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 F rance; new welfare benefits have been introduced and initiatives on the par t of the social services made in an attempt to increase access to medical c are for this underprivileged section of the population. Professionals in he alth care and researchers view this economic and social vulnerability and i ts effect on health in the context of a situation in which need and exclusi on are predominating factors. An analysis has been made of the results of t wo 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 chro nic disease or requiring heavy and/or long-term treatment, we show how thes e three issues are indissociable, and constitute a unique life profile; and also, when the patient's perceptions of his situation are taken into accou nt how they contribute toward maintaining his sense of identity. An awarene ss 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 medica l care not only for this destitute or underprivileged section of society, b ut for the benefit of the community as a whole. (C) 2000 Editions scientifi ques et medicales Elsevier SAS.