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.     

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.     

Maximizing potential: innovative collaborative strategies between one-stops and mental health systems of care

Barriers to seamless service delivery between workforce development and mental health systems of care have kept both entities from maximizing their potential in regards to employment for job seekers with mental illness who are capable of work and seeking employment. Using a multiple case study design, this study examined the nature of collaboration between workforce development and mental health systems to understand the policies and practices in place to assist individuals with mental illness to find and keep work. The paper presents innovative strategies that involved staff from both workforce development and mental health agencies. Findings from this research identified the following collaborative strategies: (a) the creation of liaison positions and collaborative teams; (b) staff training on mental health and workforce issues; and (c) multi-level involvement of individuals with mental illness. Implications for workforce professionals are offered as a way to stimulate implementation of such strategies.     

Public health,research and rights: the perspectives of deliberation panels with politically and socially active disabled people

Public health research purports to provide the evidence base for policies, programmes and interventions to improve the health of a population. However, there is increasing awareness that the experiences of disabled people have played little part in informing this evidence base. This paper discusses one aspect of a study commissioned by England’s National Institute for Health Research (NIHR) to review the implications for public health of theories and models of disability. This part of the study focused on the development of a tool or decision aid to promote ethical inclusion of disabled people in public health randomised controlled trials (RCTs) and evaluative research. The tool was introduced at four regional ‘deliberating panels’ involving politically and socially active disabled people. In addition, we held a panel with public health professionals. The deliberation panels debated how the focus of public health was narrowing, why disability was excluded and positive and negative issues with using rights to guide research and evaluative practice. Politically active disabled people argued for a social model of human rights to guide any rights based tools or decision aids in public health and disability research.     

Trends in Sexuality Education in United States and Canadian Medical Schools

Summary

There has been a concern that earlier gains in the teaching of human sexuality in medical schools may have eroded in recent years. An extensive survey of 109 U.S. and 13 Canadian medical schools revealed that a dramatic decrease in the number of curriculum hours devoted to human sexuality has not occurred. In fact, 28% of U.S. and 36% of Canadian schools have actually increased hours, and ninety-two percent of all medical schools responding currently offer core curriculum material in sexuality, averaging approximately 11 hours in U.S. and 18 hours in Canadian schools. Unfortunately, nearly a third of schools in both countries do not specifically address important health issues, such as sex and illness or disability, and some schools even neglect training in the taking of a sexual history. Data on these issues is important for making future decisions regarding the contents of the increasingly overburdened medical curriculum.     

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.     

Work‐life policies and programs: Comparing the responsiveness of nonprofit and for‐profit organizations

Analysis of the data from the 1998 Business Work‐Life Study, one of the first comprehensive studies of how U.S. organizations are responding to the work‐life needs of the nation's changing workforce, indicates that nonprofits with one hundred or more employees are more likely than for‐profits to offer particular types of work‐life policies and programs (such as extended leaves following birth or adoption) and to pay for at least some of the costs of health insurance for part‐time employees. In contrast, nonprofits are less likely to offer other work‐life supports (such as paid maternity leave). Despite the resource constraints that can restrict the compensation and benefits packages offered by some nonprofits, the overall scope of the work‐life initiatives established by nonprofits is similar to those initiatives at for‐profit organizations. Regression analyses find that although organizations' profit status does not explain variance in the scope of their work‐life initiatives, three of the variables measured by this study (indicators of workplace commitment to diversity and work‐life issues, percentage of women in executive positions, and the size of the workforce) do.     

Transition from school for youths with a disability: issues and challenges

Australian research has demonstrated that students with a disability are more likely to remain out of the full‐time workforce. These research findings have been the catalyst for a call for a comprehensive career development and transition planning approach for all students with disabilities in schools as well as for employers to rethink the role of people with disabilities in the workforce. In the Australian context the transition from school for individuals with a disability is complicated by a disparate and fragmented group of service agencies providing a range of services, including employment, supported accommodation, recreation and leisure pursuits, as well as training and placement, along with, at times, a deep‐seated prejudice towards people with disabilities in the market place. This paper reviews a number of issues and challenges confronting individuals with a disability making the transition from school to the post‐school environment.     

Community reaction to persons with HIV/AIDS and their parents: an analysis of recent evidence from Thailand

We systematically examine community reaction to persons living with HIV/AIDS (PHAs) and their older parents in Thailand. We focus on parents as well as PHAs because parents are major providers of care for their ill adult children. Our analyses are based on several sources of recently collected survey and qualitative data from a wide range of perspectives. We find important variations in community reaction to PHAs and their families, but overall these reactions are much more positive than is widely assumed. We conclude that much existing research on community reaction to AIDS neglects both a rich body of social theory on stigma and a strong tradition of population-based empirical research in sociology. Much existing research also fails to adequately distinguish between key aspects of the social settings where most AIDS cases occur and the social settings where most of the stereotypes surrounding AIDS-related stigma have originated. A closer marriage between empirical and theoretical approaches to social stigma is required to advance our understanding of this critically important dimension of the AIDS epidemic.     

The invisibility of adolescent sexual development in foster care: Seriously addressing sexually transmitted infections and access to services

Adolescents residing in foster care are at higher risk for acquiring sexually transmitted infections (STIs) and human immune deficiency virus (HIV) compared to their non-foster care peers. A literature review was conducted to determine whether youth residing in foster care face different barriers to sexual health care compared to their peers in the general population and, if so, what those barriers are. The review revealed barriers common to adolescents in general as well as additional barriers specific to the ecosystem of adolescents in foster care. Systemic issues that decreased access to sexual health services included child welfare policies that were either missing or implemented without fidelity; complicated financial factors; barriers to service utilization; lack of collaboration between child welfare and medical professionals; and limited information provided to foster youth on their sexual health and development. Consent and confidentiality issues that foster youth face in seeking sensitive health services also need to be resolved. More research is needed on how to facilitate development of coherent policies and effective practices that promote sexual health care access for adolescents in foster care.     

Editorial

Abstract

This comprehensive research study examined how schools of social work in Canada have responded to disability issues. The study focused upon specific policies and practices ofthe Canadian schools of social work which have been developed to create a more inclusive environment for students, staff, and faculty members with disabilities and to prepare students for practice in dealing with individuals who are disabled. A ten page survey consisting of closed and opened-ended questions was sent to the deans and directors of the thirty-five schools of social work in Canada. This study found that although there have been significant changes in these schools over the last ten years, there are many barriers to disability inclusion from recruitment and admissions; accommodations; retention, graduation, and employment; curriculum; hiring faculty and staff with disabilities; and university relations/resources. It concludes with recommendations for schools of social work.     

Difficulties in Shifting from Individualistic to Socio-political Policy Regarding Disability in Canada

An individualistic conception of disability has been replaced by a socio-political definition. The socio-political model implies that disability stems from the failure of the social environment to adjust to the needs of people with disabilities rather than from the inability of disabled individuals to adapt to societal demands. This paper will examine the extent to which Canadian policies have changed to embrace this new definition. There has been some progress in policies related to shelter, transportation and recreation. However, policies related to income and employment are still individualistic in nature because policy change in these areas requires a major shift in governmental approach to unemployment and fundamental reform of the Social Assistance system. In a period of high unemployment, people with disabilities are viewed as surplus labour, and the Canadian government has found that high unemployment is politically tolerable. Obstacles to an increase in income support include a strong work ethic, the philosophy that social assistance benefits should be less than could be earned in the work-force, and the private insurance and litigation industries which benefit from the current income system. Other barriers to change are the lack of power of disabled groups and the dominance of professionals.     

Training Mental Health Professionals on Ethical Issues and HIV/AIDS

This report describes the importance of ethics training for mental health professionals working with persons infected or affected by HIV/AIDS. We first describe three major ethical dilemmas (confidentiality, duty to warn, and suicide) faced by mental health providers serving persons with HIV/AIDS, and the legal and clinical aspects of these dilemmas. We present data from the South Texas AIDS Training Project describing the types of mental health professionals who have attended workshops on ethical issues and HIV/AIDS. Finally, we report observations about the impact of the ethics training sessions on the participants' knowledge and attitudes.     

Pick-Your-Own Labor: Migrant Workers and Flexibility in Canadian Agriculture1

This paper explores the structures and practices of temporary migrant worker programs (TMWP) as they operate in Canadian agriculture. Acting within highly competitive, globalized markets, agri-food employers rely on the availability of migrant workers to achieve greater flexibility in their labor arrangements, drawing on employment practices beyond those possible with a domestic workforce. Most recently, changes to Canada’s two TMWP schemes have provided employers with greater scope to shape the social composition of their workforce. The paper analyzes these changes while exploring their implications for workplace regimes in agriculture.     

The Articulation of Theory and Practice: critique and resistance in Aotearoa New Zealand

In his latest book, Understanding Disability: from theory to practice (1996), Michael Oliver (p. 111) notes the 'globalisation' of disability related issues and the absence of any satisfactory comparative studies in disability policy across the globe. This paper can be seen as laying the ground work for such a study by reviewing the theorisation of disability and its practical consequence in the articulation, development and implementation of disability policy in Aotearoa New Zealand. It will describe some current examples of policies for disabled people and provides an analysis of current debates. The paper explores the emancipatory potential of current disability theorising by analysing strategies adopted by disabled people as a response to recent policy developments in the health and disability field in Aotearoa New Zealand.     

Women and HIV:

Women constitute one of the fastest growing groups of people infected with HIV. Women have always been affected by HIV as informal or formal caregivers. Despite this, HIV services and education have been directed almost exclusively towards men. Given that women comprise half of the workforce, the change in the face of the epidemic requires a reexamination of the EAP professional's approach to AIDS education and services. This article delineates HTV-related issues specific to women and their impact on the functions of the EAP. Suggestions are made for targeting AIDS workplace education and prevention to women. The implications of women's issues on early identification, counseling, and referral by EAP professionals are also explored. Consideration is given to the cultural and socioeconomic diversity of women affected by HIV.     

How Far to Gay? The Politics of HIV in Learning Disability

This paper examines work in sexual health and HIV prevention in services for people with learning disabilities from a political stance associated with the rehomosexualisation of AIDS in Britain. Arguments are made for the re-homosexualisation of AIDS in services for people with learning disabilities, based on evidence of where HIV risk lies in relation to men with learning disabilities who have sex with men. This provides an opportunity to critically review approaches and responses to HIV risk assessment and risk management in services for people with learning disabilities, with reference to the assumptions which underpin practice and issues of sexual identity. The case is made for a more radical sexual politics in learning disability to help combat HIV and to provide more realistic approaches to service commissioning and safer sex education. Pointers for service development and key areas where the re-homosexualisation of AIDS can inform practice and resource development are also provided.     

Returning to work with HIV/AIDS: a qualitative study

In addition to being an outcome, workforce reentry is a process: People with HIV/AIDS attempting to go back to work must make initial decisions to engage in such an attempt, they then must go through a series of steps that may include re-education or retraining, job searches, résumé development, and other activities. Sustaining employment, in turn, entails its own set of activities. People attempting workforce reentry may also experience barriers on their journeys back to work, they may employ certain strengths to reach their goals, and they may use resources to facilitate preparation for work. Few studies have attempted to study this process. This study was designed to provide an initial attempt to study the process of workforce reentry. Abstracted information from the progress notes of 104 people with HIV/AIDS attempting workforce reentry was qualitatively analyzed using a grounded theory approach to identify themes. Three major themes emerged with reliability: Barriers to workforce reentry, staff-identified strengths, and resources used in workforce-reentry efforts. Although none predicted successful workforce reentry, participants in the study experienced substantial barriers in their workforce-reentry efforts, staff identified significant strengths, and participants used appropriate resources in their efforts to go back to work. Implications for workforce-reentry programs for people with HIV/AIDS are discussed.     

Aging with HIV: Historical and Intra-Community Differences in Experience of Aging with HIV

Gay men living with HIV/AIDS face a complex of health issues, including those associated with the aging process, long-term HIV infection (25 years or more), and side effects from Highly Active Anti-Retroviral Therapy (HAART). If aging can increase marginalization, this is more likely for the aging HIV positive gay man, who is already marginalized for being queer and living with a stigmatizing disease. This article presents findings from a study of a long-running HIV support group. It locates the members, all gay men living with HIV, in a specific historical and political context to explore how feelings of loss and the struggle to sustain community affect long-term survivors and other older HIV+ gay men. We identify specific challenges presented by aging for men who contracted HIV early in the epidemic, contrasting them with those faced by men infected with the virus later in life. While both groups appear to struggle with a vision of what life could have been, had AIDS not forced loss and change, they also celebrate the community their shared plight has enabled.     

Validation of a French Canadian version of the Organizational Policies and Practices (OPP) questionnaire

Organizational factors are potentially powerful in accounting for work-related chronic disability following a musculoskeletal disorder. This study documents the psychometric qualities of the French Canadian version of the Organizational Policies and Practices questionnaire (OPP) [1] on a population of nurses (N=124). By excluding the two items composing the ergonomic practices factor, a factorial structure identical to that obtained by the OPP's authors is obtained for the disability management policies and practices factor, the people-oriented culture factor and the safety climate factor. The internal consistency coefficients (Cronbach's alpha) are satisfactory while the coefficients intraclass are less than those obtained by the authors in the test-retest. However, the test-retest interval is greater in this study. Consistent relationships are observed between the dimensions of the OPP and three job-related psychosocial indicators: perceived stress, social support and satisfaction. This suggests a good construct validity for the OPP. Although additional validation efforts are recommended, all of the results obtained support the validity and reliability of the French Canadian version of the OPP. This version can be used to examine the importance of organizational aspects in studies on the prevention of chronic disability.