ERIC Identifier: ED279994
Publication Date: 1987-00-00
Author: Wilson, Thomas C.
Source: ERIC Clearinghouse on
Counseling and Personnel Services Ann Arbor MI.
Counseling Roles and AIDS. Highlights: An ERIC/CAPS Digest.
Acquired Immune Deficiency Syndrome (AIDS) is a fatal viral disease
which suppresses the body's immune system causing increased vulnerability to
many other infections. Since 1981, when it was first identified by the Centers
for Disease Control (CDC), AIDS has become a "modern-day black plague"
(Batchelor, 1984). As of March 30, 1987, according to the CDC, 33,482 cases have
been reported and 19,394 deaths are known. Forty-eight percent of a
representative sample of physicians in private practive have reported seeing at
least one case (Ghitelman, 1987). The disease is no longer an isolated
phenomenon; it has extended beyond "at-risk" populations and into all
communities. Although specialized care units and treatment with exotic drugs
have permitted some patients to live more than five years, the prognosis remains
poor. Few AIDS victims live longer than 18 months after diagnosis.
The impact of AIDS occurs in all areas of life--medical, legal, financial,
political, and social. Highly controversial and unsolved questions have arisen;
for example, what treatment regimes maximize patient care and staff safety?
Should children with AIDS attend school? Must "at-risk" populations submit to
testing as a prerequisite for purchasing life and health insurance? How much
government funding of AIDS research and treatment should be approved?
Despite the controversial and diverse nature of these questions, they involve
issues that demand the attention of the counseling community. Medical
professionals have indicated that the psychological impact of AIDS on patients
and significant others follows a course similar to that of other fatal illnesses
and crises (Nichols, 1985). Given this similarity, three roles for counselors
are apparent--direct counseling for those affected by AIDS, coordination of
support systems, and education.
The steps toward adjustment to and acceptance of any terminal illness or
catastrophe often require counseling. Although medical concerns may be addressed
by physicians and medical social workers, given the prevalence of AIDS,
community and school counselors may find an increase in the number of clients
directly or indirectly affected by the disease. Techniques used in assisting
individuals with crisis situations may be applied in this environment as well.
In addition to the finality of the prognosis, AIDS victims face social
isolation. This is another area in which counselors can help, via establishing
networks of support or connecting with existing systems within a community.
Counselors can be links between formal therapy (e.g., psychiatric counseling)
and community resources. A broader base of support can be supplied through
contacts with institutions and organizations that provide services for AIDS
victims. Self-help groups are available in some locations. If none exist
locally, counselors can be instrumental in establishing them.
AIDS victims also face unique psychosocial concerns that the counseling
community can address. The fear and uncertainty that accompanies patient care
and prognosis and the potential loss of confidentiality create additional
stressors for gay men wishing to remain anonymous (Cassens, 1985), as well as
for others not wanting to be associated with "at-risk" populations. Such stress
and the individual's inability to cope may negatively affect the body's fight
against the virus (Holland & Tross, 1985). Counselors can intervene by
assisting individuals in developing appropriate coping techniques and by
teaching stress-reducing lifestyles and activities.
For students afflicted with AIDS, school counselors can assist in locating
appropriate support groups for both the students and their families. In
addition, counselors can function as liaisons while students are absent from
school and as sources of continuity at the time of re-entry. Legal issues
regarding attendance remain unresolved; rcommendations are available from the
CDC, but no binding court authority has ruled at this time. Similar counselor
involvement has been implemented in some schools for students while in treatment
for drug and alcohol problems and at their return. Support groups need not be
limited to victims; friends may wish to understand more about the disease, its
impact on the victim, and the emotional stress involved.
In an educational role, counselors can "forestall panic and increase
rationality and hope" by presenting accurate and up-to-date information about
the disease (Kinnier, 1986). Reactions to the AIDS crisis have followed a
pattern similiar to past life-threatening epidemics. Studies of the black
plague, the Boston smallpox epidemic, and yellow fever suggest that initial
indications of an epidemic are ignored, then panic displaces rationality. In the
process victims are ostracized and the healthy become obsessed (Kinnier, 1986).
Providing adequate information can help AIDS victims, the worried well, and the
general public through reducing fear and re-interpreting sensationalist stories
Education is thought to be the key to the battle against AIDS at this time.
Seventy-nine percent of the physicians polled by MD MAGAZINE supported a special
high school course dealing with sexually transmitted diseases (Ghitelman, 1987).
Community education may be beneficial, too. Making information available about
the disease, its transmission, and the procedure and reliability of the test may
encourage people to engage in "safe sex" and may decrease the amount of
misinformation. "Safe sex" has been defined in a variety of ways. Two common
definitions are monogamous relationships and the use of condoms. Neither of
these, however, offers any guarantee (Leishman, 1987). Abstention has been
recommended by some, but rarely followed. Although education clearly is needed,
it is not the cure. Individuals are motivated by more than information and many
are willing to take unexplainable risks (Leishman, 1987).
Counselors can play important roles in meeting the needs of AIDS victims.
Counseling, networking, and educating are three crucial areas for community and
school counselors, psychiatric and psychological therapists, and medical and
community social workers. Holland and Tross (1985) make recommendations for
health professionals in dealing with AIDS patients that apply to counseling in
1. Be aware of one's own attitude toward victims and toward the disease,
including the fear of caring for the fatally ill, the fear of contagion, and
2. Maintain an active, up-to-date file of information about AIDS.
3. Be comfortable in dealing with sexual issues and understand the
relationship between these issues and AIDS.
4. Have referral resources available.
5. Be aware of care and social support sources.
6. Be compassionate and sensitive.
7. Direct the victim's anger toward non-self-destructive behaviors.
FOR MORE INFORMATION
Batchelor, W.F. "AIDS: A Public Health and Psychological Emergency." AMERICAN
PSYCHOLOGIST 39(11) 1984: 1279-1284.
Belfer, M.L. PSYCHOLOGICAL IMPACT OF AIDS ON CHILDREN. Unpublished
manuscript, Harvard Medical School at Cambridge Hospital, Cambridge, MA. 1986.
ED 271 211.
Cassens, B.J. "Social Consequences of the Acquired Immunodeficiency
Syndrome." ANNALS OF INTERNAL MEDICINE 103(5) 1985: 768-771.
Dunkel, J., and Hatfield, S. "Countertransference Issues in Working with
Persons with AIDS." SOCIAL WORK 31(2) 1986: 114-117. (EJ 335 603)
Fisher, E.J. "Special Report." MICHIGAN MAGAZINE 85(3) 1986: 93-102.
Ghitelman, D. "What Doctors Think about AIDS." MD MAGAZINE 31(1) 1987:
Holland, J.C. and Tross, S. "The Psychosocial and Neuropsychiatric Sequelae
of the Acquired Immunodeficiency Syndrome and Related Disorders." ANNALS OF
INTERNAL MEDICINE 103(5) 1985: 760-764.
Kinnier, R.T. "The Need for Psychosocial Research on AIDS and Counseling:
Interventions for AIDS Victims." JOURNAL OF COUNSELING AND DEVELOPMENT 64(7)