Human Immunosuppressive Virus (HIV) infection represents a major public health and social problem in the United States. HIV infection is a condition which compromises cellular immunity. Over time, people with HIV infection become subject to otherwise rare opportunistic infections that can be life threatening. However, people with HIV infection can remain relatively asymptomatic for upwards of ten years. It is clear from the worldwide epidemiology that the spread of the disease is no longer limited. The spread of HIV has occurred only through the exchange of body fluids between individuals, specifically blood, blood products, vaginal fluids, semen, and breast milk. The virus cannot be spread by casual person-to-person contact.

Because of the stigmatization of the disease and its initial appearance within segments of the population that have traditionally been discriminated against, there is an erosion of basic human and civil rights of all people with HIV infection and even those presumed to be carrying this virus. Advocacy is often required on the individual and community level to counteract HIV related discrimination. In addition, a diagnosis of HIV infection exacerbates already existing psychosocial problems.

The current HIV epidemic represents a multidimensional crisis for those directly affected by HIV, their families, friends and communities. The incidence of HIV infection severely threatens the economic viability of individuals and their families and it heavily taxes available health and social service resources. As the number of people with HIV infection increases, more and more people will be personally and significantly affected by the epidemic. In New York City and nationally, hundreds of thousands are infected and tens of thousands each year are expected to become ill and die. In response to this epidemic, social workers in all settings have provided exceptional leadership and service. It is clear that the efforts and skills of all professional social workers, in all settings, must be readied to respond to the continuing pandemic. Toward this end the New York City chapter of NASW offers the following revised guidelines:

1. All persons diagnosed with HIV infection or the presumption of HIV shall have access to services offered by professional social workers. The obligation of all social workers to provide necessary services to the above people is comparable to the ethical obligation to provide service to people regardless of their sexual orientation, race, color, country of origin, creed, gender, age and disability.

2. Social workers in all practice settings and different levels of authority are obligated to become knowledgeable about transmission of HIV and the disease process and be prepared to educate and counsel peers, other professionals and clients.

3. All social workers are obligated to update continually both their scientific knowledge about HIV disease and their skills in effectively working with people with HIV infection, their family members, friends and others.

4. Social workers should encourage and support the development of written agency guidelines and procedures for their practice with people affected by HIV infection. Such written statements should reflect the spirit of the NASW guidelines expressed in this document and the relevant laws.

5. As specified in New York State law, all social workers are obligated to respect the confidentiality of all written and oral communications regarding HIV disease and their clients. Special attention must be given to assuring the availability of anonymous HIV antibody testing as mandated by New York State law.

6. Social workers should participate with other groups to lobby actively at the local, state and federal levels on behalf of people with HIV infection to improve the quality of their lives and to protect their civil liberties. Social workers should also advocate for increased funding for appropriate education, prevention, interventions, treatment, services, and research.

7. Social workers should be especially concerned about the emotional impact for people taking the HIV antibody test, as well as the possible threat to their civil liberties. Attention should be taken to assure that pre and post-test counseling standards, as established by New York State law, are maintained. Supportive counseling and referral should be offered by social workers or other skilled professionals. All social workers should advocate, when necessary, for access to early medical care and other needed psychosocial resources.

8. All social workers are obligated to keep up-to-date information on communities and community resources and how to access them. This includes, but is not limited to preventive education programs, mental health services, legal assistance, income maintenance, housing, hospices, long term care, child care, schooling, recreation and community participation and access.

9. Social workers should not be denied employment based on their HIV status or their presumed HIV status.

10. Social work practice with people affected by HIV infection is highly stressful due to increasing caseloads, bereavement overload, and a lack of on-going training and supervision. It is therefore important that social workers have supportive supervision, work time staff support groups, peer consultation and respite from the strain of the work.

11. The guidelines in this document are not intended to abrogate any standards of NASW.