Administrative challenges to working with HIV-positive clients: experiences of mental health and substance abuse program directors in Florida.

Administrators of publicly-funded mental health and substance abuse programs described their agencies' activities, policy development, the administrative impediments, and training needs related to caring for HIV-infected clients. Almost all have served HIV-infected clients and admit clients to their programs regardless of HIV status. The administrators reported little staff opposition to working with this clientele. Liability and confidentiality concerning testing and client/staff safety were major concerns. The difficulty of providing needed medical care and the expense of treating such clients were also viewed as major impediments to service delivery. The most critical training needs were for mental health interventions related to death and dying, grief counseling, and neuropsychological complications, as well as for policy and procedure development concerning legal and ethical issues.