Persistence and reconstruction in the health sector. Local policy to combat aids.

Aids was a disruptive factor in the health sector. According to a common hy pothesis, this disruption gave birth to a new public health policy in Franc e. According to another hypothesis, which this article stands up for, the r econstruction observed gives more weight to the public hospital within the French health system and to the individual curative model on which it is ba sed. To back this hypothesis, local policies to combat aids were studied in six different departments in relation to the institutional matrix in which they fall. An institutional matrix consists of an institutional arrangemen t within a territory and belonging to a societal sector. In the case of aid s this matrix is composed of three poles : health, political and medical-so cial welfare. Depending on its degree of integration, this matrix defines t he form and the content of actions undertaken, both in the prevention and i n the taking care of patients. In most cases it manages to reabsorb the dis putes resulting from taking medical care of patients and the monopoly of th e legitimate expertise of hospital practitioners, by imposing on the differ ent actors involved in combating aids the obligation to adopt institutional ized rules which reproduce dominant legitimate forms in the health sector. The public hospital is all the stronger after this trial, but its modalitie s of intervention evolve, especially towards prevention and a move towards opening its environment - whereas approaches from, for example, a community model remain marginal or isolated without the capacity to deeply transform the French health sector.