Working with HIV: Issues for People with HIV/AIDS Contemplating Workforce (re)Entry

Background

HIV/AIDS. As a result, some clients previously unable to work due to AIDS-related illnesses are now able to consider the possibility of workforce (re)entry in light of their improved health (Weatherburn et al., 2009; Bettinger, 1997; Martin, 1997). Despite health improvements, efforts at workforce entry have not been easy. Obstacles to workforce (re)entry exist for many HIV/AIDS infected individuals, including concerns over uncertain future health, possible loss of benefits, outdated job skills, discrimination, disclosure, and accommodation for HIV/AIDS-related disabilities.

Historically people have cited a number of reasons for working, including:

a) Financial security that contributes to survival and improved quality of life (Schlechter, 1997);
b) Enhanced self-esteem which contributes to improved health (Kasl et al. 1975; Linn et al., 1985); and,
c) The opportunity to create a social support system (Roberts et al., 1997; Vinokur et al., 1995).

HIV/AIDS-infected individuals are no different. While they struggle to overcome significant challenges that affect their ability to live independently and return to the workforce, (re)entry becomes an important factor leading to independence. Benefits of permanent employment for individuals who are able to (re)enter the workforce include decreased depression symptoms and improved peer support than those who are unable to attain employment (Rabkin, 2008).

Research shows there a number of reasons HIV/AIDS infected individuals have when considering workforce (re)entry. Some of these reasons include:

Increased income. For most disabled/unemployed HIV/AIDS infected individuals disability income (e.g., social security disability insurance (SSDI), supplemental security income (SSI)) represents only a fraction of their pre-disability income. Living on disability resources alone represents an ongoing challenge for many, if not most, disabled/unemployed HIV/AIDS infected individuals. Financial reasons are often times the catalyst for HIV/AIDS infected individuals return to work (Arns et al., 2004).

Increased personal meaning. Many people derive a substantial amount of self-worth from their jobs; a person’s self-image is closely tied to the work they do. Self-worth, or a reason for “existence”, may be seriously undermined by disability and unemployment. Workforce (re)entry may, therefore, help to restore a sense of personal worth and meaning for many disabled/unemployed HIV/AIDS infected individuals.

Control and increased self-efficacy. Employment is a setting in which many people express and gain competence, receive positive feedback, expand abilities, and experience a sense of control and achievement. This may be a uniquely important anchor while dealing with a disease that is hard to control.

Reduction of family financial burden. Related to the need for increased income and personal financial stability, many HIV-infected individuals and others with disabilities feel they have become financial burdens to their families because of the financial support their families provide. Employment allows the disabled person to help reduce the financial burden (whether real or perceived).

Increased social interaction. Employment is a major source of social interaction, in contrast to the isolation experienced by many HIV-infected individuals disabled by their disease. Employment may help reduce this isolation.

Contribute to society. For many HIV/AIDS infected individuals, their diagnosis may have spawned a desire to leave a legacy or to make a positive contribution they can leave behind when they die. Finding a job that meaningfully allows such a contribution may help address this need.

Reduction of the role of HIV. Going back to work can add an important and absorbing set of activities that provide a balance to the often-overwhelming considerations that living with HIV/AIDS imposes in a life. Working can help relegate HIV/AIDS to the status of a medical problem, rather than a lifestyle.

However, despite compelling reasons for workforce (re)entry, a number of obstacles often make the transition from disability/unemployment to employment difficult. For people with longer histories of disability/unemployment, these obstacles may suggest that efforts at workforce (re)entry are not worthwhile, or that the costs outweigh the benefits. Research has found that concerns related to possible loss of or change in health benefits, fear and anxiety over the possibility of disclosure, the reality of HIV-related prejudice and discrimination, and relative lack of job skills and/or education are leading factors in not considering workforce (re)entry. Additional issues such as fear of stress that can contribute to overall declines in health outcomes, fear of failure which can lead to further self-disappointment, a loss of social support, and a change of lifestyle they may have grown accustomed to while un(der)employed and receiving social security benefits are additional concerns that should be assessed before workforce (re)entry.

Additional factors constituting barriers arise when looking at the issue from a psychosocial viewpoint associated with HIV/AIDS. As the demographics of HIV have changed, HIV has become increasingly associated with poverty indices and long-term unemployment such as substance abuse and homelessness. People with HIV/AIDS from such backgrounds may not be "disabled" according to the government’s definition (either their disease or associated issues), but they are still unable to work. Due to poor employment histories, these individuals may need additional assistance with (re)entering the workforce, including job preparation and job-hunting.

A number of services HIV/AIDS infected individuals may need in order to assist them in their workforce-entry efforts have been identified (Brooks & Klosinki, 1999; Brooks et al. (1999). These services include employment services (referrals, job listing, interview-skills training), counseling (including benefits counseling), workshops on vocational opportunities, and educational activities. The need for these services was echoed in research by Watts and Kohlenberg (2003) who found the largest barriers to workforce (re)entry remained vocational rehabilitation, career counseling and planning, and employment services.

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