Navigating Barriers to Vocational Rehabilitation for HIV-Positive Persons

Abstract

This study documented the outcomes of 108 HIV-positive persons receiving vocational rehabilitation services. Over a 12-month follow-up, participants reported significantly decreased odds of any unstable housing (Adjusted Odds Ratio [AOR] = 0.21; 95% CI = 0.05 – 0.90; p < .05) and increased odds of being employed at least part-time (AOR = 10.19; 95% CI = 2.40 – 43.21; p < .01). However, reductions in perceived barriers to employment and increases in income were more pronounced among those not receiving disability benefits at baseline. This was consistent with findings from baseline qualitative interviews with 22 participants where those not on disability were subject to bureaucratic hurdles to rapidly accessing benefits and anticipated stigma of being on disability that propelled them to rejoin the workforce. Vocational rehabilitation could address key structural barriers to optimizing HIV treatment as prevention, and novel approaches are needed to improve outcomes among individuals receiving disability benefits.

“The land of the sick and the land of the healthy”: Disability, bureaucracy, and stigma among people living with poverty and chronic illness in the United States

“…The neoliberal social policies outlined here are therefore likely self-defeating even by their own economizing logic. Similarly, SSI/SSDI recipients have described the stigma of disability benefits as a factor that demoralized them from returning to the workforce, along with anxiety about losing the hard-won financial stability disability benefits bring (Gomez et al, 2016). And while experiences of excessive bureaucracy among SSI/SSDI applicants may fuel greater urgency to rejoin the workforce (Gomez et al, 2016), our findings demonstrate how this bureaucracy can limit the ability to act on that very urgency if it directly leads to destitution and further ill health.…”

“…The first is aimed at the public institutions themselves, which, at the very minimum, should build into their operations targeted staff training and clearly identifiable policies regarding minimizing stigma and avoiding unnecessary harmful delays. The second concerns vocational rehabilitation programs for people with chronic illnesses, which are an increasing focus of social policy research (Gomez et al, 2016). While these provide a critical resource for out-of-work patients, they must avoid reproducing the responsibilizing, stigmatizing logic of neoliberal governance discussed here.…”

“…Only if carried out in strictly non-punitive ways that provide protection from destitution and stigmatization—e.g. by operating alongside additional advice, representation, and advocacy services for disability, as did a recently evaluated program for HIV-positive individuals (Gomez et al, 2016)—can they avoid reinforcing such collateral damage. The third implication pertains to more radical current thinking around welfare and social insurance policy.…”

Validating the client-focused considering work model for people living with HIV and quantifying phases of change of commitment to work

“…With respect to future research, the integration of intervention research methods in this line of inquiry is needed to better evaluate the degree to which targeted interventions are successful in addressing identified barriers and helping individuals make a successful transition to employment. Given the potential role of career and vocational rehabilitation interventions to lead to reduced HIV stigma and positive health and prevention outcomes, [11] we recommend the use of multiple methods to evaluate career and vocational rehabilitation services that go beyond job placement alone and include key HIV health and prevention outcomes (e.g., undetectable viral load, increased CD4 count, increased engagement in care, reduced HIV stigma) associated with the updated goals of the National HIV/AIDS Strategy. [45]…”

“…Review of the HIV employment, career development, vocational psychology and rehabilitation literature reveals a sound body of research related to HIV that has explored a range of topics including vocational needs/experiences, [5][6][7] use of vocational rehabilitation services, [8,9,10] and impact of employment interventions on vocational outcomes. [11,12] More recently a new area of research has begun to emerge examining the impact of employment and vocational services on medication adherence and/or public health outcomes. [13,14] However, only one study has examined the considering work process and the complex interaction of medical, psychosocial, financial/legal and vocational issues that can influence critical vocational decisions.…”