Workforce reentry for people with HIV/AIDS: intervention effects and predictors of success

Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent and little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the effectiveness of programs to assist people with HIV/AIDS in their efforts to return to work. We used logistic regression and Kaplan-Meier survival curves to predict return to work using data from 126 individuals who participated in an HIV/AIDS return to work program. Results from the 24 month follow-up revealed that program participation, general health, benefits status, and gender, predicted successful re-entry to the workforce. We discuss these findings in the context of the need for more explicitly-defined interventions, as well as the need for additional information on factors that may hinder or facilitate workforce re-entry among people with HIV/AIDS.     

ANTICIPATORY AND ACTUALIZED IDENTITIES: A Cultural Analysis of the Transition from AIDS Disability to Work

Throughout the course of their lives, many people living with HIV/AIDS have prematurely retired onto AIDS disability. A new trend, however, has swept across the nation. Where once people were getting sick, leaving work, and embracing inevitable death, now, with advances in medical technology, many people with HIV/AIDS are renewing their lease on life and discovering a desire to go back to work. To learn how gay men's identities are impacted as they transition from AIDS disability back to the labor market, I conducted three months of fieldwork at an employment placement agency in San Francisco. During fieldwork I distributed informal questionnaires to 120 gay men and then formally interviewed 10 additional gay men who had either transitioned or were considering transitioning from AIDS disability back to work. Analyses reveal that cultural, structural, and medical contradictions typify the return to work. As gay men experience and live through these contradictions, their identities split into anticipatory and actualized components. By facilitating a reassessment of meanings and values, anticipatory identities cognitively and emotionally prepare individuals as they brave the road back to work. This version of identity represents a romanticized confluence of worker (role) identity, gay (status/master) identity, and overall sense of self (self-concept). Personal experiences with stigma, shame, and discrimination along with complexities of the workplace and medical services, however, prevent the maturation of anticipatory identities when seeking reemployment. This results in loosely coupled and situationally informed actualized identities . The relationship between these two identities suggests that many people living with HIV/AIDS—and indeed others who experience stressful life transitions—face complex choices between quality-of-life issues and the ability to survive according to external cultural and structural constraints.     

Stigma,AIDS, and HIV Prevention in Africa: Reports from Community Organizations Providing Prevention Services

ABSTRACT

The AIDS epidemic in Africa remains a serious health crisis. Nongovernmental organizations (NGOs) in Africa play a critical role in the delivery of HIV prevention services. An important barrier to their HIV prevention efforts is stigma directed at persons living with HIV/AIDS. In order to understand how stigma affects HIV prevention programming, we conducted in-depth qualitative interviews with NGO directors in 29 African countries. Qualitative analytic approaches were used to identify key themes. Substantial discrimination and stigmatization of HIV-positive persons was reported. HIV-positive women were particularly likely to suffer negative social and economic consequences. The stigma associated with HIV interfered with disclosure of HIV status, risk-reduction behaviors, and HIV testing, creating significant barriers to HIV prevention efforts.

Interventions to reduce AIDS-related stigma in Africa are urgently needed. Reducing the burden of stigma is critical to fighting the epidemic in Africa and could play an important role in global HIV reduction.     

Women with disabilities making the transition back to work: Psychosocial barriers and interventions

The economic impact of disability on employment, earnings, and education appears to be more devastating for women than for men. Women with disabilities who are making the transition either back into the workforce or into the workforce for the first time often face barriers that are unique to this population. Many researchers have described women with disabilities as having a "double disadvantage" that results in social and psychological barriers to their transition back to work. The purpose of this article is to help vocational and career development programs better address the psychosocial needs of women with disabilities by (a) describing key psychosocial barriers faced by women with disabilities in their transition back to work and (b) providing career development strategies designed to ease this transition process for women with disabilities and enhance their employment outcomes.     

The experience of returning to work

The purpose of this qualitative study was to explore from an environmental perspective the experiences of returning to work of former unemployed sickness absentees. Five separate focus-group interviews were carried out with themes concerning different environmental areas. The findings showed that the participants in their process of being off work and then attempting returning to work experienced a personal transition manifesting itself as a negative self-image, change of life-rhythm and restrictions in their roles and activities. In their progression, the participants experienced a need for reorientation and expressed feelings of alienation, and for that reason felt need of support from a network, especially a professional one. Regarding attitudes in society, the participants reported experiences of social stigmatization, both in mass media and in their immediate social environment, and an increasing egocentricity among their fellow-workers. They perceived their progression back to work as a 'time quarantine' and as a long and destructive wait for support. The findings indicate that the phenomenon of 'returning to work' after unemployment and sick leave could not be reduced to a single issue. It should rather be seen as a dynamic problem with individual and structural, environmental aspects.     

HIV/AIDS Risk Reduction Intervention for Women who have Experienced Intimate Partner Violence

A growing body of literature highlights the association between women who have experienced intimate partner abuse (IPA) and their heightened risk for HIV/AIDS (human immune deficiency syndrome/ acquired immune deficiency syndrome) infection. Finding HIV risk reduction strategies that are contextually relevant for this population is an important public policy priority. This qualitative study researched women who have experienced intimate partner abuse in order to develop a HIV/AIDS risk reduction intervention unique to their circumstances. This pilot study explored the critical components of such an intervention among a racially/ethnically stratified (African-American, Mexican-American and Anglo) sample of women (n=43) who have experienced IPA. Focus groups were conducted and transcribed, and a content analysis was used to identify major themes. In all five focus groups, participants viewed the research as interesting, good, beneficial, and/or important based on their perceptions of risk for infection. Respondents felt that they knew of ways to protect themselves from infection in non-abusive relationships; however, acknowledged the difficulties of doing so given the context of their abusive relationships. Examining the racial/ethnic differences across focus groups showed that the language used by women is quite variable. The ways in which survivors define rape, sexual abuse, and their own experiences are all unique; however, their actual experiences have many similarities. Discussed at length are the topics participants shared as critical in informing the design of an intervention and the relevance of the findings to social work clinical practice is explained.     

Career Issues and Concerns for Persons Living With HIV/AIDS

As the perception of HIV/AIDS continues to shift from a terminal illness to a manageable disease, persons living with HIV/AIDS (PLWHAs) are able to reenter the workforce or remain in their current jobs for a longer period of time. Although this change is positive, it also raises many career concerns for PLWHAs. Using an ecological approach and the theory of work adjustment (Lofquist & Dawis, 1969, 1991), the authors provide suggestions for working with PLWHAs on career‐related issues. A case vignette is presented to demonstrate how this approach may be applied.     

Chapter 10: Issues in HIV/AIDS Service Delivery to High Risk Youth

Homeless and runaway youth engage in behavior that puts them at risk for infection with HIV, the virus that causes AIDS. Prevalence of HIV disease in homeless and runaway youth is higher than it is among other adolescents. In addition, homeless and runaway youth are often forced to engage in sex as a means of survival. Although they engage in high risk behavior, AIDS education programs have neglected them as a target group for education. To some extent, they have been included in other more general categories of persons with AIDS risk behaviors, such as men who have sex with men or intravenous drug users. However, the number of adolescents receiving age-specific HIV/AIDS information is far below the number infected (Hein et al., 1992). Often high risk youth are disenfranchised, having been forced from home by their families after disclosing their gay or lesbian identities. Lacking a political voice and having no spokesperson, they represent a group with complex unmet needs. These youth typically have immediate needs for food, shelter, and clothing. In addition, they often need medical management, mental health and drug counseling, crisis management, and HIV/AIDS information. These needs are often overwhelming to the agencies that serve youth. This article examines the barriers and issues that exist in providing services to high risk youth. Then, suggsetions for removing those barriers by empowering both service providers and youth are offered. Some of the suggestions are based upon the authors' own experience in providing HIV/AIDS in-service training to service providers to high risk youth. The article makes recommendations for policy on youth and HIV/AIDS.     

A qualitative analysis of African American fathers’ struggle with reentry,recidivism, and reunification after participation in re-entry programs

The experiences of African American fathers with reentry, recidivism, and reunification after a period of incarceration and after participation in a re-entry program. Results of the thematic analysis yielded the following major themes: unaddressed childhood trauma, self-identification, reentry; self-esteem and self-worth; reentry; family reunification after incarceration; and recidivism. Unaddressed childhood trauma and post-release stress emerged as the major barriers to successful transition from incarceration. Implications for social work policy, research, practice, and education are provided.     

Self-transcendence and depression among AIDS Memorial Quilt panel makers

Self-transcendence is a process that can help individuals reestablish well-being after experiencing a significant, life-altering event. In this study, we sought to identify the relationship between self-transcendence and depression in individuals who lost loved ones to HIV/AIDS and to describe and compare self-transcendence, self-transcendence variables of acceptance and spirituality, and depression among bereaved individuals who created AIDS Memorial Quilt panels with those who did not. The findings support Reed's self-transcendence theory, with inverse correlations between self-transcendence and depression obtained from both the total group and the panel makers. Significant differences were also found between certain self-transcendence variables and depression among the study participants related to gender and ethnicity. In addition, thematic analysis of panel maker interviews revealed five themes: Quilt panel making provides validation, Quilt panel making creates a living memory, liberating acceptance of loss, community of survivors, and connection to a higher power. These findings assist in understanding the complexities of the grief process and support the usefulness of Quilt panel making as an intervention for coping with grief related to HIV/AIDS.     

Understanding the African American Research Experience (KAARE)

Summary

Despite recognition that the African American population is underrepresented in studies of health and mental health treatment and prevention efforts, few investigations have systematically examined barriers to African American research participation. Without their participation, treatment and prevention strategies designed to curtail the spread of HIV in their communities will be bound to achieve less than optimal outcomes. Based on the assumption that successful recruitment of African Americans requires knowledge of (a) their beliefs about research, (b) their perceptions of the research process and researchers, (c) their motivations to participate, and (d) the historical and social factors that may be the source of at least some ambivalence, the current study undertook semi-structured interviews with 157 African American, low-income mothers residing in a large urban community where they and their children were at high risk for HIV. Given the sensitive nature of the research topic, members of the community were trained to conduct the interviews. Qualitative and quantitative analyses of the interview content suggest that despite having been consented, many participants (a) are not aware of their rights under informed consent and (b) lack knowledge of how the research will be used. Despite this and the subtle suspicion of White researchers held by some, many decide to participate for altruistic reasons. The implications for recruitment of participants in general and African Americans in particular into HIV prevention studies are discussed as are the implications for service providers directly or indirectly involved in the development and delivery of these interventions.     

Keynote 3. Living in the Valley of Death

Abstract

In 2003 alone, HIV/AIDS killed more than three million people, of which between 2.2 and 2.4 million were from Sub-Saharan Africa. This disease is having a devastating effect on the previously firm foundations of intergenerational relationships in affected countries. For many nations in Africa, Asia and South America, life has become a mirage, a paradox in which almost everything is overshadowed by the pangs of death. Poverty, HIV/AIDS and, surprisingly, compassion are the combined common causes of death. Consequently, social, ecological, economic, political and educational systems are almost entirely dislocated. Traditions demand that the young ones should outlive their elders. So there is a deliberate effort on the part of the elderly to embrace death in attempting to be compassionate. This paper is an attempt to explore this scenario with the aim of articulating the linkage between poverty and HIV/AIDS, and proposing ways of reducing their impact through intergenerational programming.     

Stigma Management Among Gay/Bisexual Men with HIV/AIDS

People with HIV infection are subjected to prejudice, discrimination and hostility related to the stigmatization of AIDS. To manage the stigma of their disease, they mount complex coping strategies. This paper reports results from a qualitative study that examined gay/bisexual men's experiences of living with HIV infection. Unstructured interviews from a diverse sample of 139 men were analyzed to examine how men coped with AIDS-related stigma. We discerned a variety of stigma management strategies that could be arranged along a continuum from reactive to proactive based on the extent to which they implicitly accepted or challenged the social norms and values that underlie the stigmatization of HIV/AIDS. Reactive strategies to cope with stigma involve defensive attempts to avoid or mitigate the impact of stigma, but imply acceptance of the underlying social norms and values that construct the stigma. Examples of reactive strategies include hiding one's HIV status, presenting one's illness as a less stigmatizing one (e.g., cancer), or distancing one's self from more damaging aspects of AIDS-stigma (e.g., attributing infection to blood transfusion). Proactive strategies challenge the validity of the stigma and imply disavowal and resistance of the social norms and values that underlie the stigma. Examples of proactive strategies include engaging in public educational efforts that address misperceptions about HIV transmission and social activism to change the social and political conditions that affect PWA/HIV.     

Workfare Programs

Abstract

Workfare initially originated as an approach to guide welfare recipients towards self-sufficiency. Today, the same strategy is being utilized as a desperate means by the States to move welfare recipients into the workforce in order not to suffer further cuts in federal assistance.

This paper reviews many of the common barriers which participants experience as they attempt to move from being welfare recipients to employees. In addition, it presents effective workfare programs, identifies critically needed support services for workfare participants, and suggests policy recommendations for the future.     

Between skepticism and empowerment: the experiences of peer research assistants in HIV/AIDS,housing and homelessness community‐based research

People living with HIV/AIDS (PHAs) in Canada are a highly researched population, yet their inclusion in the research process is minimal. Community‐based research (CBR) has become a recognized tool for addressing issues of power and exclusion within researcher/community relationships by inviting the community's equitable involvement as research partners. Within the context of HIV/AIDS research, this includes a commitment to the Greater Involvement of People Living with HIV/AIDS (GIPA) at all stages of the research process. One way of adopting GIPA principles within CBR is through providing employment, research training, and capacity building opportunities for PHAs as peer research assistants (PRAs). Drawing on data from two in‐depth focus groups with seven PRAs from the Positive Spaces, Healthy Places: Community‐based Research Study, this paper will highlight important methodological practices for academic and community‐based researchers who are working with and supporting PRAs.     

Back to work: vocational issues and strategies for Canadians living with HIV/AIDS

Much has been written since the first appearance of HIV/AIDS in 1981 about its effects on the Canadian health care and social services systems. However, researchers have given limited attention to issues of entry or re-entry to the competitive job market for HIV positive individuals. The emergence of highly active antiretroviral therapies (HAART) has allowed a significant number of persons who are HIV positive to experience a major recovery in health and energy. This increase in physical health has in turn led to a re-examination of the possibility of returning to former types and levels of activity, including the prospect of going back to work or entering the competitive workforce for the first time. The purpose of this paper is to outline some of the issues and concerns that impact HIV positive individuals' attempts to return to or enter the competitive workforce, particularly those relating to disability policies and public insurance. Data from in-depth interviews with a sample of people living with HIV/AIDS (PHAs) are used to help illustrate the disconnect between these policies and the lived experiences of PHAs. Also discussed are the opportunities for Canadian policies and practices to employ a functional definition of disability and a philosophy of early intervention in vocational rehabilitation.     

Clinical services to persons with AIDS: The parallel nature of the client and worker processes

Social workers working in the area of AIDS confront individuals struggling with a plethora of issues and problems related to an AIDS diagnosis.Especially important to this work is the interplay of themes between the worker and client; a parallel process emerges that provides both insight and potential dilemmas for the social worker. While the worker may attempt to maintain a posture of disciplined subjectivity, she is confronting in the professional relationship a situation that intimately touches the core of her own identity.Through a case presentation from practice in an AIDS clinic, this paper will examine the parallel nature of the client and worker processes. Key issues will be identified and potential responses will be considered.