontrer ou de refuser de rencontrer un soignant. L’analyse des données recueillies inscrit la rencontre dans l’axe de la reconnaissance capacitaire [des compétences], permettant ainsi d’envisager une pluralité de figures de la reconnaissance et de la rencontre. Elle indique aussi que si la formation à l’identité professionnelle biomédicale constitue pour les guérisseurs une tactique de renforcement de leur légitimité, l’inscription en médecines africaines de certains biomédecins [résistants ou non conformistes] les prédisposent à une résistance institutionnelle aux normes biomédicales ; ce qui permet de nuancer, au regard de la pluralisation et de la diversification des rationalités en jeu, la compréhension du caractère monolithique des institutions. Il en résulte une réflexion sur le brouillage des frontières entre les médecines africaines et la biomédecine, ce brouillage ayant alors comme conséquences, entre autres, une possible fragmentation ou morcellement de ces médecines en termes de «biomodernisation» des médecines africaines et de «traditionalisation» de la biomédecine en contexte africain. / If yesterday the need for recognition was the core claim among traditional health practitioners, today, their quest resides in the recognition not only of their practice but also of the African conceptions of diseases and therapies; in their protection as profesionnals (such as biomedical health practictioners); in the protection of patients in case of moral or physical prejudices. The traditional health practitioners fear that their recognition will not extend to or be sanctioned by Cameroonian law, which regulates their care practices. Without legal and institutional recognition, it is impossible for these practitioners to remain in the social care space; to change, from their illegitimate position, their condition of precarious practitioners, and especially their relationship to biomedical health practitioners. Thus, what are the modalities of mutual interestedness or disinterestedness that allow traditional [institutionally weakened] and biomedical practitioners [strongly recognized] to evolve towards reciprocity of perspectives? The study is seeking to identify modes of wrenching from the institutional weakening, focusing, on one hand, on empowerment and reinforcing processes of healers’ legitimacy; and on the other hand, to the impact of empowerment on the redefinition of objects and figures of encounter and of recognition, on the reconfiguration of social care space and the profile of the therapist. To achieve this objective, we have sought the reference framework of sociology of proofs and the anthropology of capacity of Ricœur. The observations of consultations in «Maisons de Soins» and to the «Centre Mère et Enfant» and interviews have led to a reflection on the interpretation associated by mothers, traditional and biomedical health practitioners to what it means to consult or refuse to consult traditional healer or biomedical practitioner. The analysis of data situates the encounter in the axis of capacity of recognition, allowing us to consider multiple figures of recognition and of encounter. It shows that if the adoption of the biomedical professional identity constitutes for traditional health practitioners a tactic of reinforcement of their legitimacy, the integration in African medicines of some biomedical health practitioners predispose them to an institutional resistance to biomedical norms; making it possible to nuance the comprehension of the monolithic character of institutions, given pluralization and diversification of rationalities at stake. This results in a reflection on blurring of frontiers of African medicines and biomedicine, thus giving place to a possible fragmentation of these medicines in terms in terms of biomodernization of African medicines and traditionalization of biomedicine.

Ce mémoire de maîtrise vise à comprendre comment la question de l'accessibilité aux soins de santé mentale se pose dans l'univers des jeunes adultes en difficulté. Plus précisément, le but de l'étude est de documenter les barrières à l'accès aux soins de santé mentale, d'analyser les logiques sous-jacentes à ces barrières et finalement d'évaluer l'impact de l'expérience d'être jeune adulte en difficulté sur celles-ci. L'approche de l'anthropologie médicale et le concept de souffrance sociale, sensibles aux facteurs culturels, socio-économiques et politiques, servent de contexte d'analyse aux 12 entretiens semi-dirigés réalisés auprès de jeunes adultes fréquentant des Auberges du cœur à Montréal. L'identification de barrières à l'accès a, dans un premier temps, permis d'observer que les obstacles dans l'expérience de recours aux soins de santé mentale peuvent provenir autant des institutions que des jeunes adultes eux-mêmes. Dans un deuxième temps, l'analyse qualitative a servi à dégager trois principales logiques qui sous-tendent ces barrières : le parti pris positiviste, la logique marchande, et la tendance à la psychologisation. Les données récoltées tendent à montrer que des influences politiques et économiques sont déterminantes dans le maintien de différents types de barrières à l'accès et qu'une pleine reconnaissance de ces enjeux profonds est essentielle pour agir positivement sur l'accessibilité aux soins de santé mentale de la population en général, et plus particulièrement des jeunes adultes en difficulté dont les besoins se font criants. / This Master's thesis aims to understand how the issue of access to mental health care arises in the world of young adults in difficulty. More precisely, the research's objectives are to document the barriers to access to mental health care, to analyze tendencies underlying these barriers and to evaluate the impact of being young adult in trouble on them. The approach of medical anthropology and the concept of social suffering, sensitive to cultural, socio-economic and political factors framed the analysis to the 12 semi-directed interviews conducted with young adults using services from Auberges du coeur to Montreal. First, the identification of barriers to access allowed to observe the obstacles in the experience of use of mental health care may come as institutions that young adults themselves. Secondly, the qualitative data analysis was used to identify three main logic underlying these barriers: the positivist bias, market logic, and the trend of psychologizing. The data collected suggest that political and economic influences are critical in maintaining different barriers to access, and full recognition of these deep issues is essential to act positively on access to mental health care of the general population, especially young adults in difficulty whose needs are urgent.