Margulies SS. “Candidaturas” y HIV-SIDA tensiones en los procesos de atención. [“Candidacies” and HIV-AIDS tensions in healthcare processes.] Cuadernos Médico Sociales [Medical Social Notebooks] 1998 November; 74:53-59.

Objectives: To analyze the social construction of the HIV-AIDS problem, through the representations and practices of health professionals who work in public hospitals in Buenos Aires , Argentina .

Methodology: Ethnographic.

Results: The author presents the results of research on the bio-medical construction of HIV-AIDS and the particular modalities which its institutionalization assumes in public hospitals. The chief category employed is that of “candidacy,” that is, how a patient arriving for a medical consultation is turned into a “candidate” to be studied for HIV-AIDS.

The category of “candidacy” allows health professionals to explain risk factors for AIDS as well as the practices and outlooks of the clinic concerning this disease. Physicians defined “candidates” as those patients “inclined” to become infected with HIV. These “candidates” include patients for whom health professionals raised a suspicion that led to requests for diagnostic tests. Other candidates were classified as “codified” patients, or “biosecurity” patients, due to precautions adopted in the work routine.

Professionals interviewed pointed to a set of traits to characterize patients “inclined” to contract the disease. These traits included certain pathologies (present or past), drug addiction (intravenous or not), sexual preferences, poverty, young age, and membership in socially excluded groups. In this way, the notion of “candidate” contained no predetermined, unifocal, empirical point of reference. Rather, from an articulation among the reality of suffering, the epidemiological categories of risk groups and risky practices, and clinical selection, health professionals elaborated a construction of subjects as HIV-AIDS patients.

Conclusions: To make a clinical evaluation involving the terminology of risk frequently reflects medical uncertainty more than the capacity to predict or know results. The evaluation of risk permits the appearance of control over what in fact are unknown events pertaining to individuals. In this conception of disease, etiologies are viewed as mechanical causes and individuals as aggregates of risk factors, related statistically.

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