The role of organized labor in combating the hepatitis B and AIDS epidemics: the fight for an OSHA bloodborne pathogens standard.

The United States is experiencing a hepatitis B epidemic that has until recently received relatively little public attention. Many groups of workers are at risk of infection, death, or chronic carriership because of workplace exposure to blood; those at risk include not only health care professionals but police, fire fighters, life guards, hospital-based laundry and cafeteria workers, park rangers, sanitation workers, etc. One of the most important victories against the hepatitis B pandemic in the United States occurred when the Occupational Safety and Health Administration issued a Bloodborne Pathogens Standard that required employers to protect 5 1/2 million workers from infection by offering those at risk free hepatitis B vaccination, and forced employers to bear the costs of providing equipment (e.g., gloves, gowns, masks, puncture-proof containers) to maintain "universal precautions" for employees handling bodily fluids. While most people assume the new standard was primarily aimed at fighting the AIDS epidemic, it was actually based on the more significant risk posed by hepatitis B infection. The standard resulted not from leadership provided by the experts in the Public Health Service mandated to control infectious disease, but rather from pressure applied by labor unions--providing a clear example of the continued importance of unions for worker protection in our supposedly post-union era.