Academic journal article Journal of Marital and Family Therapy

Training Issues for Supervisors of Marriage and Family Therapists Working with Persons Living with HIV

Academic journal article Journal of Marital and Family Therapy

Training Issues for Supervisors of Marriage and Family Therapists Working with Persons Living with HIV

Article excerpt

The purpose of this article is to address the special issues and considerations Marital and Family Therapy (MFT) supervisors might face with the increasing HIV/AIDS epidemic. Three primary issues will be addressed in this article. First, the importance of educating therapists regarding various aspects of the disease process and its transmission will be discussed, followed by educational strategies programs might adopt. Second, we will discuss the ethical and legal considerations that may need monitoring by supervisors and trainees. Third, special therapeutic considerations will be provided to supervisors of therapists working with stigmatized populations.


Many marriage and family therapy training programs and clinics strain under the pressure to instruct their student and intern therapists on the appropriate handling of sensitive social issues that pervade society. Such issues include cultural pluralism, sexual orientation, sexism, chemical dependency, and violence. In fact, according to the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE), accredited Master's and doctoral programs must offer significant material on issues of gender, sexuality, sexual dysfunction, sexual orientation, ethnicity, race, socioeconomic status, and culture as well as issues relevant to the populations in the vicinity of the training program or clinic. As the prevalence of HTV infection and AIDS cases increases, another training responsibility materializes.

How relevant is HTV infection to the field of marriage and family therapy? As of June 1998, more than 665,000 cases of AIDS and 99,000 cases of HTV infection in the United States have been reported to the Centers for Disease Control (CDC; Center for Disease Control, 1998). The CDC (1996) estimates that one in every 250 Americans is infected with HTV. Adult and adolescent men constitute 83% and 72% of all AIDS and HIV infections, respectively, while children under the age of five account for approximately l%-2% of both AIDS cases and reported fflV infections (CDC, 1998).

Men still constitute the largest group of infected individuals; however, over the past few years, the demographic profile of these men has been changing. Historically, gay men have constituted a majority of AIDS cases. Currently, gay men represent 51% of new HTV infections and 65% of all AIDS cases. HTV and AIDS cases for men involving injection drug usage (15% and 22%, respectively) have increased over the years but currently remain steady (CDC, 1998). Although 6% of gay men with HTV report both sex and intravenous drug usage as risk factors, HTV-positive injection drug users are predominantly heterosexual Hispanic (24%) and African American (20%) men (CDC, 1998). Among young men, 46% of all 13-19 year olds and 51% of 20-24 year olds reported contracting HTV from having sex with other men (CDC, 1998). Seven percent of the 13-19 year olds and 6% of the 20-24 year olds contracted HIV from heterosexual contact, while 5% of 13-19 year olds and 6% of 20-24 year olds contracted HIV from injection drug use (CDC, 1998). Furthermore, since 1994, AIDS has been the leading killer of men between the ages of 25 and 44 in the United States (National Center for Health Statistics, 1994). These figures suggest a changing demographic profile of men with HTV/AIDS.

Although ADDS cases continue to arise predominantly in men, the fastest rising at-risk group for HIV infection is heterosexual women (CDC, 1996). To date, women constitute only 16% of AIDS cases, yet 27% of all new HIV infections are being diagnosed in women (CDC, 1998). Of these new HIV infections, 81% are diagnosed in women between the childbearing ages of 20 and 44. The CDC (1998) reports that HIV infection in adolescent and adult women results primarily from heterosexual contact (39%) and injection drug usage (23%). The modes of contraction for ADDS cases in adult and adolescent women are different from men as infections have resulted primarily from injection drug usage (43%) and heterosexual contact (39%; CDC, 1998). …

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