FFOOCCUUSSAs demand for antibody counseling

and testing has grown, program admin-istrators at both publicly run andcommunity-based testing programshave looked increasingly to volunteersto compensate for staffing shortfalls.Volunteers have responded, seeing testcounseling as unique among the manyHIV-related volunteering opportunitiesthat have been available since thebeginning of the epidemic. This articleexamines the potential advantages anddisadvantages of volunteer counselingprograms, sets out the process ofdefining responsibilities for volunteers,and explores the relationships betweenpaid and volunteer staff members.

Ultimately, deciding whether todevelop a volunteer program requiresbalancing benefits and drawbacks aswell as savings and costs. Among themost important benefits of usingvolunteers are that they: assist staffwith large workloads; inject enthusi-asm into the workplace; are able toavoid the stresses of full-time work;and, since they are often drawn fromthe community, are able to offerinsights based on grassroots involve-ment and cultural competence. Amongthe drawbacks are that: volunteers mayremain on the job for shorter periodsthan paid staff; they may, for severalreasons, be less reliable in terms ofattendance; and they may requiregreater coordination and supervision.

The Roles of VolunteersIt is important to clearly establish

and describe the volunteer role. Thisdescription should include a catalog ofthe distinctions, if any exist, betweenthe responsibilities of volunteers andpaid staff, particularly in terms ofaccountability, commitment, and ter-mination. For example: Will screeningcriteria for volunteers be differentfrom criteria for paid staff? If so, how?Will volunteers be allowed more flexi-bility in work scheduling than paidstaff? Will performance expectations ofvolunteer and paid staff be the same?Will volunteers be considered for paidpositions that become available?

Among the topics volunteer coordi-nators should discuss with volunteercounselors both during screening and

on an ongoing basis are responsibili-ties, qualifications, motivations, limita-tions and benefits, burnout, disciplineand termination, and legal issues.

Responsibilities. When volunteershave the same level of counselingexperience and skills as paid staff,they may be able to assume, soonafter training, many of the same coun-seling duties. For most volunteers,however, responsibilities may comemore slowly. It may be useful forvolunteers to perform a variety of testsite duties for the first six months oftheir commitment, and then to spendseveral months offering pre-test coun-seling before beginning post-testcounseling. It is important for volun-teers to progress in this sequence at apace that is comfortable for them, andfor supervisors to closely monitor avolunteer’s work, for instance by peri-odically, and with appropriate clientconsent, sitting in on counselingsessions.

At some test sites, volunteersprovide post-test counseling for bothantibody positive and negative clients.Other sites restrict volunteers tocounseling only seronegative clients,a practice that some believe sends asignal that counseling seronegativeclients is less important. In addition,this practice may create a situation inwhich people waiting for results canguess the results of individuals basedon which counselor gives that personthe result. Decisions in this areashould be based less on a definedpolicy than on an evaluation of eachvolunteer’s abilities.

Qualifications. Supervisors need todetermine whether volunteers will beheld to the same qualifications as paidstaff, and, if not, to set forth qualifica-tions volunteer staff must meet. Somequalifications, such as a weekly timecommitment or a period of service,should be clearly defined. Other require-ments, such as previous counselingexperience, education, or licensure, mayapply more to paid staff. Many qualifica-tions, for instance, communicationskills—the abilities to listen, to be sup-portive rather than directive, and toconvey messages simply—are necessaryfor both volunteers and paid staff.

Motivation. Ask volunteers abouttheir motivations for providing testcounseling services. This will help indeveloping an understanding of whatthey are seeking and what they arewilling to offer. It is often easiest towork with volunteers who have clearlyexpressed motivations, because theycome with specific goals.

Volunteers may identify altruism astheir motivation. In most cases, how-ever, this speaks to a general desirebut not to qualities related to ongoingcommitment to the particular job andits demands. Because altruism is anunselfish concern, it does not takeinto account a person’s own needsand boundaries, which will eventuallysurface. Attempt to understand whatunderlies general altruistic desires.

It is helpful to uncover specificmotivations, for example, the desiresto give back to a supportive communi-ty, to learn more about the field ofcounseling work, and to help others,and the need to provide counseling tomeet academic requirements.

Volunteers may express motiva-tions that are based on unrealisticexpectations or that are inappropriatefor test site counselors. For instance,volunteers may be motivated by per-sonal wishes to make sure peopleengage only in safer sex, an expecta-tion that may rob clients of theirautonomy and lead to disappointmentfor volunteers. They may also believethat their volunteer position will leadto a job as a paid counselor, an expec-tation that may be unrealistic.

Benefits and Limitations. One of thegreatest benefits test sites offer vol-unteers is the feeling that they aremaking a valuable contribution inproviding HIV-related services. Addi-tional enhancements include receivingfeedback through supervision andworkshops, and social support, includ-ing social programs, where volunteercounselors are recognized for theirwork and can meet with others. Thegreatest benefit to both the test siteand the volunteer comes when thevolunteer position can meet a per-son’s professional or personal goals.

Volunteer dissatisfaction oftenoccurs when volunteers no longerfind the job meets their expectationsand desires. To avoid this, supervi-sors should clearly communicate thelimitations of volunteer opportunities.

Volunteer CounselorsJohn Tighe

Volume 8 Number 7 June 1993 Supplement to FOCUS: A Guide to AIDS Research and Counseling On HIV Antibody Test Counseling

Determine what professional or socialopportunities, such as trainings and socialgatherings, will be offered to volunteers. Forinstance, will volunteers be given preferentialconsideration when paid jobs become avail-able? Will volunteers attend the same meetingsas paid staff? Will they attend staff trainings,consultations, or social activities? Will paidstaff be invited to attend volunteer sessions,including volunteer social events? It is impor-tant that volunteers be offered significantfeedback about and affirmation of their work.

Burnout. Discuss the potential for burnout.Volunteers become more susceptible to burn-out when their needs from a volunteer com-mitment are not being met and when they arenot supported in their work.

It is important that volunteers be aware oftheir level of stress. In the absence of relatedcounseling experience or anticipation of poten-tial job stresses, volunteers may be more likelythan paid staff to be overwhelmed by experi-ences like delivering a positive test result orpatiently working with a client who does notwant to change sexual behaviors.

Many volunteers, like paid staff, are suscep-tible to burnout because they overextendthemselves. In their enthusiasm, they maywork many hours a week. When their enthusi-asm eventually wanes, so might their commit-ment. Such feelings of being burned out maylead volunteers more readily than paid staff toleave a test counseling position, largely be-cause volunteers are not economically depen-dent on the work.

Discipline and Termination. Make clear, bothorally and in writing, the standards by whichvolunteers will be judged. Explain specificactivities, such as those related to missing awork shift or using substances, that may leadto discipline or termination, and explain thedisciplinary process. State whether volunteersare held to the same standards as paid staff.Supervisors may choose to allow more flexibil-ity to volunteers. For instance, a volunteermay be allowed to miss a certain number ofwork shifts if he or she finds another volun-teer as a replacement.

Written evaluations of job performance holdsignificant value for paid staff. While evalua-tions may be less crucial for volunteers, theformality of a written evaluation is a usefulway to convey the importance of the volun-teer’s contribution, create a record of theireffectiveness, and ensure that they are held toagreed-upon standards.

Legal Issues. Organizations are legally re-sponsible for training, monitoring, and super-vising volunteers. Providing volunteers thesame access to trainings as paid staff is gener-ally considered to meet this need. Organiza-tions with volunteers are advised by legalexperts to develop and publish guidelines andstandards for volunteer training, monitoring,and supervision, and to include volunteers onagency liability insurance policies. It is impor-tant that site supervisors educate volunteerson legal duties, such as the duty to warn, inthe same ways that they educate paid staff.

The Mix of Paid and Volunteer StaffPaid staff may see the presence of volun-

teers as a relief from an overwhelming work-load, and a positive morale boost to the testsite. Volunteer staff, for their part, may viewpaid staff as respected professionals who caneducate volunteers.

This ideal response, however, does notalways occur. For instance, paid staff maybelieve that they will be replaced by inexpen-sive volunteers, particularly when volunteersperform well. They may feel the value of theirprofessional skill is being questioned whenvolunteers perform similar functions. Paidstaff also may resent the fact that volunteersreceive additional supervision or consultationor more frequent affirmations.

Volunteers may grow to believe that theyshould be paid for their work if others are paidto perform the same functions. In addition,volunteers may resent the fact that staff arepaid for a job that members of the communityare willing to perform for free.

To avoid or deal with such feelings whenthey arise, supervisors should encourage opencommunication between volunteer and paidstaff and with supervisors. At one test site, paidstaff initially perceived volunteers as unwel-come replacements for relief staff, with whompaid staff had worked closely for years. Whensupervisors explained that funding was nolonger available for relief staff and that, in theabsence of volunteers, services would be cut,paid staff adjusted to the new relationships.

It is not easy to resolve feelings among paidstaff that their jobs are threatened by volun-teers. HIV antibody test counselors may alreadyfeel frustrated by a variety of factors related tofunding, workload, or working conditions. Ex-pressing resentment regarding the presence ofvolunteers may be a convenient way to dis-close these frustrations.

Make clear to staff that the needs of eachgroup are equally important. To deal withresentments that may develop, volunteersupervisors and program coordinators need tohave an active presence in introducing andintegrating paid and volunteer staff.

So that feelings can be heard and expressedby members of each group, meet with paid andvolunteer staff separately to discuss issuesrelated to their status as either paid or volun-teer staff. Be aware of frictions that may devel-op in the workplace, and intervene and mediatewhen they occur.

To ensure the smooth running of volunteerprograms, administrators should considerempowering “volunteer coordinators” to advo-cate for volunteers, mediate between volun-teers and paid staff, and communicate agencypolicy and decisions regarding volunteers.

ConclusionVolunteer programs may be a solution to

financial challenges. In implementing programs,however, failure to plan for the special needs ofvolunteers or to create a structure into whichthey will fit will lead to an unsuccessful program.Using the criteria discussed above, on the otherhand, will strengthen the planning process andenable the effective use of volunteers.

John Tighe is Staff Writer forFOCUS and Writer/Editor ofHIV Counselor PERSPEC-TIVES. Among those whoprovided input to this articlewere: Kelly Butler, MD;Jordana Raiskin, LCSW;Stewart Sokol, MS; StanNorth; Abe Sanchez; FrancisSalmeri, MA.

2 FOCUS June 1993

Executive Editor; Director,AIDS Health ProjectJames W. Dilley, MDEditorRobert MarksStaff WritersJohn TigheClare PotterFounding Editor; AdvisorMichael HelquistMedical AdvisorStephen Follansbee, MDMarketingPaul CauseyRichard McCormackDesignSaul RosenfieldProductionJoseph WilsonStephan PeuraLeslie SamuelsRoger ScroggsCirculationSandra Kriletich

FOCUS On HIV AntibodyTest Counseling is a quar-terly supplement toFOCUS: A Guide to AIDSResearch and Counseling,both published by theAIDS Health Project,which is affiliated with theUniversity of CaliforniaSan Francisco. The Supplement is pub-lished under a grant fromthe California Departmentof Health Services, Officeof AIDS, and is distributedto HIV antibody test sites.Permission to reprint anypart of the Supplement isgranted, provided acknow-ledgement of FOCUS andthe California Departmentof Health Services isincluded. FOCUS itself iscopyrighted by the UCRegents, which reservesall rights.Address correspondenceto: FOCUS, UCSF AIDSHealth Project, Box 0884,San Francisco, CA 94143-0884; (415) 476-6430.

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