Classifying Populations in Health Services: Practical Reasons and Discretion

How can providing health services generate inequality? This paper seeks to clarify the classifications practised by public health workers and to reveal the forms of discretionary practice implicit in their work. In a free and anonymous AIDS screening setting, everyone is present for the same reason. This makes it possible to observe how health service providers divide their clients into social categories such as class, gender, sexuality and race and offer different service responses to an essentially identical demand. The research analyses NGO archives, quantitative data and interviews with health workers, as well as observation of their work in public and at NGO screening centres. It shows that gender and class affiliations receive little attention, whereas racial and sexual categories are of prime importance. Only white men are asked about their (homo)sexuality and receive more personalised information. Women and non-white men are presumed to be heterosexual, and therefore receive more standardised advice, unless health workers obtain more accurate biographical information during longer consultations.