This study reports on a continuing project of group employment counseling for people living with HIV/AIDS (People with AIDS =PWAs). The concrete program, called Making A Plan (MAP), explores the needs, fears, perceived barriers, and affective dimensions of considering work for PWAs. This article describes the concerns and barriers of HIV-positive clients in four essential factors related to considering work and the changes in those concerns produced by participation in a group counseling process. The data to be reported below are derived from: (a) a quantitative evaluation of client change over the course of the program, (b) a qualitative focus group evaluation several weeks after program completion, and (c) several years of vocational counseling experience with this population. As described briefly below, this examination is timely in light of (a) advances in medical treatment for this population, and (b) the challenges the disease presents for vocational rehabilitation.
With the advent of protease inhibitors and combination therapies, many people living with HIV/AIDS (PWAs) have experienced a relative stabilization of their health. They have prospects of an extended future that can now include the realistic likelihood of employment (McReynolds, 1998). The process of this disease is unpredictable, with setbacks, complicated side effects, difficult and intrusive medical regimens, and a variety of psychological effects (e.g., anxiety, depression). The volatile disease profile, characterized often with sudden reversals of health, can force the individual to modify or abandon a positive educational or employment experience. The nature of both the disease and its medication regimen mean that the path of considering work is more unpredictable for the person living with HIV/AIDS than it is for a person with a more predictable disease profile (Anders, 1996; Canadian AIDS Society, 1998; Carton, 1996; Kohlenberg, 1997).
These features of the disease process add an extra complication for service organizations that wish to actively assist PWAs to consider entry (or re-entry) into some form of employment. Agencies that have traditionally served PWAs (AIDS service organizations = ASOs) have mostly focused on medical and psychosocial issues--prevention, regimen adherence, symptom treatment, support. Many ASOs now find that the option of work is increasingly feasible for their clientele and need guidance on how to respond to the challenge of vocational counseling for this population. Research on the employment counseling process and support for PWAs is limited although service agencies and grass roots organizations are increasingly called upon to respond to these new needs.
There are various models for vocational counseling for people with HIV/AIDS. Some generalize from other disabilities and are based on the classification of AIDS as a formally defined disability under federal law. For reasons that are discussed elsewhere (Kohlenberg & Goldblum, 2001), it is recommended that a multifactor model be used that takes into account the unique characteristics of the HIV/AIDS disease. The recommended model includes the four essential factors involved in considering work for PWAs (medical, financial/legal, psychosocial, and vocational). The model also takes into account the capricious course of the disease and the difficulties of its treatment.
Although it is a matter of debate whether HIV/AIDS shares major similarities with other disabilities in its impact on employment issues (Martin, Brooks, Ortiz, & Veniegas, forthcoming; De Lima, et al., 1997), it is clear that more information is required about appropriate models of vocational assessment and counseling and on the efficacy of employment counseling for this population. A limited but growing number of studies have begun to document empirically the relationship between HIV/AIDS and employment (Blalock, 2001; Brooks, Ortiz, Veniegas, & Martin, 1999). …