Competing reference frames and influence process : Living or assessing health risks Geneviève Paicheler CNRS/CERMES Paris- France

The policy of risk Increasingly, political decisions have to deal with risk management But risk is very fuzzy and difficult to grasp, which makes political decisions particularly difficult As a social construction, risk is the result of controversies based on different ways of conceiving the danger Therefore, different social groups have opposed risk perceptions To impose one’s own perception — or framing— allows to influence political decisions

The crisis of expertise The disenchantment of science Experts are no longer relied on when risk management is at stake : scientists arouse more and more distrust and scepticism. More science can mean more uncertainty The validity of the scientific tools and methods of risk assessment is questioned Science is loosing its authority and is no more conceived as the unique way to grasp the risks it often contributes to create

The rise of a « non-professional expertise » What is the best way of knowing the risks : assessing or living them ? Lay people — through organized movements — claim an inside knowledge of risk through their intimate experience This knowledge is emotionally tainted (outrage, blaming, denunciation).

The assumption The failure of scientific expertise, due to the uncertainty and indecisiveness of health risks creates a vacuum of authority that favours lay expertise — life, field, experience expertise — based on new visions of risk linked of moral, symbolic, emotional dimensions, to a citizens’ involvement and to an intense mediatization.

The example Prophylaxis of AIDS transmission after sexual exposure « Accidents » of prevention ? Fast decisions in the French context : availability without limit ? The cost out of concern. The impossible evaluation of the relevance of the political decision.

A twofold framing Controversies : battle of words, fights of figures. The epidemiologists’ frame : risk scale, benefit/risk, cost/benefit. The organizations’ frame : everybody is entitled to receive the treatment : no « good » or « bad » risk exposure. The « property of the problem » is based on an intimate knowledge, of the illness, alien to the healthy people pretending to interfere.

Credibility struggles and risk exposure Focused on the validity of two kinds of epidemiological data : the probability of transmission for one sexual contact, and the follow-up of the people receiving the.prophylactic treatment The arguments are either internal — treatment and interpretation of data — or external to epidemiology, by supplying information for the field changing the interpretation of data. Other arguments take into account the dramatic individual dimension of HIV transmission.

The ethical and emotional dimensions of controversies Reference to values : equality principle and rejection of stigmatization. Rejection of political cynicism : the refusal of the cost- efficiency balance. Dramatization and visibility : the instrumentalization of the media.

Conclusion The rise of a lay expertise is based on the use of subversion aiming to a consensus on the extreme positions of the more involved actors, suffering in their own bodies. Experts are expelled out of the political stage where efficiency and rationality are disqualified to the benefit of dramatization and emotions. The question of risk becomes focused on the question of individual exposure, on the singularity of the situations but at the same time realized a rise in generality based on moral values of discrimination rejection and of the right to life protection.