An organizational, institutional and cultural analysis of New Haven, Connecticut's response to the AIDS epidemic.

摘要

This dissertation conducts an organizational, institutional, and cultural analysis of New Haven Connecticut's response to the HIV epidemic from 1980 to 1991. Using three perspectives I examine why AIDS spread so extensively in New Haven and Connecticut, despite early knowledge of the epidemic's presence and the existence of so many organizations designed to protect the public from health threats. In the first decade of the epidemic medical schools, hospitals, health departments, mental health clinics, community clinics and other organizations, were unable to significantly slow the spread of AIDS in New Haven and other cities in Connecticut. From a neo-institutional perspective I look at how institutionally embedded scripts impeded innovation among different organizations. The medical school and health department, for example, did not have a repertoire of actions, "a tool kit" for responding to a fatal epidemic among marginalized people. Without appropriate tools the organizations fumbled. From the older institutions perspective, I examine how short-term organizational interests deflected the longer-term formal organizational goals of stopping the epidemic. From this perspective, vested interests, informal structure, relationships to the local community, efforts to coopt various organizations, and so on, all played decisive roles in displacing formal goals. From a cultural perspective, I examine how the HIV epidemic's association with gay men, especially in the early phase of the epidemic, constrained organizational and institutional responses to the epidemic. In particular, I look at the cultural construction of "the closet" (that is, the relationship between gay people/institutions and heterosexual people/institutions) and excavate its specific organizational effects. For example, I present data that shows how anxiety over homosexuals and homosexuality, among gay and heterosexual staff in the hospital and the medical school, reduced levels of institutional commitment to AIDS.