Coping In Crisis: Lessons from Early AIDS Work for Contemporary Social Work Practice

Background and Purpose: In the early years of the AIDS epidemic, members of Gay Men’s Health Crisis (GMHC) provided care under conditions of uncertainty, limited medical knowledge, and uneven institutional response. The distinction between “staff,” “volunteer,” and “client” was often fluid, and contemporary frameworks for understanding burnout, trauma, and self-care had not yet been fully developed or incorporated into social work practice. This study examines how people across these hybrid roles navigated sustained exposure to illness and death, focusing on how coping and care were collectively constructed outside conventional professional frameworks.

Methods: This study draws on qualitative analysis of oral history interviews (N ≈ 100) with former GMHC staff and volunteers, supplemented by archival materials, including internal documents, program records, and contemporaneous publications. Participants represent a range of roles, departments, and time periods. Data were analyzed using an inductive thematic approach. Transcripts and archival materials were coded for patterns related to coping, meaning-making, emotional experience, and organizational context, with attention to how responses to ongoing loss were embedded within collective practices and workplace culture.

Findings: Participants described responses to sustained exposure to illness and death including humor, ritual, collective support, and continued engagement in caregiving. Across roles, involvement was framed as a way to remain present to suffering, stay present to loss while continuing the work, and maintain a sense of agency amid uncertainty. Grief, exhaustion, and fear coexisted with purpose, connection, and moral commitment. For many, the work itself functioned as a way of managing loss and sustaining engagement in a context where death was pervasive and often socially unacknowledged.

Because many staff entered through activist and community networks rather than formal training, the boundaries of “appropriate” practice were more fluid. Participants described irreverence, play, gallows humor, political engagement, anger, and collective forms of endurance as integral to both care and survival. Rather than departures from effective practice, these forms of engagement can be understood as adaptive responses within a crisis logic—conditions in which ongoing loss and institutional insufficiency reorganize expectations around care, boundaries, and emotional expression. In this context, coping was socially organized and enabled continued participation in care work.

Conclusion and Implications: These findings suggest that sustaining care in high-intensity practice conditions characterized by sustained, overwhelming demand, uncertainty, and limited or absent institutional support depends not only on individual resilience, but on collective, context-specific practices shaped by crisis logic that may fall outside conventional professional norms. This gap is increasingly salient in practice contexts shaped by the COVID-19 pandemic, workforce strain, and contraction of social service funding—conditions that produce sustained exposure to loss and instability. Current frameworks emphasizing burnout and secondary trauma may not fully capture how practitioners sustain engagement in such settings. The GMHC case highlights the need to recognize collective forms of coping, create supervisory spaces for processing ongoing loss, and allow for contextually grounded forms of expression. More broadly, it underscores the importance of organizational cultures and supervisory practices that support practitioners in remaining present to loss while continuing the work.