Encourage self-empowerment, consciousness-raising, and participation in the lesbian and

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gay community.

Encourage your program to hire openly lesbian and gay counselors/therapists.



Educate others about internalized homophobia and heterosexism. Be gay- and lesbian-



affirming rather than just gay- and lesbian-tolerant.

Stay abreast of current information on resources and display this information in your



office. Attend seminars and professional workshops about working with lesbian and gay

clients.

Fear of infection

Fear of infection is one of the most challenging issues for counselors. It is essential that

providers examine this issue without blaming or judging themselves and others. Most

professionals who work with substance abusers and HIV-positive individuals have thought about

becoming infected with HIV, hepatitis, or tuberculosis (TB) through their jobs (Sherman and

Ouellette, 1999). Some fear that scientists are not aware of modes of infection or transmission

that might put service providers and their families at greater risk of infection (Montgomery and

Lewis, 1995). The key to dealing with this fear is to discuss it and vent the feelings with

someone who is safe, trusted, and informed, and to practice universal precautions at all times.

Beyond this, it is essential for providers to have regular and frequent inservice training with

updates on the latest research and data about transmission and treatment of HIV/AIDS, hepatitis,

and TB.

Special considerations for counselors who treat HIV-infected clients

The challenges and stresses related to working with people with HIV/AIDS are in some ways

unique. The fact that providers often deal with multiple and serial losses and see clients suffering

on a daily basis clearly affects the providers' psychological health. In recent years, the rapists

have begun to examine and assess these service providers for symptoms of posttraumatic stress

disorder (PTSD).

Burnout often is referred to as "bereavement overload." One definition characterizes burnout as

lowered energy, enthusiasm, and idealism for doing one's job, that is, as a loss of concern for the

people served and for the work (Hayter, 1999). Unlike fatigue, burnout does not resolve after a

given amount of rest and recreation.

Burnout prevention and stress management techniques should be used both in the work setting

and in counselors' personal lives. Working with HIV-infected substance abusers requires

agencies and individuals to be more creative and flexible in finding new and different ways to

support and nurture counselors to prevent burnout. Agencies that have taken on this challenge

with integrity and commitment have seen highly effective staff function at optimal levels for

many years.

Suggestions for ways in which agencies can take care of counselors at work include