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Clearly career counselors must take a comprehensive and holistic approach when providing services to clients with HIV/AIDS. It is likely that these clients will have concerns related to coping with their illness in the workplace, dealing with medical personnel, managing their medical treatment, and developing effective strategies for coping with their illness. There is also the need for counselors to ensure that they possess the knowledge, skills, and awareness required for providing efficacious interventions to clients with HIV/AIDS, which in some cases will require advocating for clients.
The information acquired from participants in this study suggests that to work effectively with clients with HIV/AIDS, counselors need to be aware of the psychosocial, medical, and financial implications of living with a long-term, life-threatening illness. HIV disease, in particular, carries with it the social stigmatization that complicates mental health and threatens life-sustaining activities. Therefore, a broad range of skills and understanding is required for helping professionals who work with HIV-positive clients. In addition, counselors need to be aware of the wide variety of cultural factors that may affect their clients, and in turn their work with their clients. For example, injection drug users who are HIV infected may be unemployed or underemployed when they learn about their HIV status. They would need a different kind and degree of services than a person who is employed and who has health insurance and other resources available. Career counselors need to be aware that many people living with HIV disease have "multiple barriers to employment, including low educational attainment, substance abuse, and psychiatric distress" (Hoffman, 1997, p. 177).
Counselors also need to be cognizant that clients with HIV/AIDS are challenged to cope successfully with the vicissitudes of this illness in every aspect of their lives. Thus, no single intervention is likely to adequately meet clients' needs. Counselors may need to engage in consultation with medical experts, financial advisors, clergy, and others to provide holistic care. To cope effectively with HIV/AIDS, clients will need to focus on their coping resources as they encounter challenges related to work and medical treatment. Having adequate sources of social support (e.g., through participating in an AIDS support group) is a strategy that study participants found to be useful. Therefore, counselors need to be aware of community resources to help clients identify opportunities for social support. Because counselors provide an important coping resource for clients with HIV/AIDS, it is obvious that counselors need to have a clear understanding of their own attitudes and assumptions related to HIV/AIDS. Kain (1989) argued that "the counselor's own attitude and feelings toward HIV-positive clients will be of primary importance in allowing the establishment of a safe and trusting therapeutic relationship" (p. 69).
In addressing career and workplace issues, counselors need to be aware of several factors that clients struggle with as they adjust to their diagnosis and treatment. Primary in the respondents' list of concerns is disclosure. Study participants were confronted with the dilemma of to whom and when to disclose their illness. Counselors can help clients identify the risks and benefits they are likely to encounter by disclosing their illness. Helping clients explore concerns associated with the fear of disclosure, living with nondisclosure, or coping with any prejudice they may encounter as a result of disclosure are important issues to address.
The existence of workplace discrimination against people living with HIV disease continues despite legislation and educational programs aimed at preventing such discrimination (Brooks & Klosinski, 1999; Hoffman, 1997; Kain, 1996). Learning to cope effectively with such prejudice is an obvious task for workers with HIV/AIDS. In addition, many workers with HIV/AIDS who consistently encounter such discriminatory attitudes may feel so compromised by this workplace attitude that they will choose to end work, separating from a potentially life-sustaining resource.
To help people living with HIV/AIDS cope with their workplace concerns, counselors need to advocate for clients. Effective advocacy requires that counselors be knowledgeable about federal, state, and local laws. Counselors can help clients become aware of, and interpret, pertinent legislation while also advocating for clients who may have encountered discriminatory and illegal treatment in the workplace. Included among the legal issues to deal with are concerns involving disability status, insurance, employee rights, and benefit entitlements. Counselors need to be informed of all areas related to client care that would be compromised should the client cease to work. Thus, advocating for clients with HIV/ AIDS extends beyond the privacy of the counseling office and into the community. As potential change agents, counselors must acquire at least basic knowledge related to HIV/ AIDS and to their clients' work-related rights and benefits.
Counselors working with people living with HIV/AIDS must also be prepared to help their clients cope with various issues related to medical treatment. Client concerns surrounding the issue of medical treatment include concerns about adjusting to health-related limitations, coping with emotional reactions to their illness and to interpersonal insensitivity from medical care providers, and managing the paradox of hope and realism related to the prognosis of their illness. Medical advances challenge clients to incorporate myriad drug therapies into their lives. Clients have to assimilate a large and ever-changing amount of medical and pharmaceutical information as it relates to their maintaining reasonable stability in their health status. Moreover, decisions about medical treatment strategies are complicated by the fact that physicians often disagree about which medical interventions are appropriate for their patients. "When it comes to antiviral drugs or experimental and holistic treatments, there are wide differences of opinion. This makes it particularly difficult for ... [clients] to know what choices to make" (Remien & Wagner, 1995, p. 186). As a consequence, counselors should expect to find that their clients might be overwhelmed with their medical treatment, medical personnel, and health care systems. Clients may also struggle to find ways to combine their daily work responsibilities and medical care so that some normal routine can be maintained.
Although most counselors are not medical experts, when counselors possess an appropriate understanding of drug protocols and have familiarity with toxicity and consequences of treatment, they can play a role in helping their clients obtain proper and adequate medical services. In the struggle many clients face to maintain some level of normalcy in their lives, counselors can also provide critical support in helping clients navigate the psychological and social turbulence created by this additional layer of medical care while working to maintain appropriate levels of hope.
Career concerns for clients coping with HIV/AIDS extend beyond work to include issues related to medical treatment and resources to enable the person to cope. Advocating for clients by making appropriate referrals and having adequate medical and legal knowledge pertaining to HIV/AIDS is an important intervention strategy for counselors. Through advocacy, counselors can help empower clients to live effective and productive lives as they actively participate in their work and their relationships.