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Employment Issues as Related by Individuals Living with HIV or AIDS.
by Margaret K. Glenn , Jo Ann Ford , Dennis Moore , David Hollar Counselors working with individuals living with HIV/AIDS face a challenging dilemma: a significant number of this group are feeling better, yet many are concerned about transition issues as they reach out to once again embrace work and careers. Returning to work is unexplored territory for many and we have little precedent to guide them, especially now that complex medication therapies are part of the equation. The following study outlines the issues that are confronting people living with HIV and AIDS as they work to move out of disability benefit dependence into the world of work today. Many health care professionals no longer view HIV/AIDS as the acute deadly disease of the early 1980's but consider it a long-term chronic illness, one for which preparation for long term care is essential. National statistics showed marked declines in AIDS incidence and deaths beginning in 1996 and continuing into 1998. As the number of deaths related to AIDS declined, the number of people living with the disease increased substantially. Decreases in AIDS deaths were attributed to better prophylaxis for opportunistic infections (OI), and treatment with highly active antiretroviral therapy (CDC 1998, 2001). Despite improvement in health as a result of the availability of new treatments, efforts at workforce entry has not been easy for this population (Martin, 1999). People who have undertaken a medication therapy regimen experience problems with compliance, lifestyle changes, physical or health problems as a result of medication treatments, as well as uncertainty about the advisement of workforce entry or reentry (Bogart, Kelly, Gray-Bernhardt, 2000). Estimates show the U.S. losing over $1.8 billion in productivity each year due to the absence of individuals with HIV and AIDS from the work force. Meanwhile, approximately $1.5 billion is currently being paid by public and private disability insurers to sustain people living with the disease (National AIDS Fund, 2001). Vocational rehabilitation services can assist individuals living with HIV or AIDS to address the work-related concerns and to return to the workforce. Research has shown significant correlation between long-term health and employment among people with HIV/AIDS, as they report improved quality of life and functional status (Chammas, 1999; McReynolds, 2000; Swindells, Mohr, Justis, Berman, Squier, Wagner, & Singh, 1999; Yelin, Greenblatt, Hollander, & McMaster, 1991). Those with flexible schedules and higher levels of education fared better in this research. Yet going to work is a "Catch-22" for many people living on insurance and public agency benefits (Greene, 1998; Larson, 1999). Contemplation of benefit loss can create anxiety in the decision-making process. When individuals living with HIV or AIDS consider transitioning back into the work world, a number of other barriers to success are reported in the literature. One relates to the lack of knowledge of their rights as individuals with disabilities in the workplace. Other studies report negative feelings and emotions associated with having a disease and the psychosocial issues that impact individuals' ability to work or be productive on the job (Brashers, Neidig, Reynolds, & Haas, 1998; Gilden, 1997; Livneh & Antonak, 1997; McReynolds, 2000). This is compounded by the fact that an increasing number of individuals living with HIV or AIDS lack resources and have poor or nonexistent work histories because of homelessness, substance abuse, mental health problems and a host of other related factors (Heath & Rodway, 1999; Martin, 1999). Whether or not to disclose HIV+ status is a dilemma faced by the majority of individuals. The stigma and lack of knowledge that exists in the general community and in the workplace can cause reactions which lead to fear of discrimination, loss of social relationships, possible job losses, or loss of health insurance benefits (Brooks & Klosinski, 1999; Adam & Sears, 1996). One issue under research relates to medication management and how it impacts the lives of people entering the workforce, maintaining work, or considering a new career (Crespo-Fierro, 1997; McReynolds, 2000). These complex therapies require multiple medications which need to be rigorously taken and are to be ingested at different times of the day, sometimes on an empty stomach, sometimes with food. These medications may cause fatigue, diarrhea, nausea or a host of other symptoms. Some medications must be refrigerated. Disclosure to employers becomes a concern for many as they may require reasonable workplace accommodations so they can continue the medication regimen. In order to assist people in exploring these work transitions, rehabilitation counselors must ...
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