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Medicine thesis defended in 2018, shorter version, supervised by Dr. Jean-Hervé Bradol and sociologist Marc Le Pape.

After more than thirty years of combating HIV (human immunodeficiency virus) and despite progress in both treatment and reducing the stigmatization of people living with HIV (PLHIV), issues related to the epidemic persist.

This is the reality in Nyanza Province, a rural area in western Kenya where this study was conducted. The prevalence in this region of 4.4 million inhabitants is an estimated 15%, and in some districts is as high as 25%. The mortality rate is also very high, due to AIDS (Acquired Immune Deficiency Syndrome) in particular.

In a high-prevalence area, behavior change is often spurred by an individual’s awareness of the risk of infection, by testing, and by learning that he is HIV-positive. In particular, such change is reflected in the relationship between the sexes and in the demand for care. The individual then weighs the HIV-related risks against a whole set of health, social, and economic considerations. Hence there may be some process by which the risks and benefits of given behaviors are prioritized.

At a time when there seems to be a great deal of pressure on the individual and societies to achieve the global objective of HIV eradication, it would seem important to include and support every individual in the health care effort and process. As we will see, simply setting up a testing or care campaign does not necessarily mean that the entire population will participate; the message has to be tailored to the target population and fine-tuned even within that population.