Foundations for Living: Evaluation of an Integrated Employment and Housing Program for People Living With HIV

Abstract

Unstable housing and unemployment have been identified as major structural barriers to optimal HIV treatment outcomes among people living with HIV (PLWH). One solution is to provide integrated services that combine medical, employment, housing, and other psychosocial services to address the complex needs of PLWH. This program evaluation reports outcomes of the Foundations for Living program: an integrated employment and housing services program designed for PLWH. Employment and housing outcomes of participants who completed at least one 6-month reassessment were reported by frequency analysis. HIV immune health (CD4 count and viral load) are examined using a matched paired t test. HIV prevention outcomes were assessed by examining changes in the percent of participants with an undetectable viral load. Our findings indicate that among the participants who completed reassessments, 44.8% gained or maintained employment, 86.2% achieved viral load suppression, 75.9% achieved undetectable at the final reassessment. There was no statistical difference between the mean of CD4 count and viral load reported at intake and those reported during the final reassessment. Over half of the participants experienced unstable employment during the program, indicating that significant barriers to employment remain for this population. Implications for rehabilitation counseling practice and research are discussed.

Exploring the wider societal impacts of sexual health issues and interventions to build a framework for research and policy: a qualitative study based on in-depth semi-structured interviews with experts in OECD member countries

“…Studies have shown important links to mental health, that is, finding a need to support people’s mental health and sexual health needs holistically,23–25 as well as housing, employment status and alcohol use 26 27. More and more evidence calls for an integrated approach to address the complexity of sexual health by providing holistic services that include health practitioners, mental health professionals, social workers, youth services, employment services and others 28 29. This study contributes to this emerging literature by providing a comprehensive analysis of the broader impacts relating to sexual health and providing an initial framework.…”

“It Comes in Steps and Stages”: Experiences of People Living with HIV in Achieving Employment

“…One evaluation study of a housing and employment navigator model for families experiencing homelessness in three regions in Washington found a 7% higher rate of employment among participants who worked with a navigator specifically trained to support employment readiness, job skills and career resources [ 8 ]. Among people living with HIV, similar studies in Kansas City and New York found significant improvements in securing fulltime employment over time [ 9 , 10 ]. In these studies, a dedicated navigator/service coordinator proved effective in assessing employment skills, developing an individual employment plan with targeted goals, supporting employment readiness connection to job resources and educational training for clients.…”

“…In these studies, a dedicated navigator/service coordinator proved effective in assessing employment skills, developing an individual employment plan with targeted goals, supporting employment readiness connection to job resources and educational training for clients. Navigators/coordinators also played important roles in communicating across various agencies to support a person experiencing unstable housing such as obtaining IDs, social security cards, and access to transportation [ 8 , 9 , 10 ].…”

Identifying and capturing intersectoral costs and benefits relating to sexual health

“…Studies have shown important links to mental health, e.g., finding a need to support people's mental health and sexual health needs holistically (219)(220)(221), as well as housing, employment status and alcohol use (222,223). More and more evidence call for an integrated approach to address the complexity of sexual health by providing holistic services that include health practitioners, mental health professionals, social workers, youth services, employment services, and other (224,225). This study contributes to this emerging literature by providing a comprehensive analysis of the broader impacts relating to sexual health and providing an initial framework.…”