Introduction

The unexpected and sudden emergence of the HIV/AIDS epidemic in Britain in the 1980s – as in other countries – posed difficult issues for individuals, pressure groups and social movements, health care organisations, and the national political and policy process alike. This experience has to be captured quickly if memories are not to erode and while accounts are beginning to emerge of the governmental and ministerial process, of the formation of policy ‘communities’ and lobbies acting on formal policy making; and the role of professional experts in influencing the formation of national policy, there is still work to be done on the response by District Health Authorities which represent the operational tier of the National Health Service (NHS) although we can build on an earlier analysis of a single case in a high prevalence locality. Some American work has examined the organisational response in particular localities suggesting interesting local sources of variation. But we need to know more about how British health care organisations responded to an unanticipated epidemic – and new epidemics have been rare in First World health care systems – which has had such important societal consequences.

HIV can be seen as a single health care issue but one which was processed within a particular organisational form (District Health Authorities (DHAs)) which span a multiplicity of issues, involve a wide variety of interest groups, contain a strong political component and also a range of powerful professional groups.