“We are demonstrating to make ourselves heard, since we have not been able to negotiate! » storm Guylène Madeline, director of Gaps de Bordeaux. The Bordeaux Psychological and Social Assistance Group, located in an office within the Saint-André hospital, must close its doors on 1is January by decision of the Regional Health Agency (ARS). This afternoon of Thursday, December 19, the Gaps team demonstrated in front of the ARS of Bordeaux, supported by the partner associations, Sidaction and Act Up.
The Gaps, opened in Bordeaux in the midst of the AIDS epidemic, exactly thirty-eight years ago, aims to provide hand-crafted psychosocial support, on a case-by-case basis, for people who are very socially vulnerable and carrying HIV. The active Gaps queue has never really diminished, since, even today, between 400 and 450 people benefit from it each year. Why such a decision?
Case-by-case support
Currently, in the region, around 8,000 people carry HIV, more than half of whom live in Gironde. Every year, there are around 300 new patients. Since the appearance of the disease in the 1980s, therapeutic management has evolved favorably, thanks to different generations of antiretrovirals.
However, not all HIV-positive people cope with their illness in the same way. Some are incapable, for health reasons, as well as socio-economic and even cultural reasons, of taking care of themselves in order to live in humanly dignified conditions. This care mission falls to Gaps, an association which brings together ten multidisciplinary employee stakeholders, in a common project around these most vulnerable populations. “We support on a case-by-case basis people who do not have the means to access the services offered by common law structures,” recalls Guylène Madeline. I am thinking of the hospital, the sector social workers, the CPAM, etc. We offer support in a single location, and our model works, we have proven it regularly. »
The Gaps team denounces a “dismantling by the ARS”.
GUILLAUME BONNAUD / SO
Funding denied by the ARS
Last April, Gaps, like other operators in the health, social and medico-social field, was invited by the ARS to “demonstrate that our activity was convincing and promising. We had three years to present this demonstration. Impossible for us to raise the funds to carry out such a study,” according to the director of Gaps. In short, at the end of November 2023, these same operators are gathered at the ARS, whose stated wish is “to strengthen and secure the prevention and care of people living with HIV in accordance with the recommendations of the High Authority for Health (HAS ) and the national strategy to combat HIV. However, Guylène Madeline specifies that the Gaps was not invited to this final decision. “We learned at that time and without us that our funding had been withdrawn. The decision was made, without the slightest discussion,” she laments.
The ARS’ explanation came this Wednesday, December 18, via a press release sent to the media: “In 2024, the ARS is committed to ensuring a transition to prevent any risk of disruption to the health pathway of people living with HIV which were monitored by the Gaps association. She entrusted the Bordeaux University Hospital with the management of this necessary transition to ensure the continuation of comprehensive care for all the patients concerned. » In this case, at Saint-André hospital. The ARS proposes to integrate four members of the Gaps team. “Indeed, and we participated in meetings to discuss this transfer,” assures the director of Gaps. Not only is this decision unilateral, imposed without debate, and fundamentally, we are opposed to it, because we are psychosocial specialists, while the core business of the University Hospital is health. »
“The continuity and quality of care for patients living with HIV are the subject of constant attention”
“We have the feeling that the ARS prefers to standardize the courses, whereas we were tailor-made,” says the director. HIV carriers remain a niche audience… The ARS provided us with funding of 287,000 euros per year, which made it possible to pay the payroll. For the health agency, we are too expensive. Nevertheless, we were the only ones to work on the real living conditions of the beneficiaries, very fragile people. How to transfer an association project from 10 people to only four? »
Act Up and the Gaps “are worried about the future of the people followed by the Bordeaux association, fear damage”. For its part, the ARS ensures that patients monitored by the Gaps have been alerted of this shift of skills to the Saint-André hospital and confirms that “the continuity and quality of care for patients living with HIV make subject of constant attention and that they will continue to be monitored with the greatest vigilance in 2025.
