Pergamon zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA SW. Sci. Med. Vol. 39, No. 2, pp. 221-232, 1994 Copyright0 1994 THE IMPACT OF WORKING WITH PEOPLE WITH HIV/AIDS: A REVIEW OF THE LITERATURE ROSALINE S. BARBOUR* MRC Medical Sociology Unit, Glasgow, Scotland Abstract-This review describes and discusses research on the experiences of professionals and volunteers who work face-to-face with people with HIV/AIDS. Although there is a rapidly growing body of research which examines the attitudes and experiences of staff involved in HIV/AIDS service provision, this work has, as yet, failed to produce a comprehensive picture of the ways in which the demands of HIV/AIDS-re- lated work differ from those of other fields of work. Because studies have differed considerably, both in terms of focus and methods, few systematic comparisons between the experiences of different professional groups have been made. Research must have a comparative focus if we are to begin to distinguish those demands which are unique to HIV/AIDS from those to which satisfactory responses may have already been developed in parallel fields of work. Much of the work to date has assumed that the demands inherent in AIDS work are self-evident, but has failed to contextualize AIDS work in relation to other fields of service provision, the personal circumstances and career paths of workers, and the organizational structure within which work takes place. The studies have provided very little information about the process of adaptation to AIDS work and the rewards which may offset some of the stresses and demands of the work. This review attempts to provide a comprehensive overview of the research which has been carried out in relation to workers in different locations responding to different epidemic patterns and demands on services. It also attempts to contextualize the demands of HIV/AIDS-related work by comparing the demands and responses reported with regard to other types of work and makes recommendations for future research. Key words-HIV/AIDS, review, workers, stress INTRODUCTION HIV/AIDS has presented enormous challenges for a range of health and social care workers charged with responding to the needs of people with HIV/AIDS. There is a rapidly growing body of research relating to professionals’ attitudes towards and experiences of working with HIV/AIDS which has undoubtedly increased our understanding of the implications of AIDS-related work for specific categories of staff. However, due to the limited focus of many of the studies and the variety of methods and measures employed, this body of work has failed to provide either a comprehensive overview of, or extensive insights about, the differing experiences of various categories of staff. It is useful to conceptualize this body of work as having two distinct phases: the first reflecting a concern with the implications for potential clients of professionals’ attitudes and knowledge and the second reflecting an interest in the impli- cations of HIV/AIDS for workers themselves. The distinction is, in part, a chronological one, with the first concern characterizing the earlier research in- itiatives and the second concern apparent in the more recent studies. However, there is a considerable *Present address: Public Health Research Unit, 1 Lilybank Gardens, Glasgow G12 SRZ, Scotland amount of overlap. The main focus of this review relates to the second of the phases outlined above: the research concerned with examining the impli- cations for workers. Consequently, research into the implications for clients will be considered only briefly. IMPLICATIONS FOR CLIENTS OR POTENTIAL CLIENTS Many of the studies relating to implications for clients-both in Britain and America-have concen- trated on describing or measuring the attitudes of staff (their readiness to work with AIDS patients; their attitudes towards homosexuality and drug use, to screening and notification procedures, their fear of contamination or infection) [l-14]. Other studies have sought to examine the relationship between attitudes and knowledge (particularly about HIV transmission routes) [15-261. In addition, several studies have examined professional practice (most notably the precautions taken against infection), workload and work content 127-351. Thus the pre- dominant focus has been on the implications of professionals’ attitudes and levels of knowledge for the quality of service provision and interactions with people with HIV/AIDS. Findings from such studies have continued to give some cause for concern. Low levels of adherence to universal precautions were found in the early 1990s 221