The Structural Violence of Patient Participation in Cambodian HIV Services.

Participation of people living with HIV/AIDS (PLHA) has become a new standard of good governance in HIV services worldwide, and most HIV organizations make reference to it. This standard has had a considerable impact in Cambodia, where hundreds of PLHA have been recruited by organizations to participate in the development of HIV services. However, participation is a vague concept with various interpretations and applications. Drawing on ethnographic research conducted between 2006 and 2008, this article first clarifies what promoters expect from patient participation in Cambodia and then examines its meanings and uses for one category of PLHA working in hospitals (hereafter "volunteers"). It shows that volunteers have played a valuable role in the scaling-up of access to care and treatment policy, and that although international organizations in Cambodia see patient participation as empowering PLHA, these volunteers face structural violence caused by inherent conflicts within Cambodia's strict health care hierarchy.

Regulatory framework for the assessment of the impacts of plant protection products on biodiversity: review of strengths and limits.

The placing of plant protection products (PPPs) on the market in the European Union is governed by numerous regulations. These regulations are among the most stringent in the world, however they have been the subject of criticisms especially because of the decline in biodiversity. The objectives of this work were to review (1) the functioning and actors involved in the PPP framework processes, (2) the construction of the environmental risk assessment focused on biodiversity, and (3) the suggested ways to respond to the identified limits. Both literature from social sciences and ecotoxicology were examined. Despite the protective nature of the European regulation on PPPs, the very imperfect consideration of biodiversity in the evaluation process was underlined. The main limits are the multiplicity of applicable rules, the routinization of the evaluation procedures, the lack of consideration of social data, and the lack of independence of the evaluation. Strengths of the regulation are the decision to integrate a systemic approach in the evaluation of PPPs, the development of modeling tools, and the phytopharmacovigilance systems. The avenues for improvement concern the realism of the risk assessment (species used, cocktail effects…), a greater transparency and independence in the conduct of evaluations, and the opening of the evaluation and decision-making processes to actors such as beekeepers or NGOs. Truly interdisciplinary reflections crossing the functioning of the living world, its alteration by PPPs, and how these elements question the users of PPPs would allow to specify social actions, public policies, and their regulation to better protect biodiversity.

Main conclusions and perspectives from the collective scientific assessment of the effects of plant protection products on biodiversity and ecosystem services along the land-sea continuum in France and French overseas territories.

Preservation of biodiversity and ecosystem services is critical for sustainable development and human well-being. However, an unprecedented erosion of biodiversity is observed and the use of plant protection products (PPP) has been identified as one of its main causes. In this context, at the request of the French Ministries responsible for the Environment, for Agriculture and for Research, a panel of 46 scientific experts ran a nearly 2-year-long (2020-2022) collective scientific assessment (CSA) of international scientific knowledge relating to the impacts of PPP on biodiversity and ecosystem services. The scope of this CSA covered the terrestrial, atmospheric, freshwater, and marine environments (with the exception of groundwater) in their continuity from the site of PPP application to the ocean, in France and French overseas territories, based on international knowledge produced on or transposable to this type of context (climate, PPP used, biodiversity present, etc.). Here, we provide a brief summary of the CSA's main conclusions, which were drawn from about 4500 international publications. Our analysis finds that PPP contaminate all environmental matrices, including biota, and cause direct and indirect ecotoxicological effects that unequivocally contribute to the decline of certain biological groups and alter certain ecosystem functions and services. Levers for action to limit PPP-driven pollution and effects on environmental compartments include local measures from plot to landscape scales and regulatory improvements. However, there are still significant gaps in knowledge regarding environmental contamination by PPPs and its effect on biodiversity and ecosystem functions and services. Perspectives and research needs are proposed to address these gaps.

Self-Medication and the Pharmaceutical System in Cambodia.

Based on an ethnographic study of the Cambodian pharmaceutical system conducted in an urban and a rural setting between January 2015 and June 2016, we report on the complex dynamics surrounding the issue of self-medication in that country. We describe the history of the circulation of pharmaceuticals in Cambodia, and we discuss the contemporary relationship individuals have with these medicines and with those who distribute them. We illustrate the specific dynamics of the pharmaceuticalization of Cambodian society, where private drug vendors are playing a key role.