[Chronic hepatitis B and HIV care: the key role of the doctor-patient relationship].

In France, populations from sub-Saharan Africa represent a large proportion of the persons living with chronic hepatitis B or HIV. The objective of this study was to analyse the characteristics of the doctor-patient relationships in these diseases, when the patient is a sub-Saharan migrant, according to the doctor's objectives, the patient's expectations, and the context of care for these in diseases. A qualitative study by semi-structured interviews and by observations of medical consultations was conducted in four hospitals in Ile-de-France. Seventy-three patients from Sub-Saharan Africa living with chronic hepatitis B or HIV, and 13 doctors were interviewed. The study emphasizes the central role of the doctor-patient relationship in meeting the patient's expectations in relation to management. The characteristics of this relationship are different for these two diseases. For hepatitis B, a mismatch was observed between the doctor's objectives, centered on medical care, and the patient's expectations (information about the disease and treatment, support in everyday life with the infection and administrative procedures) in a context of misunderstanding and negative perception of hepatitis B. For HIV, the doctor's objectives and the patient's expectations were more closely matched because personal, social, and administrative difficulties are integrated into care. Management of sexual problems and legal obstacles to family entry and settlement remain uncertain. Similar studies in populations born in France would be necessary to complete these results.