Rehabilitation Counselors' Knowledge

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1 Rehabilitation Counselors' Knowledge and Attitudes TowardsConsumers with HIV/AIDS LaKeisha Lewis, MS is a graduate of the Rehabilitation Counseling Programs at SUBR. Alo Dutta, PhD, CRC, MPA is an Assistant Professor in the Department of Rehabilitation and Disability Studies at Southern University; Baton Rouge, LA. She also serves as the project director of a Rehabiiitaticn Services Administration (RSA) funded training and the principal investigator for a National Institute on Disability Rehabilitation Research NIDRR funded Disability and Rehabilitation Research Project (DRRP). Doreen Miller, RhO, CRC is a Professor in the Department of Rehabilitation and Disability Studies at Southern University; Baton Rouge, LA. Currently, she is administering an RSA funded long-term training grant at the undergraduate level. Carliss Washington, RhD, CRC is an Associate Professor in the Department of Rehabilitation and Disability Studies at Southern University U.); Baton Rouge, LA. She serves as the Faculty Advisor for the S. U. Student Rehabilitation Association. Madan M. Kundu, PhD, FNRCA, CRC, NCC, LRC is the Chair and Professor of the Department of Rehabilitation and Disability Studies, Southern University; Baton Rouge, LA. He serves as the project director for several RSA and NIDRR grants. Abstract The prevalence ofhiv/aids has exhibited an upward trend during the past three decades. With the introduction aggressive medical interventions, of individuals with HIV/AIDS have experienced a relative stabilization of their health and improvement of life span. Therefore, rehabilitation counselors continue to be challenged with the responsibility of providing a wide range of services to this population. The purpose of this exploratory study was to assess rehabilitation counselor's attitudes towards consumers with HIV/AIDS and make recommendations for enhancing quality of service delivery to address the needs of consumers. The participants counselors were rehabilitation having caseloads of consumers with HIV/AIDS diagnosis, substance dependency, and/or dual diagnosis caseloads. The findings revealed mostly positive attitudes except under circumstances that required intimate or prolonged social contact, such as marrying and dating. Exploratory factor analysis generated five factors to explain the phenomenon of rehabilitation counselor attitude: fearfulness and avoidance due to personal attitudes, social perceptions, public interaction or contact, ethical and legal issues, and comfort or tolerance level. Recommendations for future research and continuing education for rehabilitation counselors were made. Human Immunodeficiency Immunodeficiency Virus and Acquired Syndrome (HIV/AIDS) are serious health threats throughout the world. By 2010, it is projected that about 45 million people around the world will die of this condition (United Nations, 2005). In the U. S., about 1.5 million are currently HIV positive; about 25% of them do not know that they are infected; an estimated 886,575 are living with AIDS; and over the years more than 500,000 have died of AIDS. Annually, about 40,000 new infections are reported 70% of them are men and 30% are women (Centers for Disease Control and Prevention [CDC], 2002 and 2003). Though the condition and was first identified in the country in the early 1980s, studies of stored blood samples indicate that AIDS entered the U. S. in the 1970s. In the early 1980s, HIV/AIDS was primarily a condition prevalent among Caucasian homosexual males in the U. S. However, its prevalence is increasing significantly among women and ethnic minorities. Currently, women account for about 50% of 37.2 million (15-49 years) living with HIV throughout the world (United National Programme on HIV/AIDS [UNAIDS], 2005). In the U. S.,African Americans represent 50%, Latino Americans represent 21%, and Asian/PacificIslanders and American Indians represent 3%; CONTINUED... The Rehabilitation Professional- January/February/March

2 E. --- further, women of all ages and racial backgrounds represent a staggering 38% of all new cases. The prevalence of AIDS is six times higher in African-Americans and three times higher among Hispanics as compared to Caucasians (CDC, 2002). Initially perceived as a fatal condition, HIV /AIDS can now be controlled medical interventions. the effects of by new and aggressive As a result, the life expectancy for persons with HIV/AIDS has increased to years post diagnosis. It has been redefined as a chronic, long-term medical condition; persons living with the disease can now look forward to extended futures (Fiest-Price, 1997; Feist- Price, Logan, Leukefeld, Moore, & Ebreo, 2003). Though the world-wide funding to combat the condition has tripled from ~ $2.1 billion to $6.1 billion between 2001 and 2004, economically disadvantaged groups and minorities continue to have limited access to aggressive interventions (UNAIDS, 2005). As longevity of the target population increases, active involvement in gainful employment (paid or unpaid) and productive social activities becomes a key to improving their quality of life. Therefore, it is imperative that people with HIV/ AIDS incorporate their medical condition into their career identity and career goal with assistance from human services/allied health professionals. However, as per Douglas, Kalman, & Kalman (1985), Stevens & Muskin (1987), and Hunt, Jaques, Niles & Wierzalis (2003), the presence of a lowgrade homophobia, some hostile feeling towards consumers and fear of possible contraction of the virus expressed by several allied health practitioners often reduce the quality of assistance provided. Despite the above hindrances, the importance of providing equitable and compassionate services (e.g., counseling, medical, vocational, education, and financial) to individuals living with HIV /AIDS cannot be overemphasized. Society's perception of people with HIV/AIDS The pandemic ofhiv/aids has left its mark on the U. S. and the world. Although aggressive medical management is helping patients to maintain healthier lifestyles, they continue to require extensive support. Since a large segment of persons with the condition comes from supposedly ostracized populations, including homosexual men, prostitutes, intravenous (IV) drug users, and racial minorities (Shi, Samuels, Ritcher, Stoskopf, Baker, & Sy, 1997), the effects of social stigma, discrimination, loneliness, and fear of death, as well as lack of medical care and employment are more pronounced among them. Additionally, a general lack of public knowledge about the condition and its ramifications compound the barriers to education, employment, receipt of support services, and social integration of the target population. It can be stated that HIV /AIDS has been accompanied by intensely negative public reactions to persons living with the condition, especially minorities and women (Herek & Glunt, 1988). Persons with HIV/ AIDS are often perceived as deviant, depending on the mode of transmission of the condition. Human service professionals, including rehabilitation counselors, who are required to be accepting of clients and knowledgeable about the condition often harbor negative attitudes which may interfere with the counseling process and quality of outcome (Hunt, 1996). Discrimination and stigma pose a serious challenge to the provision of required services to persons with HIV/AIDS. Stigma is defined as social process that marginalizes and labels those who are different. Discrimination is defined as the negative practices/reactions that arise from stigma. As a result, a fear of the effects of prevailing stigma often discourages consumers to seek opportunities for education, employment, and fullest community integration (Hunt, Jaques, Niles, & Wierzalis, 2003). Knowledge and perception of rehabilitation professionals Human services professionals, including rehabilitation counselors, continue to be instrumental in providing personcentered services such as teaching coping skills, developing job opportunities, creating and locating resources for independent living, and being a source of general support (Glenn, Garcia, Li Li, & Moore, 1998). The medical, vocational, and case management training of rehabilitation professionals has put them in a prime position to assist consumers, including those with HIV/AIDS in their quest for a better life (Hunt, 1997). However, the existence of stereotypes (negative perceptions) and a gap between professionals' actual and required levels of knowledge continue to hinder the quality of counselor-client professional relationship. Alston, Wilkins, & Holbert (1995), in a study of 223 certified rehabilitation counselors (CRCs), found that 27% felt uncomfortable conducting personal adjustment counseling, 32% felt uncomfortable at vocational planning for clients having HIV/AIDS, and 52% felt uncomfortable at approaching employers about hiring these clients. Additionally, when the CRCs were asked to rank 13 disabling conditions by the extent of employment hindrances posed, AIDS was ranked first and HIV third after mental illness. Souheaver, Benshoff, Riggar, and Wright (1996) examined knowledge of AIDS among 362 rehabilitation professionals. Over 50% of the respondents incorrectly believed that "biting and breaking the skin" is a verified form of transmission, while 56% were unable to identify breast milk as a verified form of transmission. More than 20% incorrectly identified "wet kissing" as a verified form of transmission, 25% erroneously thought father to fetus was a verified mode of transmission, 45% were unaware of the fact that the 48 The Rehabilitation Professional- January/February/March 2007

3 AIDS virus could cause brain damage, and 38% inaccurately believed that AIDS led to heart disease.the interaction of the above factors with those pertaining to HIV/AIDS related service delivery and outcome complicates the status of women and minorities with the condition. Traditionally populations underserved with HIV/AIDS According to Dworkin and Pincu (1993), there are a variety of counseling issues and concerns unique to certain groups diagnosed with HIV/AIDS. For example, in 2002, women represented 38% of new HIV/AIDS cases. However, many clinical trials continue to exclude women's issues and the gynecological problems associated with HIV/AIDS. This may lead to women being misdiagnosed or diagnosed later, which in turn can result in reduced post -diagnosis survival time and quality of life. However, the United Nations (2005) states that HIV/AIDS is a condition of the young and the most vulnerable age girls within the ages of years. As per All & Fried (1994) and Feist- Price, Logan, Leukefeld, Moore, & Ebreo (2003), since most women diagnosed with HIV/AIDS are poor and unmarried, may be difficult for them to secure treatment because of financial difficulties, limited facilities, and lack of childcare. Psychosocial issues, including self-blame or guilt, are more evident in mothers who have transmitted the disease to their children or know that they may die and leave their children as orphans. Finally, society often views these women as promiscuous or as "bad mothers" resulting in additional issues related to depression or isolation. Another group disproportionately affected by the condition is African Americans. When counseling African American clients, rehabilitation counselors must be aware that many of these clients feel oppressed and discriminated it against. The diagnosis of HIV /AIDS may intensify these feelings. Some may also feel ashamed, isolated, and alienated as a result of the lack of acceptance and understanding of the condition in their community (Crawford & Fishman, 1996). These feelings may be intensified in homosexual and bisexual males as a result of widespread homophobia in the African American community (Feist-Price, Logan, Leukefeld, Moore, & Ebreo, 2003). Furthermore in the African American community, there are feelings of mistrust for the medical establishment and the government (Hoffman, 1996). For example, Thomas, Aisha, & Iwrey (1989) examined knowledge of AIDS and reported risk behaviors among African American college students. The researchers found that 37% of participants believed that HIV was produced in a germ warfare laboratory and is being used as a form of selective genocide by the government. Many African Americans perceive HIV/AIDS as a disease of homosexual and Caucasian men; therefore not of concern to them (Hoffman, 1996). Such misinformation and incorrect perceptions may prove to be significant barriers to effective service delivery and long-term medical and rehabilitation outcome (Fields, 2005). Owens (1995), in an attempt of assess attitudes toward and knowledge of AIDS among 48 African American social work students, found that 42% agreed with the statement that most were responsible for contracting the disease and 21% agreed with the statement that AIDS was a deserved punishment for the sin of sexual perversion. Additionally, 65% were unsure if they would develop condition by virtue of working with persons with AIDS, 70% were uncertain of transmitting AIDS to their own families by working with clients, and 42% were apprehensive of the fact in the future AIDS may be transmitted unknown to humans. in ways currently It can be stated there is a high prevalence of negative attitudes, fear, discomfort, and knowledge deficiency among rehabilitation and allied health students/professionals. This, in turn, continues to severely affect the scope and efficacy of service provision to consumers. In spite of the effects of social and perceptual factors on service delivery, there exists a dearth of research to investigate rehabilitation counselors' attitudes towards persons with HIV /AIDS. Therefore, the purpose of this study was to assess the level of rehabilitation counselors' perception of consumers with HIV/AIDS of diverse cultures and make recommendations for enhancing vocational rehabilitation address the unique needs of this population Serrano-Garcia, & Toro-Alfonso, 2005). Design and participants (VR) service delivery to (Varas-Diaz, This exploratory and descriptive study involved 30 rehabilitation counselors employed at a state VR agency in the southern part of the U. S. Since the Rehabilitation Services Administration (RSA) 911 database does not identify HIV/AIDS status of consumers, rehabilitation counselors with high-risk caseloads such as substance dependency, mental impairment, and/or dual diagnosis were involved. Prior to the study, prospective participants were contacted via to ensure that their caseloads had consumers with the condition. Instruments TheAIDS Attitude Scale (AAS) was designed by Shrum, Turner and Bruce (1998) to measure attitudes towards persons with AIDS and HIV positive status. This 54-item instrument composed of 29 intolerantly and 25 tolerantly worded items, uses a 5-point Likert scale. For tolerant items, the options ranged from 5 =strongly agree, 4 = agree, 3 = neither agree nor disagree, 2 = disagree, to 1 = strongly disagree. Items con- CONTINUED... The Rehabilitation Professional- January/February/March

4 ~ taining intolerant words (1 = strongly agree to 5 = strongly disagree) are reverse scored. Total score that can range from 0 to 100is calculated by using the formula 25CX - N)/N, where _X = item totals and N = scored items. High scores indicate better tolerance. The reported consistency is The instrument validity. reliability or measure of internal has high face and content The focus group protocol contains five broad questions: (1) What type of training have you received in providing to consumers services with HIV / AIDS? (2) How do you feel about people with HIV? Based on the mode of transmission? you had contact with individuals (3) Have diagnosed with HIV/AIDS outside of work? (4) What external issues (psychosocial, vocational, stigma) come into play when dealing withchiv/aids clients? (5) Why do you think that the RSA 911 refrains from documenting HIV/AIDS diagnoses? Based on participants' responses to these questions, appropriate and impromptu cues were developed by the moderator. proceedings Data collection The focus group were tape recorded and transcribed. and analysis The AAS was mailed to the respondents with a cover letter, letter of informed consent, and a self-addressed stamped envelope. A three-week mail follow-up and a subsequent twoweek follow-up were conducted. The focus group consisting of five rehabilitation regional offices of the participating The descriptive statistics of rehabilitation counselors was held at one of the state VR agency. counselors' responses to each item on the AAS were a measure of their perception of consumers with HIV /AIDS. The reliability coefficient for AAS was calculated. An exploratory factor analysis with verimax rotation was conducted to summarize a large number of rehabilitation counselor attitudinal variables with a small number of factors. Transcriptions of the focus group discussion were content analyzed to determine the psychological or emotional states of the professionals, describe their attitudinal and behavioral responses to communications, or communication Results and identify the intentions, focus, trends of the professionals. A Cronbach's AlRha of 0.95 revealed a very high reliability. The total sample (n =30) mean AAS score was 75 (SD = 13.9),with a minimum score of 42 and a maximum score of 93. These results were somewhat more favorable/tolerant reported than those by Shrum, Turner, & Bruce (1989) for their norm group of 131 undergraduate and graduate students in various disciplines (M = 59, SD = 15.33).Most of the respondents' attitudes were tolerant towards HIV/AIDS with only a few exhibiting high levels of intolerance. For example, only 12% of respondents scored under 60% on the AAS. The two statements that indicated low tolerance or negative attitudes were: Item #3 - I would consider marrying and Item #21 - I would date a person with AIDS. In reference to the broad domains identified for this instrument demonstrated someone with HIV (legal, contagion, moral, and social), participants the highest levels of tolerance for social/moral issues. For example, 96% strongly disagreed or disagreed with the statements: Item #10 - Only disgusting people get HIV and Item #35 - HIV infection is punishment for immoral behavior. Also" 96% strongly agreed or agreed with the statements: Item #2 - Support groups would be helpful for persons with HIV/AIDS and Item #23 - No one deservesto havehiv/aidsdisease. Questions focusing on legal issues generated responses that were somewhat neutral or 50/50. For example, 40% of respondents strongly agreed or agreed, 33% were neutral, and 26% strongly disagreed or disagreed with the statement: Item #18 - People who give HIV to others should face criminal charges. Also, 23% strongly agreed or agreed, 33% remained neutral, and 43% strongly disagreed or disagreed with the statement: Item #1 - Limiting the spread of AIDS is more important than trying to protect the rights of people with AIDS. Contagion issues elicited the lowest levels of tolerance. For example, 80% strongly disagreed or disagreed with the statement: Item #3 - I would consider marrying someone with HIV while 60% strongly disagreed or disagreed with the statement: Item #21 - I would date a person with AIDS. One statement related to contagion, Item #9 - Being around someone with AIDS would not put my health in danger generated a moderate response, that is, 46% strongly agreed/agreed and 36% disagreed/strongly disagreed. It is also interesting to note that the statement: Item #13 - People should avoid going to the dentists because they might catch HIV from dental instruments, the respondents generated the highest tolerance, where 100% of disagreed or strongly disagreed. Exploratory factor analysis was performed using verimax rotation, which generated five factors which accounted for 61% of the variance in responses among the 30 rehabilitation counselors on perception of HIV /AIDS. Factor 1 is entitled fearfulness and avoidance due to personal attitudes. An extreme sense of negative feelings and absolute lack of tolerance was emanated by the participants in response to the following statements: Item #4 - I would quit my job before I would work with someone who has AIDS, Item #7 - People who receive positive results from HIV blood test should not be allowed to get married, Item #8 - I would prefer not to be around homosexuals for fear of catching AIDS, Item #10 - Only disgusting people get HIV infection, Item #20 - A list of people who have HIV infection should be available to anyone, 50 The Rehabilitation Professional- January/February/March 2007

5 Table 1 Factor Analysis Component % of Variance Cumulative % 1. Fearfulness/avoidance due personal attitudes Social perceptions Public interaction/contact Knowledge and ethical and legal issues Comfort/tolerance level Item # 29 - I couldtellbylookingat someoneifs/hehad AIDS, Item #33 - Children who have AIDS probably have a homosexual parent, Item #39 - The best way to get rid to HIV infection is to get rid of homosexuality, Item #44 - The spread of AIDS in the United States is proof that homosexual behavior should be illegal, and Item #50 - sanitariums contributed perceptions People with AIDS should be sent to to protect others from AIDS. Issues that to these feelings included negative personal of persons with HIV /AIDS (disgust, revulsion, sense of immoral behavior), fear of contagion, lack of tolerance for close physical and social contact, and negative attitudes towards homosexuality. Factor 2 is entitled social perceptions. Positive feelings were emanated in response to the following statements: hem #6 - I would like to feel at ease around people with AIDS, Item #21 - I would date a person with AIDS, Item #22 - People should not blame the homosexual community for the spread of HIV infection in the United States, and Item #38 - I would contribute money to an HIV infection research project if I were making a charitable contribution. Issues that contributed to these feelings were comfort levels in social situations indirect contact and equal use/access/availability and of medical care. However, the following statements emanated negative responses: Item #1 - Limiting the spread of AIDS is more important than trying to protect the rights of people with AIDS, Item #15 - People with HIV infection should not be prohibited from working in public places, Item #30 - It is embarrassing to have so many people with HIV infection in our society, Item #35 - HIV infection is a punishment for immoral behavior, and Item #52 - Hospitals and nursing homes should not refuse to admit patients with HIV infection. Contributing factors were fear of contagion in close proximity, immorality (pertaining to homosexual behavior), and embarrassment. Factor 3 is entitled public interaction/contact. perceptions Positive of the following statements were expressed: Item #15 - People with HIV infection should not be prohibited from working in public places, Item #23 - No one deserves to have a disease like HIV infection, Item #24 - It would not bother me to attend class with someone who has AIDS, Item #25 - An employer should have the right to fire an employee with HIV infection regardless of the type of work s/he does, item #26 - I would allow my children to play with the children with someone known to have AIDS, Item #38 - I would contribute money to an HIV infection research project if I were making a charitable contribution, and Item #39 - The best way to get rid to HIV infection is to get rid of homosexuality. The contributing issues included a sense of being relaxed and at ease around persons with HIV/ AIDS in public places and social settings. Factor 4 is entitled ethical and legal issues. Negative feelings were emanated by the following statements: Item #16 - I would not want to be in the same room with someone who I knew had AIDS, Item #18 - People who give HIV to others should face criminal charges, Item #42 - Money being spent on HIV infection research should be spent instead on diseases that affect innocent people, and Item #43 - A person who gives HIV to someone else should be legally liable for any medical expenses. An issue central to the expressed feelings was transmission to others. Factor 5 is entitled level of tolerance. Positive feelings were emanated by the following statements: Item #2 - Support groups for people with HIV infection would be very helpful to them, Item #9 - Beingaround someone with AIDSwould not put my health in danger,item #36 - I would not be afraid to take care of a family member with AIDS, Item #49 - Parents who transmit HIV to their children should be prosecuted as child abusers, and Item #53 - I would not avoid a friend if s/he had AIDS. An issue central to the responses was ease of casual contact. Results of factor analysis revealed that the majority of participants held strong, positive feelings such as comfort and ease toward moralissues regarding moderate public contact with persons having HIV/AIDS. A feeling of comfort was expressed when pertaining to social contact with people, especially children with the condition but, extreme intolerance was indicated for homosexuals with HIV/AIDS. Strong negative feelings such as disgust, prejudice, and immorality were indicated in reference to homosexuals. Contagion was an issue that emanated considerable negative perceptions such as fear and alarm. These feelings were indicated when asked about contact at close proximity, such as marrying or living with a person having HIV/AIDS. Finally, ethical issues such as non-discrimination and equality generated very positive feelings; while legal issues pertaining to transmission generated considerable negative attitudes. CONTINUED... The Rehabilitation Professional- january/february/march

6 ~ Focus group proceedings In response to the first question on formal training in serving consumers with HIV /AIDS, two of the rehabilitation counselors (50%) said they had extensive in-service training on transmission, symptoms, functional limitations, disease progression, and confidentiality issues. Another indicated receiving no training other than general information during her graduate studies. The last one reported not receiving any type of training. Additionally, none of the participants reported having any experience in placing individuals with the condition in jobs. However, there was a consensus on the need for additional training on HIV/AIDS related issues including, general knowledge of HIV /AIDS, functionallimitatioris, legal implications of the condition, and the relation of the above factors relate to rehabilitation and workplace adjustment. The second question focused on the rehabilitation counselor's perception of people with HIV /AIDS, based on the mode of transmission such as substance abuse and/or homosexual! heterosexual activity. The participants agreed that they viewed HIV /AIDS as just another disability. The mode of transmission was not a factor when providing services to clients. A feeling of "sadness" for clients diagnosed with HIV/AIDS was also expressed. The third question asked if the rehabilitation contact with individuals work. Two counselors responded counselors had diagnosed with HIV/AIDS outside of positively and two others denied having any contact. But, they denied exhibiting any differential treatment when interacting with members of the target population. The following comments were made: I had one experience. He is deceased now, and was a friend of my husband and I (sic). He contracted AIDS through a homosexual relationship when he was very young. The only people that visited him were my husband and I. His homosexual friends shunned him and his mother had a difficult time coping. I was criticized by my friends for going to see him because I was pregnant and he had AIDS. His doctor, who knew I was pregnant, said as long as you do not sleep with him. It is o.k. The fourth question focused on the external issues, such as psychosocial, vocational, and stigma related factors that may come into play when working with consumers. Societal stigma was stated to be a major concern in this regard. The differential treatment of society, coupled with the effects of the disability, often proved to be a hindrance to designing a practical vocational rehabilitation plan. The following comments were made: "Finding an appropriate vocational goal is not always easy, because you have to find an area where they cannot cut themselves, injure themselves, or expose themselves to infections." "You have got to worry about any other limitations that they may have other than just cutting themselves. You wonder if they can be in the heat, about them taking their medications, will the medications cause nausea. You really need a good medical workup." "You really have to find out from the client and educate them if they want to be in a field like food preparation they would be in contact with knives and cut themselves." Moreover, the focus group participants the challenges of providing where constantly compared services to consumers with HIV/AIDS to the challenges of serving those with less stigmatized disabilities such as cancer and diabetes. The fifth question enquired about the rehabilitation counselors' perception of the reason(s) for not requiring documentation ofhiv/aids diagnosis in the RSA 911 database. The respondents had little knowledge of the fact that RSA 911 did not identify HIV/ AIDS cases. The following comments were made: "It must be illegal to do so." "It is probably not documented because of AIDS confidentiality law:' "Is not there a code? I believe you can tell HIV /AIDS status by a code:' When the issue of providing specialized services for this population was discussed, the rehabilitation counselors indicated that there was no need to provide additional services as long as the existing services were applicable to and efficient for a particular Discussion consumer. The results indicate that rehabilitation counselors were concerned about contagion and having close contact with individuals having HIV/AIDS. For example, 36.7% of counselors strongly disagreed or disagreed with the statement: "Being around someone with AIDS would not put my health in danger" and 26.7% strongly disagreed or disagreed with the statement: Item #15 - People with HIV infection should not be prohibited from working in public places. Such responses may have been due to lack of counselor knowledge on documented modes of transmission and experience in working with members of the target population. This corroborates the findings of Souheaver, Benshoff, Riggar, & Wright (1996), which reported that 35% of respondents HIV /AIDS transmission. had knowledge deficits about Results were also consistent with Owens (1995), who found that 42% of the participants that in the future, HIV/AIDS will be transmitted feared in ways that are currently believed to be safe. Additionally, as high self-efficacy is associated with less fear of HIV /AIDS (Olley, 2003), it is 52 The Rehabilitation Professional- January/February/March 2007

7 not surprising that the participating rehabilitation counselors with limited exposure to members expressed various levels of unfounded of the target population anxiety. It was also alarming to report that most rehabilitation counselors received minimal training to address the needs of the target population. appeared to be misinformed The counselors who received training specifically about ethical and legal issues. Additionally, training sessions they attended mostly focused on general knowledge on HIV/AIDS and little on issues pertaining to vocational rehabilitation. This could be an indication of the inaccurate and infrequent nature of in-service training opportunities. These results are consistent with the findings of Shi, Samuels, Ritcher, Stoskopf, Baker, & S~ (1997) and Souheaver, Benshoff, Riggar, & Wright (1996) who concluded that rehabilitation counselors lack complete and accurate knowledge ofhiv/aids. In congruence with Olley (2003), the inadequate knowledge base of rehabilitation counselors continues to negatively impact the perception of consumers with the condition and quality of long-term case closure. Therefore, in-service and pre-service training must be offered to assist practicing and prospective rehabilitation counselors in the development of compassionate and sensitive attitudes. Moreover, professionals should learn to accept and respect lifestyles different from their own and avoid projecting negative feelings on their clients. This can be achieved by examining their inherent perceptions, regarding homophobia, culturally diverse individuals beliefs, and values drug abuse, anxiety about death, and (Feist-Price, 1997). Sensitivity training may prove useful in this respect. According to Hoffman (1996) and Hunt (1996), the utilization of therapy or support groups may assist in dealing with the issues of anxiety, counter transference, burnout, and stress. All and Fried (1994) recommend provide unique counseling services pertaining counselors must learn to to issues such as high risk sexual behavior, illness in terms of death and dying, safe drug use, and confidentiality/disclosure issues specifically related to HIV/AIDS. Therefore, there is a need to develop rehabilitation specific training materials pertaining to persons with HIV /AIDS. These materials could include films, case studies, attitude scales, and other community resources (Atkins & Hancock, 1993). Groomes (1998) suggest that these training materials be developed in collaboration with persons living with HIV/AIDS and community service organizations providing services to individuals diagnosed with HIV/AIDS. This will ensure that the impact ofhiv/aids, from the perception of individuals living with HIV/AIDS, will be understood and properly addressed. Penn and Wykes (2003) suggest that the stigma can be reduced through public education, awareness, and advocacy. ' Counselors can play an important role in educating individuals in their home communities about HIV/AIDS. Also, HIV/AIDS awareness fairs, campaigns, and public forums can be held in the schools and on college campuses. Awareness campaigns and public service announcements such as those created by public radio and television can prove to be quite efficient. Finally, advocacy behaviors may include contacting legislators and lobbying for services for individual diagnosed with HIV/AIDS or supporting agenda. political candidates with similar Since attitudes have been highly resistant to change, rehabilitation practitioners and educators must devote added attention to finding appropriate ways of educating the general public, students, and allied health professionals. A comprehensive analysis is also needed of the different tools used to measure attitudes and comparisons of the attitudes of culturally diverse students and professionals towards consumers with HIV and AIDS (Valimaki, Suominen, & Peate, 1998). Implications for future research The study can be replicated in other states, especially those with high concentrations of culturally diverse groups. However, it is suggested that future researcher utilize a more structured qualitative data collection method such as nominal group technique (NGT). This technique may help generate deeper insights and encourage contribution from all stakeholders. Also, a qualitative study to assess consumer perceptions of the quality of vocational rehabilitation services is also deemed necessary. This type of study can help foster a better understanding of the needs of this population and contribute to the development of training materials and applicable counseling methods. Train-the- Trainer Models designed to promote awareness on, and modes of, preventing HIV/AIDS among populations with cultural and linguistic differences. Such educational models will assist in the use of cultural brokers and target population specific techniques of community-based health and wellness building efforts. Additionally, a nation-wide cross-sectional study may be conducted to ascertain rehabilitation professionals' knowledge of HIV / AIDS related issues found to be important determinants for providing quality services to consumers. Based on the findings and recommendations, continuing education opportunities may be development and implemented. Limitations First, since the results of this study are based on self-report of a small group of rehabilitation counselors, awareness of the significance of HIV /AIDS disease may have influenced CONTINUED ON PAGE 54 The Rehabilitation Professional- January/February/March 2007 S3

8 participants' responses in a way they thought was socially acceptable, regardless of their true thoughts individuals with the condition. Second, the focus group portion and feelings about of this study was not anonymous and it was held at the respondents' place of employment. responded Some counselors in the focus group may have differently had the session been held at a neutral location and away from colleagues and supervisors. Conclusion Rehabilitation in achieving maximum counselors assist individuals with disabilities social, psychological, vocational, and economic independence, which empowers them to enhance the quality of their lives to their fullest capacity. These professionals can provide social support, job development and placement, adjustment services, and enhance quality of life for consumers, including people with HIV/AIDS. Attitudinal and knowledge deficits regarding this condition barriers continue to result in ineffective and insensitive service delivery in all strata ofvr. It is the responsibility of the rehabilitation counselor to restructure any existing biases towards this population. It is equally important that counselors obtain education and training pertaining to HIV/AIDS issues. As supporters of the rehabilitation movement, it is important that the practitioners take on active roles as advocates, educators, researchers, and policy makers for individuals with HIV/AIDS. REFERENCES All,A. & Fried, j. (1994). Psychosocialissues surrounding HIV infection that affect rehabilitation. journal of Rehabilitation, 60(2), Alston, P. P., Wilkins, L. M., & Holbert, D. (1995). Rehabilitation counselor attitudes towards working with clients with AIDS. journal of Applied Rehabilitation Counseling, 26(3), Atkins, B. & Hancock, A. (1993). African American women living with HIV/ AIDS: Mental health issues. American Rehabilitation, 19(3), Centers for Disease Control and Prevention. (2002). HIV/AIDS surveillance report. Retrieved july 17, 2004 from stats/hasr II 0I.pdf Centers for Disease Control and Prevention. (2003). Advancing HIV prevention: New strategies for a changing epidemic - - United States Available online: [http://www.cde.gov/mmwr/preview/mmwrhtml/mm5215al.htm] Crawford, I. & Fishman, B. (1996). Psychosocial interventions in HIV disease. Northvale, Nj: jason Aronson Ine. Douglas, C. j., Kalman, C. M., & Kalman, T. P. (1985). Homophobia among physicians and nurses: An empirical study. Hospital and Community Psychiatry, 36 (12), Dworkin, S. H. & Pincu, L. (1993). Counseling in the era of AIDS. journal of Counseling & Development, 71, Fields, S. D. (2005, Winter). Adaptation of an existing HIV knowledge questionnaire for use with young men of color who have sex with men. journal of Multicultural Nursing and Health. Available online [http://www.findarticles.com/p/ articles/mi_qa3919/is_20050i/ai_ni ] Feist-Price, S. (1997). The biopsychosocialapproach to HIV and AIDS:Implications for instruction. Rehabilitation Education, 11(1 & 2), Fiest-Price, S., Logan, T., Leukefeld, c., Moore, c., & Ebreo, A. (2003). Targeting HIV prevention on African American crack and injection drug users. Substance Use and Misuse, 38(9), Glenn, M., Garcia, j., Li Li, M., & Moore, D. (1998). Preparation of rehabilitation counselors to serve people living with HIV/ AIDS. Rehabilitation Counseling Bulletin, 41(3), Groomes, D. (1998). The multiple impacts ofhiv/aids: What rehabilitation counselor's need to know. journal of Applied Rehabilitation Counseling, 29(3), Herek, G. M. & Glunt, E. K. (1988). An epidemic of stigma: Public reactions to AIDS. American Psychologist, 43, Hoffman, M. (1996). Counseling clients with HIV disease. New York: Guilford Press. Hunt, B. (1996). HIV/AIDS training in CACREP-Approved counselor education programs. journal of Counseling and Development, 74(3), Hunt, B. (1997). Rehabilitation Counselors' Attitudes and knowledge about HIV disease. Rehabilitation Education, 11(1&2), Hunt, B., jaques, j., Niles, S., & Wierzalis, E. (2003). Career concern for people living with HIV/AIDS. journal of Counseling and Development, 81(1) Olley, B. (2003). Investigating attitudes towards caring for people with HIV/AIDS among hospital care workers in Ibadan, Nigeria: The role of self-efficacy. African journal of AIDS Research, 2(1), Owens, S. (1995). Attitudes toward and knowledge of AIDS among African American social worker students. Health and Social Work, 20(2), Penn, D. & Wykes, T. (2003). Stigma, discrimination & mental health. journal of Mental Health, 12(3), Shi, L., Samuels,M. E., Ritcher,D. L.,Stoskopf,C. H., Baker,S.L.,&Sy,E (1997). Primary care physicians and barriers to providing care to persons with HIV/ AIDS. Evaluation of Health Professionals, 20(2), Shrum, j. c., Turner, N. H., & Bruce, K. E. (1989). Development of an instrument to measure attitudes toward acquired immune deficiency syndrome. AIDS Educational Preview, 1(3), Souheaver, H., Benshoff, j., Riggar, T. E, & Wright, W. (1996). AIDS Knowledge among rehabilitation professionals. journal of Rehabilitation, 62(2), Stevens, L. & Muskin, P. (1987). Techniques for reversing the failure of empathy towards AIDS patients. journal of the American Academy of Psychoanalysis, 15(4), Thomas, S. B., Aisha, G. G., & Iwrey, C. G. (1989). Knowledge about AIDS and reported risk behaviors among black college students. College Health, 38, United National Programme on HIV/AIDS [UNAIDS]. (2005, june). WHO estimate of number of people requiring treatment - end 2004:1850. Available online: [http://www.who.int/3by5/support/june2005_pan.pdf] United Nations. (2005). United Nations world youth report Available online: [http://www.un.orgiesa/socdev/unyin/wyr05.htm ] Valimaki, M., Suominen, T., & Peate, I. (1998). Attitudes of professionals, students and the general public to HIV/AIDS and people with HIV/AIDS: A review of the research. journal of Advanced Nursing, 27(4), Varas-Diaz, N., Serrano-Garcia, I., & Toro-Alfonso, j. (2005). AIDS related stigma and social interaction: Puerto Ricans living with AIDS. Qualitative Health Research, 15(2), CEU INFORMATION This article has been approved for continuing education credits for CRC, CCM, and CDMS for IARP members through the IARP Certification Maintenance Program. At the time of printing we have requested approval of 1.0 credit. To obtain CEUs after reading the article, the following is required. 1. Complete both the exam and the evaluation form on page Write a check to IARPfor $15 (IARPprofessional members), $20 (IARPassociatemembers), or $25 (non-members and subscribers) to processthe request. 3. Send everything, including your name, address, phone/fax numbers, CRC, CDMS,and/or CCM number(s) to the address below. larp CEU Processing. 1926Waukegan Rd.,Ste. 1. Glenview,IL This continuing education activity is provided by IARP and has been pre-approved by the Commission on Rehabilitation Counselor Certification (CRCC), the Certification of Disability Management Specialists Commission (CDMSC), and the Commission for Case Manager Certification (CCMC) for 1.0 clock hour of continuing education. Certificants must submit this completed quiz to IARP by mail by December 31, 2007 to receive a Verification of Completion form. IARP will be unable to issue credit for quizzes submitted after this time. 54 The Rehabilitation Professional- January/February/March 2007

9 Name: Phone #: ( Multiple Choice Exam for Continuing Education Credit Questions based on the article Rehabilitation Counselors' Knowledge and Attitudes Towards Consumers with HIV/AIDS by LaKeisha Lewis, MS; Alo Dutta, PhD, CRC, MPA; Doreen Miller, RhD, CRC; Carliss Washington, RhD, CRC; and Madan M. Kundu, PhD, FNRCA, CRC, NCC, LRC, beginning on page What proportion of people living with HIV in the world are women? a. 50% b. 80% c. 60% d. 70% 2. Large segments of populations with HIV/AIDS are from what type of social and cultural backgrounds? a. Caucasian middle class male b. Homosexual men and prostitutes c. Alaskan Nativesin rural regions d. Lesbian female 3. What are the definitions of stigma and discrimination? a. They are defined as the negative practices/reactions that arise from race. b. They are defined as a legal mandate to classify persons from various social strata. c. They are defined as social process that marginalizes and labels those who are different. d. They are a perceptual barrier between the majority population on the basis of gender. 4. Cause/causes of reduced quality of services received by people with HIV/AIDS include: a. Presence of a low-grade homophobia and discomfort b. Lackof education availableto people with HIV/AIDS c. Professional differences between various health sciences fields d. Agency policies against consumers with the condition 5. A counselor's high self-efficacyin serving consumers with HIV/AIDS may often reduce a. The levelof professional competence b. The levelof accessto availableservices c. The levelof consumer involvement d. The level of unfounded fear 6. According to this study, which area of HIV/AIDSwere least addressed by training sessions? a. Sexualissues b. Ethical and legal issues c. Agencypolicy related issues d. Funding issues 7. An area in which unique counseling services can be provided to members of the target population include: a. Confidentiality/disclosure issues specificallyrelated to HIV/AIDS. b. Availabilityof funding for community integration c. Education/training related to vocational outcome d. Awareness of various medical interventions available to consumers 8. According to the article, how can this study be replicated? a. Utilizing double blind clinicaltrials b. Utilizing survey method c. Utilizing nominal group technique d. Utilizing online data collection 9. How will train-the-trainer model be helpful in promoting awareness? a. Byusing the Internet b. Byinvolving cultural brokers c. Byeducating general public about the condition d. By disseminating the findings of this research among minorities 10. The prevalence ofhiv/aids is times higher among African Americans as compared to Caucasians. a. Two b. Five c. Six d. Nine EVALUATION FORM Excellent 1. was 2. and utilizationof disabilityinformation. 3. The article provided information which will be useful to me regarding the dissemination and utilization of disability information The issues addressed in this article were valuable The article furthered career Your comments are appreciated. Please use a separate sheet of paper. Very Good Good Average Poor The Rehabilitation Professional- January/February/March

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