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Du Monde Au Cambodge, Le Sida DU MONDE AU CAMBODGE, LE SIDA Des Contextes, des Programmes et des Personnes De la Théorie à la Pratique Des Origines à l’Avenir Par Dr Pierre-Régis MARTIN Directeur des Programmes de SEAD Sharing Experience for Adapted Development 2010 [email protected] DEDICACES A ma famille, qui est toujours avec moi malgré l’espace et le temps et sans qui rien ne serait. Hommage et Reconnaissance. Michel, mon adorable Père Danielle, ma bien-aimée Mère Nicolas, mon inestimable Frère Borini, ma gracieuse Sœur A ma sublime femme, qui m’a apporté son Cœur et la moitié du Monde qui me manquait Amour, Amour. Akiko Togo A mes enfants, qui m’enseignent à chaque instant la beauté des Mondes et de ses Etres Merci, Merci. Rémy-Kay, Yumé-Maël, Sans oublier : Bori, Frédéric, Régine, Jean-Marc, Joran, Liliane, Manu, Julia, Françoise, Jean-Pierre, Bernard, Sylvie, Sophie, Roland, Martine. A mes ascendants, Jean Auberlet dit "Palou" (mon grand-père), Emile Auberlet dit "Papa-mimi" (mon arrière grand-père) et à George Andrieux (beau-frère de mon grand-père) qui ont participé à la reconstitution du temple d'Angkor pour l'exposition coloniale de 1931 à Vincennes en tant que respectivement : décorateur- staffeur, responsable des relations publiques et directeur technique. Et à Malou, Pajean et Malène. A l’initiateur, qui a été Coordinateur de MDM Cambodge de 1990 à 1998, qui m’a accompagné de sa force, de son cœur et de ses leçons de vie. J’ai ainsi nommé : Jean-Claude Prandy, A Médecins du Monde Paris qui, tout en me permettant d’aider les indigents de ce merveilleux pays, m’a aussi donné la possibilité de réaliser ce travail. En particulier : Dr Frédéric Lauwers, Dr Philippe Micheau, Zohra Clet, Dr Eric Peterman (RM Paris) et Valérie Pardessus (Desk Paris). A mes collègues du Cambodge, avec qui je partage la même aventure humaine. Amitié indéfectible. Au Dr Philippe Guyant, confrère et homme d'esprit. Evolution A Arnaud Roux, journaliste, partenaire d’aventures et de découvertes. Evasion A Michel Marty, un exemple de courage et de volonté. Respect A Michel Ghigo, frère de sève et de visions. Partage A Joël Durand, homme de patience et de tolérance. Ecoute Au Dr Jean-Philippe Dousset, contemplation et compétence. Sagesse A Lim Bun Hok, homme affable et talentueux. Joie. Vive notre Président ! Aux Mékong Pirates Arnaud, Ali, Dominique, Eric, Gildas, Julien, Marion, Michel, Mom, Nicolas, Olivier, Philippe, Volker Aux amis du Cambodge qui sont maintenant ici ou ailleurs, Dr. Christian Rathat André Calabro Dr. Christophe Iborra Frédéric Amat Dr. Claude Dumurgier Jean Claude Dhuez Dr. Denis Cahour Callarec Jean Paul Chan Dr. Emmanuel Baut, Kim Gjemmestad Pr. Jean-Yves Follézou Philippe Escabasse Dr. Natalia Bodarenko Sacha Andriyanov Dr. Pascal Crépin Serge Corrieras Dr. Patrick Mornet Stanley Harper Dr. Pierre Souteyrand Xavier Lafut Aux équipes cambodgiennes d’avant et de maintenant Pr Teng Soeun, Pr. Pichith, Dr Pagnaroat, Dr. Chakravuth, Dr. Mao, Dr. Srun, Dr. Vathanak, Dr. Chea, Dr. Norathik, Nan, Achhara, Kakakda, Lao, Kannitha, Lidet, Nissai, Sothea, Dara, Mégn, Seng Tha, Vat, Vanna, …et les dizaines d’autres. EPIGRAPHES La vie est brève, L’art est long, L’opportunité fugitive, L’expérience dangereuse, Le jugement difficile Hippocrate, Premier aphorisme (Vita brevis, ars longa, occasio praeceps, experimentum pericolosum, judicium difficile) Dans les chemins que nul n’a foulés, risque tes pas Dans les pensées que nul n’a pensées, risque ta tête Anonyme – Ecrit sur les murs du théâtre de l’Odéon, Paris, mai 1968 Vis comme si tu devais mourir demain, Apprends comme si tu devais vivre toujours. Vivre simplement pour que simplement d’autres puissent vivre. La fin est dans les moyens comme l’arbre est dans la semence. Gandhi Mohandas Karamchand Mahâtmâ TABLE DES MATIERES GLOSSAIRE DES ACRONYMES .............................................................................................................. 13 PREFACE ....................................................................................................................................................... 15 INTRODUCTION .......................................................................................................................................... 17 MATERIEL ET METHODE ........................................................................................................................ 21 MATERIEL : RECENSEMENT DES DONNEES ............................................................................................ 21 QUESTIONS DE METHODE ...................................................................................................................... 21 PROLOGUE (1968-1979) .............................................................................................................................. 29 PREMIERE ACTE : CONTEXTES & SITUATIONS (1980 – 1994) ...................................................... 31 I.A. SPHERE VIRO-IMMUNOLOGIQUE ........................................................................................ 31 I.A.1. Les débuts de l’épidémie ................................................................................................... 33 I.A.2. A la recherche des origines ............................................................................................... 41 I.A.3. Le virus et les anti-virus .................................................................................................... 47 I.A.3.a Les Antirétroviraux (ARV) ................................................................................................. 47 I.A.3.b L’espoir vaccinal ............................................................................................................... 49 I.B. SPHERE INTERNATIONALE ................................................................................................. 52 I.B.1. Statistiques mondiales et organismes internationaux (1981-1994) .................................. 53 I.B.2. Les programmes internationaux – les initiatives ............................................................... 56 I.B.2.a Transmission - Prévention ................................................................................................. 57 I.B.2.b Infections Sexuellement Transmissibles (IST) et VIH ........................................................ 64 I.B.2.c Les ARV sont chers et inaccessibles. .................................................................................. 67 I.B.3. Impact des épidémies ......................................................................................................... 68 I.C. SPHERE NATIONALE (PAYS, GOUVERNEMENT, POPULATION) ........................................... 71 I.C.1. Le pays ............................................................................................................................... 71 I.C.1.a Présentation géographique ................................................................................................ 71 I.C.1.b Une histoire tourmentée ..................................................................................................... 72 I.C.1.c La situation économique et sociale .................................................................................... 75 I.C.1.d Système sanitaire et état de santé de la population............................................................ 76 I.C.2. Les débuts du VIH – les premiers cas ............................................................................... 80 I.C.3. La réponse gouvernementale ............................................................................................. 84 I.C.3.a Les premières structures .................................................................................................... 84 I.C.3.b Les premières stratégies..................................................................................................... 85 I.C.3.c Les premières enquêtes ...................................................................................................... 85 I.D. SPHERE ONG .................................................................................................................... 87 I.D.1. L’arrivée des ONG ............................................................................................................ 88 I.D.2. L’arrivée de Médecins du Monde ...................................................................................... 89 I.E. SPHERE INDIVIDUELLE ...................................................................................................... 91 I.E.1. Chapitre premier : 1980-1990........................................................................................... 91 I.E.2. Chapitre second : 1991-1994 ............................................................................................ 93 9 Des Contextes, des Programmes et des Personnes - De la Théorie à la Pratique - Des Origines à l’Avenir DEUXIÈME ACTE : PROGRAMMES & RÉSULTATS (1995-2008) .................................................... 95 II.A. La Prévention et le dépistage (1995-2008) ...................................................................... 96 II.A.1. Actualités 1995-1996 ......................................................................................................... 96 II.A.2. Stratégie nationale ............................................................................................................ 99 II.A.3. Actions et résultats .........................................................................................................
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