Hundreds of thousands of occupational exposures to the blood and body fluids of patients occur every year in health care settings. The risk of acquiring HIV infection after exposure to HIV infected blood is 0.452%. Despite this low risk, the impact of each of these exposures is significant to the health care worker who is exposed. This paper focuses on the importance of adapting HIV education and counseling models to occupational settings. It recommends the incorporation of psychosocial assessment, risk reduction education, counseling, and support into existing exposure management programs. Barriers to effective occupational exposure counseling and their possible solutions are examined. Case studies are used to illustrate the complex issues raised during counseling.