Table Of ContentOrganizing AIDS
Social Aspects of AIDS
Series Editor: Peter Aggleton
Institute of Education, University of London
Editorial Advisory Board
Dominic Abrams, University of Kent at Canterbury, UK
Dennis Altman, La Trobe University, Australia
Maxine Ankrah, Makerere University, Uganda
Mildred Blaxter, University of East Anglia, UK
Manuel Carballo, Nyon, Switzerland
Judith Cohen, University of California, San Francisco, CA, USA
Anthony Coxon, University of Essex, UK
Peter Davies, University of Portsmouth, UK
Gary Dowsett, Macquarie University, Australia
Jan Grover, Oakland, CA, USA
Graham Hart, MRC Medical Sociology Unit, Glasgow, UK
Mukesh Kapila, Overseas Development Administration, UK
Hans Moerkerk, National Commission on AIDS Control,
Amsterdam, Netherlands
Cindy Patton, Temple University, Philadelphia, PA, USA
Diane Richardson, University of Sheffield, UK
Werasit Sittitrai, Chulakongkorn University, Thailand
Ron Stall, University of California, San Francisco, CA, USA
Robert Tielman, Utrecht, Netherlands
Simon Watney, London, UK
Jeffrey Weeks, South Bank University, Bristol, UK
Organizing AIDS:
Workplace and Organizational
Responses to the HIV/AIDS
Epidemic
David Goss and Derek Adam-Smith
© David Goss and Derek Adam-Smith, 1995
All rights reserved. No part of this publication may be reproduced, stored ina
retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without permission in
writing from the Publisher.
First published 1995
By Taylor & Francis
11 New Fetter Lane, London, EC4P 4EE
Taylor & Francis is an imprint of the Taylor & Francis Group
This edition published in the Taylor & Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or
Routledge’s collection of thousands of eBooks please go to
www.eBookstore.tandf.co.uk.”
A Catalogue Record for this book is available from the British Library
ISBN 0-203-99163-X Master e-book ISBN
ISBN 0 7484 0258 6 (Print Edition)
ISBN 0 7484 0259 4 pbk
Library of Congress Cataloging-in-Publication Data are available on
request
Contents
Acknowledgments vi
Series Editor’s Preface vii
Chapter 1 AIDS, Employment and the Workplace 1
Chapter 2 Defensive Responses to HIV/AIDS 25
Chapter 3 Constructive Responses to HIV/AIDS 46
Chapter 4 HIV/AIDS and Workplace Dilemmas 70
Chapter 5 Sex, Work and HIV/AIDS 90
Chapter 6 HIV/AIDS and British Employment Law 114
Chapter 7 Legislative Responses to HIV/AIDS in Europe 132
and USA
Chapter 8 Conclusions 144
References 149
Index 158
Acknowledgments
We are indebted to a number of people and organizations without
whose help and cooperation the completion of this book would not
have been possible. The fieldwork research reported in the book
was supported by the Economic and Social Research Council
(grant number R000 234131) and we record our gratitude to those
organizations, managers and staff who gave freely of their time to
answer our questions. Thanks also to three of our colleagues at
Portsmouth: Karen Meudell and Karen Gadd who undertook a
number of the interviews, and Adele Sinclair who commented on
earlier drafts of Chapters six and seven. We are also grateful for
the support given to us by Vanessa Hardy and her colleagues at
the National AIDS Trust. Finally, special thanks to Fiona, Sophie,
Charlotte, Dilys and Kip for their patience and good humour while
we spent too many unsocial hours at the word processor.
David Goss and Derek Adam-Smith, January 1995
Series Editor’s Preface
Since the earliest days of the epidemic, people with HIV and AIDS,
and people presumed to be infected, have been subjected to
discrimination, ostracization and even dismissal from their place
of employment. Efforts have often been made to justify such
actions on public health grounds or in terms of responsiveness to
the anxieties and demands of coworkers. But as David Goss and
Derek Adam-Smith show, these responses conceal a more hidden
agenda linked to enduring anxieties about ‘normality’ and
‘abnormality’, and social as well as virological contagion. Of
course, there have also been attempts to foster more supportive
workplace and organizational responses towards people living with
HIV, spearheaded by affected communities, enlightened public
health workers and community organizations working for those
affected. While not uncontested, such actions have contributed
towards a more realistic appreciation of HIV disease and its work-
related consequences. This book charts the origins, emergence
and effects of both of the above dominant patterns of response. It
does so with a view to offering employers, managers, researchers
and organizational theorists insight into some of the more
productive ways in which HIV can be tackled in the workplace.
Using case study material from a range of countries, and in an
engaging and accessible manner, the authors point to ways in
which anxieties and fears can be successfully challenged through
good workplace policy and practice.
Peter Aggleton
Chapter 1
AIDS, Employment and the
Workplace
Introduction
This book is about the various ways in which people have
responded to the HIV/AIDS epidemic in their roles as employers,
employees, and the users of services provided by employing
organizations. This is an area that has been largely ignored by
researchers investigating the social implications of AIDS, a neglect
that probably stems from a number of inter-related factors. Firstly,
the workplace is not generally associated with behaviours which
lead to the transmission of HIV, i.e., the ‘recreational’ activities of
sex and drug-use. Secondly, for many of those who have become
ill as a result of HIV infection, work is not an option. Indeed, many
are encouraged by advisers to give up work at an early
opportunity in order to gain full access to state benefits or to avoid
stress or exertion that could further impair their health (Green,
1995). Finally, there is the view, particularly common in western
Europe with its well developed culture of state welfare provision,
that issues relating to HIV/AIDS, whether they be concerned with
prevention, treatment or care, are principally the responsibility of
‘expert’ state agencies or voluntary/community organizations,
rather than the employer. Without necessarily denying some
validity to these propositions, it can also be argued that there are
important reasons why the sphere of employment and work-
related activity should be a focus for HIV/AIDS research.
Actual and Perceived Risk of Transmission
Virtually all guidance and opinion makes clear that there is
virtually no risk of transmitting HIV through normal workplace
activity. Even in the field of medicine where there is a very small
chance of transmission (usually from patient to medical worker
rather than vice versa) this can be drastically reduced if standard
2 ORGANIZING AIDS
procedures and precautions are followed (Shanson and Cockcroft,
1991). However, a low level of objective risk is not necessarily
perceived or accepted as such, and the fear of contracting the
virus from some forms of work-related activity has by no means
disappeared. Scepticism and uncertainty about possible
transmission routes of the virus are prevalent (see, chapter 5
below) and employees infected with HIV, especially if they are
employed in caring professions, continue to be the focus of media
sensationalism, often with severe ramifications for those directly
and indirectly affected. In a very recent case, for example,
newspapers initially named the wrong doctor, before ‘forcing’ the
publication of the infected doctor’s identity. The UKSunday
newspaper The People, for instance, has also focused on a HIV
positive doctor and dentist (characterized throughout as ‘perverts’
[sic]) to promote calls for the universal and regular testing of all
medical workers to ‘protect us’ (The People, 15 January, 1995).
Perceptions of risk inform action and attitudes regardless of the
accuracy or otherwise of the information upon which they are
based and, as such, may have important implications for the
treatment of clients or colleagues thought to be infected.
Although the risk of HIV infection through ‘normal’ work activity
is, indeed, negligible—either because no risk exists or, as in
medical work, because potential risks are controlled by specific
procedures— there is one area of work where a real prospect of
infection may be present, namely, sex work (see, chapter 5 below).
Prostitution in particular, may put both women and men at risk
as the result either of engaging in unprotected sex (through
necessity, coercion or ignorance, see Morgan Thomas, 1992;
Maciver, 1992) or from involvement in the practices of drug use
that are associated with some areas of this trade (Plant, 1990).
Similarly, there is evidence to suggest that certain indirectly
work-related activities may expose people to risk of infection. This
applies particularly to workers who spend long periods travelling
or working away from home (e.g., seafarers, lorry drivers) who may
make greater use of male and female prostitutes or those, such as
hospitality industry workers, whose work facilitates opportunities
for casual sexual encounters with, for example, visiting tourists.
Bloor (1995), for instance, reports a study of 386 migrant tourist
industry workers in the UK resort of Torbay, only seven per cent
of whom had not engaged in intercourse in the past year, with
nearly half of the male workers reporting intercourse with four or
more tourists. Overall, only 40 per cent reported condom use
during their last intercourse, with use being lowest among those
with the most partners.
