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Organizational boundary definition and the micropolitics of organization-constituency relationships and organizational autonomy

ProQuest Dissertations and Theses, 2009
Author: Linda R Catalano
Organizational boundaries have most often been studied for their role in regulating organization-environment exchanges and, in this way, promoting or impeding organizational survival. In contrast, scant attention has been paid to the first-order problem of how and why organizational boundaries are defined and redefined as they are, and with what specific consequences for organization-environment relationships and organizations themselves. Using data from participant-observation, interviews, and organizational documents, I examine how and why one community-based HIV/AIDS service organization in New York City defined and redefined its boundaries with various constituent groups in the environment, and how different boundary definitions played out in different amounts or kinds of organizational autonomy. I find that the relationship between organizational boundary definition processes and products and organizational autonomy turns on shared purposes. That is, I find a positive causal relationship between organizational boundary definitions and organizational autonomy when the distinctions these definitions draw also invoke a more fundamental similarity between the organization and the constituency in question. More specifically, I find this to be the case when the similarity pertains to organizational mission. Thus, I conclude that organization-constituency power relationships rest not only on material resources but also on symbolic and social ones. [PUBLICATION ABSTRACT]

TABLE OF CONTENTS TABLE OF CONTENTS i LIST OF TABLES AND FIGURES iv ACKNOWLEDGMENTS v DEDICATION vi Chapter 1: Introduction 1 Project Background 1 Research sites 7 Case Selection 7 Historical Context 12 The HIV/ AIDS Epidemic in New York City 12 Socio-political and Funding Environments 17 Case-Organization Profile 25 Founding and Early Development 25 Comparative Analysis 31 Chapter 2: Conceptual Framework 39 Organizational Boundaries and Boundary Definition 41 Literature Review 45 Standard Accounts of Organizational Boundaries 45 The Social Science Literature on Boundaries 48 "Boundary Work" 49 The Negotiated Order Perspective 53 Negotiation 54 Order, Structure, and Organization 57 Boundaries 65 Synthesis 74 The Negotiated Order of Organizational Boundaries 76 Chapter 3: Boundary Definition between Organization and Funder. 82 i

I. Organization-Funder Boundaries 85 The Standard Account 85 Critique 88 An Alternative Account of Organizational Boundaries 89 II. A Case of Organization-Funder Boundary Definition 93 The Boundaries 93 Traditional-Nontraditional 93 Participation-Nonparticipation 95 Evaluation-Research 96 The Actors 98 The Situation 101 The Constitutive Boundary Work 108 Conclusion 114 Chapter 4: Boundary Definition between Organization Leaders, Organization Staff and Subsidiary Organization 119 A Holistic Model of Boundaries and Boundary Work 123 The Case 125 The Actors 125 The Situation 129 The Boundaries 131 Cost-Care 131 Community Based-Hospital Based 134 The Boundary Work 136 Boundary Minimization 138 Phase 1 140 Phase II 146 Conclusion 151 Chapter 5: Conclusion 158 Findings 162 Assessment 169 Generalizability 169 ii

Concept of Boundaries 174 Conceptual Framework 176 Bibliography 184 Appendix A: Data and Methods 189 Access 189 Harlem United 189 Momentum AIDS Project 190 God's Love We Deliver 192 Field work: Participant-observation and Interviewing 193 Participant-observation 193 Interviewing 201 i i i

LIST OF TABLES AND FIGURES Tables Table 1: Percent within Each Risk Group by Race, 1988 16 Table 2: Hemes's (2004) Two-dimensional Framework for Analyzing Organizational Boundaries 92 Table 3: Summary of Self-other Attributions, Referents, and Points of Contrast 163 Figures Figure 1: AIDS in Adult Males by Race/Ethnicity and Year of Diagnosis, 1986-1994 14 Figure 2: AIDS in Adult Males by Transmission Category and Year of Diagnosis, 1986-1994 15 iv

ACKNOWLEDGMENTS Many, many thanks, first, to my faculty advisors Francesca Polletta, who got me started with interesting ideas, challenging questions and always- constructive feedback; and Priscilla Ferguson, who, with her eye fixed on the prize, got me finished. Eternal thanks to my incredibly generous and patient family, who followed me into the dissertation labyrinth and only once or twice questioned whether I'd find my way out. I simply would not have been able to keep trying for as long as I did without their support. Thanks to my good friends, including colleagues Juliana Blome, Amanda Damarin, and Nina Bambina-Buck, who all in one way or another (and usually more) showed me the way; my lifelong gem of a friend Sheila Kenny, who kept me in non-perishables, treated me to fun, and otherwise unfailingly supported what must at times have seemed like a wild goose chase; and to my dear friend Edison de Mello, who first put it into my mind that I could do this. And finally, sincerest thanks to the staff of Harlem United, who gave me their trust as well as their time, making for a wonderfully rewarding research and learning experience. I have the utmost respect for your work and appreciate to no end your sharing the ins and outs of it with me. Thanks especially to Harlem United Executive Director Patrick McGovern, who took me seriously without any reason in the world to, and thus afforded me the opportunity to cut my professional sociological teeth. Consider me greatly in your debt. v

DEDICATION For my parents, Al and Renate Catalano. And In loving memory of my teacher and guide, Tamara Engel. VI

1 CHAPTER 1: INTRODUCTION Project Background I arrived at the topic of this dissertation through the question of organizational responsiveness, or more precisely, how and why community-based and/or local nonprofit service organizations do or do not manage to adapt to external demands and expectations (and changes therein) with their founding purposes intact. I was most interested in how this question played out in organizational decision-making about whether to provide, or not to provide, services to new and existing clientele groups; such as, for example, people with or without certain needs, social or cultural identities, or even who do or do not live in certain geographic areas. I conceptualized this decision-making dynamic in terms of clientele definition and redefinition. My initial research aim was to identify the factors that lead organizations to define or redefine their clienteles in different ways, such as more or less broadly or narrowly. My interest in this question grew out of my experience volunteering at a large HIV/ AIDS service provider in the City. The HIV/AIDS epidemic has never been static in terms of who it affects and how, and this was perhaps especially evident during my tenure at this organization (1996-2005). Just before I started to work there, a major advancement had occurred in the medical treatment of HIV disease, namely, the introduction of protease inhibitors. This new class of anti viral agents was enabling many PLWHAs to live longer, healthier lives. This posed something of a challenge for the organization I was volunteering at because

2 it was established at a time when AIDS was still an acute, fatal illness, and specifically, to serve those who were too debilitated by AIDS to prepare their own meals. With HIV now a chronic disease that one manages over an indefinite lifespan, the question arose as to whether the organization's services were still relevant. Could or should the organization continue serving now-comparatively healthier PLWHAs, or should it rather redirect its energies toward groups that better matched its service repertoire (or program) as specified in its mission? The broader and more sociological question was whether the organization could adapt to these changes in nature of HIV disease without losing its identity? Both the "PLWHA" and "too ill prepare one's own meals" were critical components of the organization's founding identity. And as Minkoff (2002) notes, an organization's original identity is critical to maintaining its internal base of support. The organization solved this "identity dilemma" (ibid.) by expanding both its stated mission and its service repertoire and thus preserving both components of its founding identity. Specifically, the organization expanded its mission to include people with serious illnesses other than HIV/AIDS, and it expanded its service repertoire (or program) to include frozen meals. Unlike hot meals, frozen meals can be delivered days in advance, thus reducing the number of deliveries a client must be at home to receive and allowing for their greater mobility.) Upon speaking with the Director of Strategic Planning about these changes in mission and program, I learned that a major impetus for the change in mission (expanded clientele definition) was a demand for the organization's services among those with serious illnesses other than HIV/AIDS, such as cancer. Members of these illness groups and their advocates (e.g., family members or

3 professional care-givers of various types) often called this organization in hopes of accessing its services. Other illness groups do not have the same supportive services infrastructure that HIV/ AIDS does. Expanding the organization's mission to include these groups, whose health is generally poorer than that of its current clientele, was therefore a response to an expressed need—one that the organization was equipped to handle, and that accorded with a central component of its original mission, namely, 'to help the really sick' (Interview with Director of Policy and Planning, 5/13/02). I further learned that the particular change in program came out of focus groups with current clients. The focus groups revealed that clients did still need the organization's services, albeit differently than they had. Thus, the particular expansion in program that the organization undertook was in direct response to what its original clientele said it needed. Addressing this need, too, was well within the organization's capacity, and original mission to help PLWHAs. Together, these expansions in mission and program resolved the organization's identity dilemma by enabling the organization to adapt to external change (clients' improved health) while maintaining fidelity to mission (to help the seriously ill). To be sure, there were also strategic considerations shaping how the organization responded to the challenges of a changed environment, not least of which was how other valuable constituencies, especially existing funders and volunteers, would view the expansions in mission and program. And indeed, it was only after determining that these expansions would not significantly disrupt the organization's relationships with these constituencies—or more explicitly, that it would not cause these constituencies to withdraw their support of the

4 organization and thus threaten the organization's survival—that the organization decided to pursue them.1 Because such expansions in mission and program pertain ultimately to questions of organizational extent—scope, range, reach, outer limits, etc.—and the role of organizational constituencies in determining this—I theorized them in terms of organizational boundary definition and redefinition, particularly with different organizational constituencies. In the organizations literature, organizational boundaries are generally associated with organizational autonomy. This association seemed fitting to the dynamics I was exploring (as evinced by my organization's consideration of hinders' reactions to its proposed expansions in mission and program before deciding to implement them), so I added organizational autonomy to the mix as my dependent variable. Thus, my full research question became: How and why do community-based/local nonprofit service organizations define and redefine their boundaries with key constituencies in the environment and with what effect on their autonomy? Herein I cast organizational boundary definition as a solution of sorts to organizational challenges involving questions of organizational mission, identity, impact and survival, such as those that the organization I was volunteering at had experienced. My notion of organizational boundaries going in was very crude, to say the least. I hadn't given them much thought as in any way problematic with respect to their makeup—their placement, yes (albeit rudimentarily), but not more. In 1 God's Love We Deliver, "Strategic Plan," 23 May, 2001.

5 fact, I did not even initially distinguish between clientele definition and boundary definition (surprising to me now because organizational boundaries and boundary definition encompass much more than just clienteles; that is, if s a much more generic process than clientele definition). It wasn't until I started analyzing my data and really trying to understand how and why organizational actors defined boundaries with their various constituencies that I began to think about boundaries more theoretically. I did so through a reading the social science literature on boundaries, and particularly, the literature on "boundary work" (Gieryn 1983). Herein, boundaries are variously treated as conceptual or social distinctions by which people sort and order, and accordingly act toward, people, things, places, events, activities and the other elements of social life. In the literature especially on boundary work, boundaries are treated as interactional accomplishments—that is, as constituted and reconstituted through the purposeful social action and interaction of those to whom they are meaningful—with decisive effects on social groups' differential access to material and symbolic resources. I could imagine such boundaries shaping relationships between organizations and constituencies (there are plenty of differences between them that may be operative at any given time) so that the question became how, why, and with what consequences they were defined as they were. A similar reading of the organizations literature on boundaries was less fruitful. Whereas the social science and boundary work literatures offered a model of boundaries as being variously explicitly and implicitly defined and redefined by organizational actors with a stake in the outcome (and thus, as sociologically compelling objects of investigation), I found abstracted "system boundaries"

6 unproblematically differentiating the organization from the surrounding environment and / or regulating exchange relationships between them. In either capacity organizational boundaries were essential to maintaining the organization as an ordered entity, and only on a material level. Thus, organizational boundaries were not deliberately and meaningfully defined as such, but variously maintained or bridged through formal structural means. Thus, one of my aims was to, not so much challenge as provide an alternative to the organizations literature's concept and treatment of organizational boundaries. I kept this literature's focus on organization- environment relationships and the challenges to organizational autonomy that often come with them, but instead of only material constructs, I added the idea of organizational boundaries also being cultural and social constructs. The perspective or argument that I set out to challenge was the resource dependency claim that organizations seek first and foremost to secure their own survival and that this leads them to be strongly influenced, if not controlled, by the resource suppliers they depend on for sustenance. If this were the case than one would expect community-based/local nonprofit service organizations to be subject to resource suppliers' self-advantageous boundary definitions. That is, one would expect such organizations to have little or no say in how their boundaries with powerful constituencies are defined or redefined; and/or, to whatever extent they do have a say, one would expect them to define or redefine their boundaries in whatever way best enabled their acquisition and retention of vital resource flows, regardless of their stated missions. Neither of these scenarios appertain to the organizational challenge and corresponding solution I described earlier, and it

7 seems reasonable to surmise that other organizations similarly situated would experience and do similarly, as I next explain. Research sites I chose to study community-based HIV/AIDS service organizations (CB ASOs) because of their ongoing need to adapt to the ever-changing needs of people living with HIV/ AIDS while remaining true to their founding purposes and accountable institutional funders, and the therefore especially prominent boundary definition practices they likely engaged in. At the time, I was especially interested in how and why organizations redefine their boundaries with respect to whom they serve (their clienteles). The epidemic's evolution from one that primarily affected a single community to one that affects multiple and quite diverse communities primed CBASOs for a study of this type. Case Selection Once I decided upon community-based HIV/AIDS organizations as my research "site" (Schatzman and Strauss 1973), I identified potential cases through searches of databases and directories of HIV/AIDS service providers, particularly the United way CARES database of HIV/AIDS services in New York City, The New York City Ryan White Title I Service Directory (1999 version), and the CDC National AIDS Clearinghouse Resources and Services Database (now the CDC National Prevention Information Network database).2 2 Available at http:/ / www.unitedwaynyc.org/?id=65, http://www.ryanwhitenyc.org/directory.html, and http://www.cdcnpin.org/scripts/hiv/index.asp, respectively (accessed 15 March, 2008).

8 Initially, I was looking for organizations that were: 1) located in Manhattan, 2) established at around the same time, and 3) community-based or founded by private citizens, as opposed to institutions such as government agencies or longstanding independent nonprofit organizations.3 I selected organizations with these similarities to control for variations in boundary definition due to differences in local environment (while recognizing, of course, that Manhattan is internally diverse), accountability to grassroots constituencies (whether founding communities, original beneficiaries, or the like), and experience in dealing with HIV/AIDS. Once I had amassed a group of organizations matching my selection criteria, I used full-text databases of newspaper and magazine articles, particularly Lexis-Nexis and ProQuest Direct, and search engines such as Google, to gather additional information from which I constructed relatively detailed profiles of the organizations I was most interested in studying. Based on these profiles, I chose Harlem United Community AIDS Center (HU), Momentum AIDS Project (MAP), and Gods Love We Deliver (GLWD) to pursue as cases.4 In addition to being located in Manhattan, the case organizations share a common founding in the mid-late 1980s and community-based origin. This particular time period is characterized by increasing survival times and the 3 Some local nonprofit HIV/ AIDS service organizations were initiated by the New York State Department of Health's AIDS Institute when community-based organizing did not occur (Chambr6 1997). 41 used search engines for information from other sources, particularly the organizations themselves (e.g., event announcements, program descriptions) and organizational affiliates (e.g. other organizations, individuals with past and /or present connections to the organization). The profiles actually took the form of timelines so that I could examine the organizations' development side-by-side. I was interested in both similarities and differences between organizations in this regard, as well as in correspondences between

9 consequent need to serve people living with (as opposed to dying from) AIDS by offering support groups, medical advice and recreation programs. It is also characterized by the establishment of organizations specifically for people of color and intravenous drug users (IDUs) (Beaudin and Chambre 1996). MAP and GLWD were both founded in 1985, and HU was founded in 1988. With respect to their community-bases, MAP was founded by a Gay Men's Health Crisis (GMHC) volunteer to provide congregate meals and social services to (at the time, primarily White) gay men, GLWD was founded by a hospice volunteer to provide home- cooked meals to homebound (again, at the time, White) gay men, and HU was founded by "two men and a Jesuit priest" to provide social and spiritual support to homeless people of color (gay, straight or otherwise).5 internal organizational developments and external events; e.g., the availability of government funding and consequent program expansion. 5 Regarding the founder of MAP, Laura Engle, "Be Our Guest! Meals for People with HIV," Body Positive, May 1999, http://www.thebody.com/content/art30642.html (accessed 17 June, 2002). Founded in 1981, GMHC is the oldest community-based HIV/AIDS services organization in the nation. The quoted description of HU's founders is from: Harlem United, "A Brief History of Harlem United," http://wwwJiarlemunited.org/history.html (accessed 25 March, 2008). Sources other than HU itself attribute HU's founding to one or another variant of: "Jules Johnson, Ralph Horton and a group of pastors, social workers, therapists, theologians, health providers, gay men and lesbian women with the concern of the spread of HIV/AIDS" in Harlem/the African-American community. Quotation from Harlem OneStop, "Harlem United," http:/ /www.harlemonestop.com/organization.php?id=222 (accessed 25 March, 2008). Depending on the source, the "two men" credited with founding HU are Black, gay, and/or chemically addicted. In my very first conversation with HU's current Executive Director, he specifically stated that HU 'was never a gay organization' (Interview, 4/3/03). However, the organization's original clientele was comprised largely of (Black) gay men, because, according to a then-volunteer and now staff member, "that was mainly the clientele that was either affected, or honest about being affected by AIDS" (Interview, 10/20/04). Whom these organizations served and/or their communities of origin is a function of who comprised the bulk of the AIDS cases and which communities their founders were in some way a part of (member or affiliate). With respect to the latter, for example, GLWD was founded by a White, presumably heterosexual (there is no evidence to the contrary), woman hospice volunteer who was delivering groceries to clients, many of whom had AIDS, in Greenwich village, a historically gay neighborhood. Her efforts began when one of her AIDS clients was too weak to prepare the food she had brought him. She went to the corner deli and brought him back a hot meal. This man and very soon, his friends, were GLWD's first clients. Thus, although not founded by gay men, GLWD was de facto founded for them.

10 The organizations literature emphasizes resource dependency as a primary factor accounting for organizational decisions and actions. In order to assess the relative importance of resource dependency in determining why and how organizations define and redefine their boundaries, I selected organizations that varied most notably in their kinds and levels of funding. GLWD obtains most of its income from private sources (independent and corporate foundations, and individuals), HU obtains a substantial proportion of its income from service fees (Medicaid reimbursements), and MAP derives its funding primarily from government grants.6 In the literature on nonprofit and community-based organizations, different kinds of funding are attributed with variously enabling and constraining effects on organizational action. Specifically, private funding is seen to give organizations freedom to act (or not to act) according to their own goals and purposes, as opposed to those of the state in particular. Reliance on service fees is considered to make organizations more susceptible to influence by beneficiary constituencies (Powell and Friedkin 1987; Zald 1987). And government funding is widely regarded as, if not determining, then at least strongly directing organizational action by subjecting organizations to the needs and demands of the state, often to the neglect of the needs or demands of intended beneficiaries and other core constituencies (Cain 1993; Altman 1995; Cain 1995). Thus, I projected different factors to account for boundary definition /redefinition in each organization; 6 In 2001, these proportions were, for GLWD, 69% and HU, 50%. For MAP in 2000 (the closest chronological equivalent I could access), this was 84%. I obtained GLWD and HU data from these organizations' IRS 990 tax returns, and MAP data from the Guidestar.org database of nonprofit organizations, http://ww.guidestar.org (accessed 7 May, 2002). I calculated the percentages myself.

11 specifically, in GLWD, expressed need; in HU, constituencies; and in MAP, resource dependency. Unfortunately, MAP withdrew from my study several months into it (I explain why in Appendix A), leaving GLWD and HU. My access to HU was ideal so it became my primary research site, with GLWD then serving as a comparative case. However, as the study progressed I began to have doubts about GLWD's appropriateness as a comparative case to HU. The problem was GLWD's vastly different service repertoire from that of HU. Whereas HU provides an array of services in housing, prevention education, and healthcare, GLWD provides just two closely related services, namely, home-delivered meals and nutrition education / counseling. It became increasingly clear to me that this difference bore as much on the organizations' boundary definition as their difference in funding did. Because one of my study's aims was to assess the impact of differential kinds of funding on organizational boundary definition, and because this impact was obscured by the presence of so strong a competing factor as "program" (the organizations' service repertoires), I decided to discontinue gathering data on GLWD and to work solely with the data I had on HU. Thus, what started out as a three-way comparative case study of organizational boundary definition became a single case study of organizational boundary definition. The remainder of the chapter proceeds as follows: First, I provide a historical sketch of the context surrounding HU's founding and early development, including the nature of the AIDS epidemic and corresponding policy and funding developments. Then I present a short history of HU, noting

12 especially introductions of key program elements. Finally, I consider HU's founding and early growth in relation to those of other HIV/AIDS service organizations in New York City. Historical Context The HIV/AIDS Epidemic in New York City New York City has the highest concentration of AIDS cases of any locality in the country, and the oldest, largest, and most complex service delivery system (Chambre 1999). In what follows, I provide a sketch of the HIV/AIDS epidemic in New York City in the years leading up to and including HU's founding and early development, between 1986 and 1994. These years correspond to those in which HU marked its most significant programmatic milestones toward becoming the largest multi-service HIV/AIDS provider in Upper Manhattan. The sketch features graphs that show the proportion of adult (aged 13 and up) male AIDS cases consisting of Whites, Blacks, and Hispanics, and attributable to male-male sex and injecting drug use by year of diagnosis. The graphs illustrate the dramatic changes in the social and demographic makeup of the AIDS population in New York City that transpired during these years. The graphs and accompanying narrative therefore elucidate the single most important external factor driving HU's initiation and development, namely, the HIV/AIDS epidemic itself. Following the social and demographic sketch of AIDS in New York City, I present

a brief history of parallel developments in the funding environment that also shaped HU's particular developmental course.7 As is well known by now, the first AIDS cases were diagnosed among young, sexually active, gay-identified men who have sex with men (MSM), who were also largely White (Quimby and Friedman 1989). Since then it has increasingly affected heterosexuals, ethnic and racial minorities, women, and injecting drug-users (IDU).8 71 created the graphs myself based on raw numbers of people with AIDS reported though December, 2001 and published in: HIV/AIDS Surveillance Program (2002). "HIV/AIDS Semi-Annual Report: Surveillance Update, Including Persons Living with AIDS in New York City." New York City Department of Health. Unless otherwise indicated, the data in this section derive from this source. I calculated the proportions myself. I used proportions instead of numbers of cases because the latter vary widely from source to source and year to year, due to changes in case definitions, reporting lags and the like. In contrast, proportions of cases by race/ethnicity and mode of transmission are fairly consistent across data sources and years of publication. The categorical descriptors "White," "Black," and "Hispanic" are those used by the New York City Department of Health and Mental Hygiene (NYCDOH). I use them for consistency's sake because nearly all of my data derive from this source. 8 The inclusion of "gay-identified" in the characterization of MSM is from: New York City Commission on HIV/AIDS (2005). "Recommendations to Make NYC a National and Global Model for HIV/AIDS Prevention, Treatment, and Care." NYC Department of Health and Mental Hygiene (accessed 2 July, 2008). This characterization is notable because it describes a social group rather than a group defined by demography or even behavior. One unique aspect of the AIDS epidemic is that it initially appeared to strike people on the basis of social identity, as opposed to the geographic or physiological similarity on the basis of which epidemics are usually defined. Shirts, R. (1987). And the Band Played On: Politics, People, and the AIDS Epidemic. New York, St. Martin's Press. As the epidemic expanded beyond the gay community (albeit often through male-male sex) the more behavioral descriptors "MSM" and "IDU" came into use (many Black and Hispanic MSM do not identify as gay or bisexual). I mention the race of those with the first reported cases of AIDS because: 1) that it was White is generally assumed but rarely stated, and 2) although the connection between "White" and "gay-identified" among those first diagnosed with AIDS is strong, it is not absolute. That is, not all of the initial "gay- identified" AIDS diagnoses were among Whites. This obviously goes for the other common race/ethnicity and transmission risk category combinations (e.g., Black and IDU). Though obvious, it is worth mentioning to avoid reinforcing common misconceptions about who, socio-culturally speaking, has AIDS in the U.S. I'm referring especially to the belief among many, still, in the African-American community, that AIDS is "a gay White disease." Although significant overall, changes in the distribution of adult AIDS cases by sex in the years leading up to and including HU's founding in 1988 and early development until 1994 are far less dramatic than they are for the distributions by race/ethnicity and transmission category among males. Males have consistently comprised the vast majority of adult AIDS cases in New York City. In 1986, for example, 88% of adult AIDS cases were among males while 12% were among females. Nearly ten years later in 1994,75% of adult AIDS cases were among males and only 25% were among females. In 2006 (the most recent year for which data are available), the proportion of adult male AIDS cases was still an appreciably disproportionate 68%. Changes in the racial /ethnic and transmission risk proportions of AIDS cases among adult females has

14 Figure 1: AIDS in Adult Males by Race/Ethnicity and Year of Diagnosis, 1986-1994 ioo% 90% 80% 70% 60% 50% 40% 30% 10% -White -Mack -Hispanic 0% 1986 1987 1988 1989 1990 1991 1992 1993 1994 These shifts in the social and demographic makeup of the AIDS population were clearly in evidence in the years leading up to and including HU's founding in 1988 (Figure 1). In 1986 (two years prior to HU's founding), for example, 45% of adult male AIDS cases were among Whites, 29% were among Blacks and 25% were among Hispanics. In 1987, by comparison, the proportion of adult male AIDS cases among Whites had declined three percentage points to 42%. Among Blacks it had increased by one point to 30%, and among Hispanics it had increased by two points to 27%. also not been as dramatic as they have been among adult males. Female AIDS cases have consistently been overwhelmingly comprised of Blacks and Hispanics. In 1986, Whites comprised only 18% of adult female AIDS cases, while Blacks comprised 51% and Hispanics comprised 31%. In 1994, Whites comprised 12% of adult female AIDS cases, Blacks again comprised 51%, and Hispanics comprised 36%. With regard to transmission risk, in 1986, 65% of adult female AIDS cases were attributable to IDU and 26% to heterosexual sex. More than ten years later in 1994, these proportions were a very similar 52% and 39%, respectively. For these reasons, the social and demographic sketch I present of the AIDS epidemic in New York City between 1986-1994 is based, on AIDS case data pertaining to adult males only.

Full document contains 217 pages
Abstract: Organizational boundaries have most often been studied for their role in regulating organization-environment exchanges and, in this way, promoting or impeding organizational survival. In contrast, scant attention has been paid to the first-order problem of how and why organizational boundaries are defined and redefined as they are, and with what specific consequences for organization-environment relationships and organizations themselves. Using data from participant-observation, interviews, and organizational documents, I examine how and why one community-based HIV/AIDS service organization in New York City defined and redefined its boundaries with various constituent groups in the environment, and how different boundary definitions played out in different amounts or kinds of organizational autonomy. I find that the relationship between organizational boundary definition processes and products and organizational autonomy turns on shared purposes. That is, I find a positive causal relationship between organizational boundary definitions and organizational autonomy when the distinctions these definitions draw also invoke a more fundamental similarity between the organization and the constituency in question. More specifically, I find this to be the case when the similarity pertains to organizational mission. Thus, I conclude that organization-constituency power relationships rest not only on material resources but also on symbolic and social ones. [PUBLICATION ABSTRACT]