Ilario Rossi

Immigration, a political, economic, demographic, social and ethic, as well as a medical issue, continues. Among migrants, asylum seekers, refugees and undocumented immigrants are characterised by their vulnerability, particularly related to their health status. Western physicians are more and more frequently confronted to "colorful" and often vulnerable patients. They face diseases related to international migrations; and at the same time have to integrate the differences in representations and meanings given to illness by patients of diverse origins. A bio-psychosocial and spiritual approach coupled with an evaluation of pre-migration, migration and post-migration trajectories is therefore useful for the clinician; these complementary approaches have all been integrated in the learning of cultural competencies.

Pourquoi organiser, à l'intention des professionnels de la santé, une formation consacrée spécifiquement à la médiation culturelle dans le monde des soins? Plusieurs raisons justifient une telle démarche. Elles touchent avant tout aux mutations sociales et culturelles propres à notre époque. En effet, dans un contexte de migrations généralisées, deux phénomènes majeurs concernent directement le monde des soins: l'internationalisation des maladies d'une part et le pluralisme culturel qui caractérise de plus en plus nos sociétés d'autre part. Si les réponses à donner au premier reposent essentiellement sur le paradigme médical, celles que requiert le second appellent à un élargissement des compétences. En effet, par la relation qu'ils entretiennent avec les migrants, les soignants sont mis en demeure de modifier leur attitude personnelle ainsi que leur culture professionnelle. Face aux enjeux de l'interculturalité, il s'agit alors de s'orienter vers la co-disciplinarité. Warum eine Ausbildung in kultureller Mediation für Gesundheitsberufe? Mehrere Gründe sprechen für ein solches Vorgehen. Neben den sozialen und kulturellen Veränderungen unserer Epoche sind vor allem zwei Phänomene zu nennen: die Interkulturalität von Krankheiten einerseits, aber auch der kulturelle Pluralismus, der unsere Gesellschaft zunehmend charakterisiert. Während beim ersten die Grenzen des medizinischen Paradigmas nicht überschritten werden, wird beim zweiten eine Erweiterung der Fachkenntnisse unerlässlich sein. Durch die Beziehung zu Migranten müssen Pflegende und Behandelnde ihre persönliche Haltung und ihre Berufskultur ändern. Die Herausforderungen der Interkulturalität erfordern eine Neuorientierung hin zu einer interdisziplinaren Zusammenarbeit. Why organize a training course destined for health care professionals which is specifically devoted to cultural mediation in the sphere of health care? There are several reasons justifying such an initiative, mainly relating to the social and cultural mutations pertaining to the present world situation. In fact, two major phenomenas may be said to directly influence the health care scene in the current context of generalized migration: the internationalisation of diseases on the one hand and on the other hand, the cultural plurality to be found to an increasing degree in society in general. While the responses to the first scenario fall within the limits of standard medical practice, those which are necessitated by the second situation demand a widening of expertise. By reason of the relationship they establish with migrants, it is mandatory that carers should modify their own personal attitudes as well as their professional framework. In the face of the requirements imposed by interculturality, it is imperative to move in the direction of co-disciplinarity.

This study compares the clientele of a Swiss anonymous test centre with the general population tested. Information was obtained through similar questionnaires submitted to two samples of HIV-tested people aged from 17 to 45 years: the first administered in the context of a general population telephone survey ( n = 245) and the second completed during face-to-face interviews of the clientele of an anonymous test centre ( n = 250). The test centre sample has higher proportions of younger and single people. Attenders for anonymous testing were more likely to have acquired a new regular partner during the year preceding the interview (48.0% versus 14.4%). These differences remain when controlling for age and gender. Decision to test comes mostly from the respondent's own initiative, but suggestion from a doctor is more frequent in the general population (23.8% versus 0.8%), whereas suggestion from partner or friends is more frequent in the anonymous centre (44.4% versus 3.0%). The anonymous test centre clientele is not different from the general population tested except for the relational situation and origin of decision for testing. The test centre has become a place where the general population finds a response to a situation-specific need for HIV testing.