Precarious living conditions, disease and medical treatment: three issues but a unique life profile.

Precarious living conditions now affect a significant number of people in France; new welfare benefits have been introduced and initiatives on the part of the social services made in an attempt to increase access to medical care for this underprivileged section of the population. Professionals in health care and researchers view this economic and social vulnerability and its effect on health in the context of a situation in which need and exclusion are predominating factors. An analysis has been made of the results of two social studies, one on access to medical treatment for persons attending free clinics, and the other on adherence to and compliance with treatment in HIV-infected individuals. The interrelations between disease, precarious living conditions and treatment have been examined. For patients with chronic disease or requiring heavy and/or long-term treatment, we show how these three issues are indissociable, and constitute a unique life profile; and also, when the patient's perceptions of his situation are taken into account how they contribute toward maintaining his sense of identity. An awareness of these interrelations and of the way in which the patient assumes the social management of his disease should be included in the approach to this problem by professional medical practice and in the organisation of medical care not only for this destitute or underprivileged section of society, but for the benefit of the community as a whole. (C) 2000 Editions scientifiques et medicales Elsevier SAS