"It is incredible to connect with people who feel scared and isolated, to provide them with information that lets them know how common their concerns really are," he says.
Working as a full-time health communications specialist at ASHA can be stressful as well as rewarding. Chafin says fielding calls on the 24-hour hotline is taxing, and many staff members burn out after only a few months on the job. He says things have gotten worse since ASHA merged its sexually transmitted disease and AIDS hotlines last year, which bumped up the volume and intensity of calls.
"We weren't always so slammed with calls," Chafin says. "The hotline used to be a place that seemed to hold on to devoted employees, a job that you could leave feeling validated and supported."
To regain that sense of support and ease a rising tide of on-the-job stress, employees of ASHA's three federally funded hotlines recently launched a union organizing drive. They're now in the process of signing cards with the International Brotherhood of Boilermakers (IBB), a union representing more than 80,000 workers nationwide. Once approximately 30 percent of the more than 100 hotline employees have signed cards, they'll be able to petition the National Labor Relations Board for a union election.
Among the key grievances cited by union supporters are rigid schedules, increased workloads, minimal training and lack of job advancement. Hotline workers, who sit in isolated cubicles, are given only 30 seconds of "recoil" time between calls. Break times aren't long enough to allow staffers to develop supportive relationships with co-workers.
Chafin says stressful working conditions are behind the high turnover rate at ASHA, which, by management's own reports, reached 85 percent in 1999. "There is an incredible amount of information" to absorb, he says. "It took me six months before I felt really good on the hotline."
Union supporter Anne Kingston has been at ASHA for more than two years and has a background in social work. For her, the real problem is that management doesn't respect the vital counseling role performed by hotline workers.
"We are told that we are just doing customer service, that we are informational," Kingston says. "But that doesn't acknowledge the breadth of what we are doing."
Bill Parra, Chief Operating Officer at ASHA, is quick to point out that the organization's high staff turnover rate is typical of the hotline industry. As to how management addresses grievances, he cites "town-hall" type meetings where employees can voice concerns and an overall "open-door" approach by ASHA managers.
Parra says complaints about working conditions haven't been brought up in those forums, although he does acknowledge that hotline workers expressed concerns about last year's merger of the AIDS and STD hotlines. Overall, he worries that a union would create a divisive atmosphere.
"It would change the character of our organization," Parra says.
Union supporters counter that hotline employees need a united voice in order to be taken seriously. Organizers chose the Boilermakers because of the union's experience representing federal contract employees. Because ASHA has a federal contract to operate its CDC hotlines, call-center employees are covered by federal "prevailing wage" laws. Under those rules, the U.S. Department of Labor sets wage scales for hotline workers based on prevailing rates in the industry and region. ASHA hotline employees now make between $9 and $12.40 per hour.
Gary Prochnow, an organizer with the Boilermakers, says that a union could be a powerful advocate if hotline workers wanted to push for higher wages. A union contract would also give employees more protection should the hotline contracts be awarded to another area organization. ASHA's agreement with the CDC is up for renewal at the end of this year, and the organization will be competing for a new five-year contract to operate the STD, AIDS and National Immunization Information hotlines.
ASHA has been in the hotline business a long time. The organization began the National STD hotline in 1979 and staff members were soon answering upwards of 100,000 calls annually. The CDC agreed to fully fund ASHA's hotline in 1983, and the two organizations worked to develop the CDC National AIDS hotline in 1986. The immunization hotline was added in 1997.
The AIDS hotline quickly became the largest health-related hotline in the world in terms of the number of calls. In the early 1990s, after basketball star Earvin "Magic" Johnson announced that he was HIV-positive, call volume skyrocketed to more that 1.5 million per year.
Calls to the AIDS hotline have fallen off in recent years, down to an average of 600,000 a year. Parra attributes the decline to a number of factors, including increased media attention that has made AIDS information more widely available, less social stigma attached to the disease, and medications that improve the quality of life for those living with HIV.
The CDC proposed the merger of the AIDS and STD hotlines in part because, while call volume at the AIDS hotline has waned, calls to the STD hotline have risen slightly to about a quarter of a million per year. ASHA managers say the merger has provided callers with "one-stop shopping" for information about a host of sexually transmitted diseases.
But for hotline employees, the merger has meant more calls coming in, more information to cover and more on-the-job stress. Some employees of ASHA's immunization hotline worry that they may one day be called on to answer calls about STDs and AIDS if the trend toward merging services continues.
And while the merger expanded the scope of services for callers, it hasn't meant more money from the federal government. The CDC has actually reduced the amount of money allotted to cover overhead costs at ASHA's hotlines. According to ASHA's most recent annual report, the percentage of costs covered by the federal agency dropped from 30 percent to 24 percent between 1996 and 1999.
Parra doesn't think federal support for the hotlines will change, but he does say that with a Republican administration in Washington, programs dealing with sexual health will be heavily scrutinized.
"When you have a Republican administration, they are always less supportive of programs dealing with sexual health," Parra says. "There is always a question of what we are promoting."
For hotline employees, the bottom line isn't money, it's respect. Chafin says the art of working at the hotline is finding a way to deliver needed information to reluctant and often frightened callers. In STD treatment, where fear and misinformation are the biggest barriers, he says, an intuitive caring voice can make a crucial difference--and deserves support from management.
"We are not counselors, but we tread that line to give people the information they need," Chafin says. "That is what makes the service a useful one for prevention."