[Do reproductive health care practices create a risk of HIV, HVB, and HVC transmission? Case studies in Cambodia]

The processes involved in nosocomial transmission of HIV, HBV, and HCV nosocomial transmission have not been studied at a global level; little is known about them or about the underlying social and cultural logic that contributes to this transmission. Hospital hygiene has mainly been studied from a biological perspective until now. However, hospital hygiene is shaped by norms and sociocultural representations, and the increase or limitation of disease transmission always takes place within social relations. We need to analyse the practices related to hygiene from a cultural perspective, especially since norms are interpreted at the local level according to social and symbolic logic. Our paper aims to investigate these issues in the context of reproductive health care practices in Cambodia. We describe various perceptions, attitudes and roles of both medical and non-medical caregivers and show how they determine practices, as well as how sanitary, social and institutional contexts shape practices. Since 1995, public health institutions have provided contraceptive methods (condoms, oral or injectable contraceptives, contraceptive implants, intrauterine devices, and emergency contraception). Except for the free distribution of condoms, particularly by NGOs as part of HIV prevention programs, access to contraception is not free. Private clinics and local and international NGOs provide many of these services. Many women in both urban and rural areas seek reproductive health care in the informal sector, from caregivers who may or may not be trained. We thus wonder if these practices, as implemented in the formal and informal care sectors, create a risk for the transmission of HIV, HVB, and HVC. We analyse those issues in considering especially the injection of Depo-Provera, insertion of intrauterine devices, vaginal cleaning practices, and surgical abortion. This investigation of the sociocultural dimension of hygiene in the field of reproductive health care underlines how and to what extent these practices may present a risk of nosocomial transmission of HIV, HBV, or HCV when they are performed by trained or untrained caregivers practising outside the formal health care setting. We also wonder if in some circumstances, reproductive health practices may be at risk when they are performed "informally", particularly at night and on weekends by caregivers in the public sector of care. Finally, because of the high cost of abortions in the institutions allowed to provide this service, many women have recourse to informal care sector, where the materials and techniques, as well as the lack of training for practitioners, appear to be the source of haemorrhagic risks and subsequent infection.