The Greater Involvement of People Living with AIDS principle: theory versus practice in Ontario's HIV/AIDS community-based research sector.

Drawing on the Greater Involvement of People with HIV/AIDS (GIPA) principle, the HIV/AIDS movement began to "democratize" research in Canada in the mid-1990s. To date, there is little evidence about the success of the community-based research (CBR) movement in relation to the implementation of GIPA. We draw on findings from a larger study examining barriers and facilitating factors in relation to HIV-related CBR in Ontario, Canada. An online survey was completed by 39 senior managers in Ontario AIDS service organizations (ASOs). Twenty-five in-depth, semi-structured interviews were then conducted to further explore the survey findings. Survey respondents reported that, compared to researchers and frontline service providers, people living with HIV/AIDS (PLWHA) tended to be the least involved in all stages (input, process and outcome) of CBR projects. AIDS service organizations with a mandate that included serving rural and urban communities reported even lower levels of PLWHA involvement in CBR. Qualitative data reveal complex barriers that make meaningful PLWHA engagement in CBR difficult, including: HIV-related stigma; health-related challenges; "credentialism"; lack of capacity to engage in research; other issues taking priority; and mistrust of researchers. Facilitating factors included valuing lived experience; training and mentoring opportunities; financial compensation; trust building; and accommodating PLWHA's needs. While there is strong support for the GIPA principles in theory, practice lags far behind.

Hospital restructuring: positioning social work to manage change.

In the shifts to programmatic hospital organizations, social workers are having to learn to reframe their work, reorganize their thinking, and restructure their professional disciplines in order to survive. The experience is frequently one of frustration, anger, and impotence. Yet, social workers are masters of systems thinking in hospitals, and are well positioned to effect change. The beauty of shifting to a flattened hierarchy that is patient focused, is that it endorses change consistent with the social work mission in health. The challenge for social work is to grapple with the big issues: our belief in ourselves; defining our roles and functions and priorities; defining our vision in programmatic hospital organizations; being critical of what we do; and articulating what we have to offer. This paper identifies ways social workers can position themselves to effect positive change in hospitals undergoing restructuring.

Social work in restructuring hospitals: meeting the challenge.

From bureaucratic to programmatic institutions, hospitals across North America are experiencing restructuring. Using the results of a telephone survey and a semistructured questionnaire, this research study explores the effect of hospital restructuring on the organization and delivery of social work services and the strategies social workers select to manage change in a sample of Ontario hospitals. Respondents identified a number of issues related to control over the nature of work in the organization, social work roles, and the management of structural change. This article discusses the implications for the profession of the move to program management.

The unencumbered child: family reputations and responsibilities in the care of relatives with Alzheimer's disease.

Using a grounded theory methodology in exploratory interviews with noncaregiving and caregiving adult children, differences were found in their experience of burden, their focus, their suffering, and their sense of responsibility. Childhood reputations appeared to follow siblings into adulthood, and they describe finding their adult positions in the family clearly circumscribed and entrenched because of family legacy. Children who were in some way different and excused from family responsibilities in childhood because they were, for example, "spoiled," a "problem child," the "intellectual," or "flaky," appeared to be unencumbered as adults when faced with caregiving responsibilities for a relative with Alzheimer's disease. Although these uninvolved and unencumbered children seemed to take less caregiving responsibility, they describe their loss and suffering in relation to a loss of identity and selfhood, whereas other children describe their burden and the overwhelming pulls and demands made on them. These preliminary findings suggest the need for systematic scientific inquiry about families, including multiple relatives, family history, impact of family-of-origin legacy, family reputations, and family negotiation patterns.

Social work and the new integrative hospital.

The principles of bureaucratically organized hospitals are counter to the values of social work. In a move to new integrative hospitals, social work can be the champions. The values of the social work profession that emphasize negotiation, change, flexibility, relationships, choice and control, the right to exercise autonomy, and participatory decision-making, are congruent with the principles that form the foundation for the new integrative models for hospitals. A model for the organization of social work practice, continuing education, standard setting, research and the student program. The Professional Standards Group, is proposed for the new hospital age.

Free enterprise, professional ideology, and self-interest: an analysis of resistance by Canadian physicians to universal health insurance.

Under Canada's universal health care system, physicians are remunerated through government-run health insurance plans; a private market for physicians' services is virtually nonexistent. A proposal to ban the practice of extra-billing, whereby some physicians billed patients for amounts over and above insured rates, met with physicians' opposition. The particular constellation of legislative, social, and political events that followed the proposed ban presented a unique opportunity to explore the nature of the medical profession's resistance to encroachment on professional autonomy. The results of this survey of physicians in four specialties (N = 313) in metropolitan Toronto suggest that resistance to universal health insurance is complex; it involves a prevailing social ideology among physicians, which happens to be antiwelfare and conservative generally, entangled with economic self-interest and a specific set of beliefs about medical practice and physicians' rights and privileges.