Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV.

Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the "syndemic" model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69-1.47; 2 syndemic factors: 1.59, 0.89-2.84; 3 syndemic factors: 1.62, 0.44-5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care.

Is any job better than no job? Labor market experiences and depressive symptoms in people living with HIV.

The purpose of this study is to determine the relationship between the psychosocial work environment and labor market experiences (including unemployment) on mental health among adults living with HIV. We used data provided by 538 participants at clinical and community sites across Ontario, Canada. Generalized estimating equation models showed that employment was associated with lower depressive symptoms. For employed participants, adverse psychosocial work conditions, specifically job insecurity, psychological demands, and decision authority were associated with depressive symptoms. For the entire sample, the number of adverse psychosocial work conditions was associated with higher depressive symptoms while participants working in poor quality jobs reported similar levels of depressive symptoms than those who were unemployed or not in the labor force. This study showed that poor quality employment (as assessed by having a high number of adverse psychosocial work exposures) was associated with a similar level of depressive symptoms as unemployment, suggesting that "bad jobs" may not offer the same mental health benefits as "good jobs." Policies to improve employment outcomes should take the quality of employment into account to maximize mental health benefits as better employment may lead to better mental health.

Exploring the Impact of an Integrated Trauma-Informed HIV and Vocational Intervention for Black/African American Women Living with HIV.

Given the increased recognition of the role of social determinants of health on the prevalence of HIV in the United States, interventions that incorporate and address social determinants of HIV are essential. In response to the health disparities facing Black/African American women living with HIV, HIV activists and mental health specialists developed an innovative integrated HIV prevention and vocational development intervention, Common Threads, that underscores and addresses key economic and other social determinants of health experienced by Black/African American women within a trauma-informed care (TIC) framework. This research study applied grounded theory methods to conduct a qualitative study of Common Threads based on interviews with 21 women who participated in the Common Threads intervention. Participants shared several critical aspects of program components that reflected the TIC principles, endorsing a safe environment, trust building, and a sense of belonging. These components also encouraged transparency and promoted autonomy. Additionally, participants shared perceived program outcomes, including changes of knowledge and skills in four considering work domains (i.e., medical, psychosocial financial/legal resources, and vocational) that facilitate health and vocational development.

Measuring Phases of Employment Decision-Making and the Need for Vocational Services as a Social Determinant of the Health of Employed People Living with HIV.

(1) Background: Secure employment has been recognized as a social determinant of health for people living with HIV (PLHIV), but limited research has been conducted to understand the employment needs and vocational decision-making process of those who are employed. The purpose of this study is to examine the applicability of the client-focused considering-work model to assess the employment outcomes and employment decision-making phases of a sample of employed PLHIV. (2) Methods: This study analyzed data of 244 employed PLHIV who completed National Working Positive Coalition's Employment Needs Survey which included a 20-item Considering Work Scale-Employed version (CWS-Employed) and a single-item Classification of Employment Status Scale (CESS). Factor analysis was used to evaluate the CWS-Employed. Chi-square tests of homogeneity of proportions were conducted to assess the domain-specific needs of individuals in each phase of employment decision-making. (3) Results: Our findings revealed high rates of insecure employment and diverse vocational service needs among research participants. Additionally, the CWS-Employed accurately predicted 71% of the self-reported classification of phases of employment decision-making. (4) Conclusions: When investigating the role of employment as a social determinant of health, more research is needed to better understand the vocational needs and outcomes of PLHIV who are working. Improving the measurement of the phases of employment decision-making is needed to better identify appropriate vocational interventions that can lead to improved employment and related health outcomes for this population.

Counseling in Aphasia: Information and Strategies for Speech-Language Pathologists.

Purpose The purpose of this tutorial is to provide an overview of mental health concerns of persons with aphasia (PWAs), strategies that speech-language pathologists (SLPs) can use to address the mental health concerns of PWAs within their scope of practice, guidance related to how SLPs can help facilitate access to appropriate mental health services, and suggestions for the future of pre- and postcertification education regarding counseling in aphasia for SLPs. Method This tutorial begins with a case study that is used as a reference point throughout the tutorial. It then introduces the gap in mental health services for PWAs that prompted this work, walks SLPs through common mental health concerns PWAs experience, and provides guidance for SLPs related to counseling techniques they can utilize within their sessions and referral to counseling professionals. We end by reiterating the need for more mental health awareness and training for SLPs and suggestions for incorporating more training related to addressing client mental health concerns and developing effective collaborations with rehabilitation and mental health counselors, as needed. Conclusions The mental health needs of PWAs are not being met. This is partly due to a lack of training in counseling for SLPs and a lack of training in communication techniques for rehabilitation and mental health counselors. With this tutorial, we hope to bring more awareness to the current need for mental health services for PWAs and to provide SLPs with some tools for addressing these needs among their clientele.

The unmet vocational rehabilitation needs of women with HIV/AIDS.

This article discusses the growing population of women with HIV/AIDS as an emergent disability group with unique needs for vocational rehabilitation services. Data from the National Working Positive Coalition Employment Needs Survey for people living with HIV/AIDS was used to describe the demographic, economic, health, and employment characteristics of a sample of 122 female respondents. Findings make several contributions to understanding this emerging population and their vocational development needs including limited knowledge of employment resources, incentives and barriers to employment, and unmet needs for vocational rehabilitation services. Implications for vocational rehabilitation professionals and future research are discussed.

Linking hope factors, barriers to employment and health outcomes for individuals living with Human Immunodeficiency Virus (HIV).

BACKGROUND: Employment and hope have been correlated with improved health outcomes in individuals with disabilities. OBJECTIVE: The objective of this study was to investigate the relationship among barriers to employment and hope theory factors and whether those factors mediate between barriers to employment and health outcomes in individuals living with Human Immunodeficiency Virus (HIV). METHODS: The sample from this study consisted of 1,702 participants who completed the National Working Positive Vocational Development and Employment Needs Survey NWPC-VDENS and identified as unemployed. A structural equation model was used to assess relationship among functioning level, past adversity, vocational goal setting, pathway thinking, agentic thinking, mental health, general health perception, and T-Cell counts. RESULTS: Overall, the fit of the final structural equation model was good (RMSEA = 0.055, TLI = 0.924, CFI = 0.945). In this model, all the paths were significant below 0.001 of p-value except the path from agency to T-cell count, which was also significant below 0.05 of p-value. CONCLUSIONS: Goal setting showed high direct effect on agentic thinking and pathway thinking. Functioning level and past adversity impacted pathway thinking and goal setting while outcomes of hope factors to health variables were significantly positive as hypothesized.

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

The primary purpose of this study was to validate the client-focused considering work model and to gain a better understanding of the nature of the relationship among the four domains purported to influence the considering work process (medical, psychosocial, financial/legal and vocational). A second goal of the study was to quantify the relationship between these four domains and the phases of considering work (contemplation, preparation, action, resolution). Structural equation modeling was used to analyze data of 1702 diverse (43% Black, 31% White, 19% Latino 7% other) unemployed respondents who were recruited from AIDS Service Organizations (ASO) and networks across the United States to complete the National Working Positive Vocational Development and Employment Needs Survey (NWPC-VDENS). Overall the results of this study supported the validity of the client-focused considering work model and helped to provide a deeper level of understanding of the relationship among the domains of influence and their contribution to the level of commitment to the considering work process. Implications for Rehabilitation This model enables rehabilitation professionals to consider interventions for clients at different phases (contemplation, preparation, action) of considering work. Rehabilitation professionals are encouraged to provide prevocational services to engage people with HIV in the considering work process. When assisting PLWH within the considering work process, it is important to assess not only medical status but also psychosocial, financial and vocational concerns.

A Critical Review of Health, Social, and Prevention Outcomes Associated With Employment for People Living With HIV.

A growing need has emerged among HIV service providers, policymakers, and researchers to understand ways in which employment, as a key social determinant of health, can be leveraged toward improved health outcomes among people living with HIV (PLHIV) and the prevention of HIV transmission. This critical review summarizes and assesses current research related to (a) the employment needs and challenges among populations disproportionately impacted by HIV, (b) the relationship between employment and important health outcomes associated with the HIV Care Continuum, and (c) implications for policy, service provision, and future research. As a first step to deepening an understanding of these issues, this analysis identifies gaps in knowledge to underscore the need and direction for future research so that well-targeted interventions can be designed and evaluated and more responsive policies can be developed to address the public health implications of the vocational development and employment needs of PLHIV.

Workplace discrimination and HIV/AIDS: the national EEOC ADA research project.

This article utilizes data from the Equal Employment Opportunity Commission's Integrated Mission System database to document the levels of employment discrimination involving individuals with HIV/AIDS. The researchers explore the theory that the nature of HIV/AIDS related employment discrimination is rooted in deeper stigmatization than discrimination against other disability groups. Researchers compare and contrast key demographic characteristics of Charging Parties and Respondents involved in HIV/AIDS related allegations of discrimination and their proportion of EEOC merit resolutions to those of persons with other physical, sensory, and neurological impairments. Findings indicate that, in contrast to the general disability group, HIV/AIDS was more likely to be male, ethnic minorities, between the ages of 25-44, in white collar jobs, in the South and West and to work for businesses with 15 to 100 employees. Additionally, the allegations in HIV/AIDS were more likely to receive merit resolution from the EEOC by a large difference of ten percent.

A solution-focused approach to psychiatric rehabilitation.

This paper relates the values of Psychiatric Rehabilitation (PsyR) to the strategies of solution-focused therapy (SFT), exploring the applicability of SFT in a PsyR setting. A review of the literature demonstrates that SFT complements the values and principles of PsyR and is a viable course of intervention throughout recovery for empowering persons with severe mental illness. The specific application of SFT to supervision and case management is examined.

The impact of vocational services and employment on people with HIV/AIDS.

The perceptions of vocational services and the impact of employment among 25 individuals with HIV/AIDS diagnoses were explored through a qualitative study. Participants who ranged in age from 22 to 58, represented diverse ethnic backgrounds and were at various stages of the employment process. The key themes that emerged from the data fell into three main areas: (a) personal impact of vocational services, (b) programmatic qualities of vocational services, and (c) impact of employment. Factors that influenced each of these themes and the implications for rehabilitation counselors are discussed.

Using the Americans with Disabilities Act to the advantage of persons with severe and persistent mental illness: what rehabilitation counselors need to know.

This article explains central constructs and definitions underlying the Americans with Disabilities Act (ADA) and discusses their implications for persons with severe and persistent mental illness, as well as for rehabilitation counselors working with this population. Focus is placed upon Title I of the ADA, which prohibits discrimination in employment. The article provides a brief review of legislative history relevant to the integration of people with mental illness into public life. It proceeds with a discussion of definitions under Title I of the ADA. Considerations in applying the ADA to assist persons with severe and persistent mental illness in employment are addressed throughout and are discussed in detail in the final section of the article.

Examining the role of vocational rehabilitation on access to care and public health outcomes for people living with HIV/AIDS.

PURPOSE: The purpose of this study is to examine the role of vocational rehabilitation services in contributing to the goals of the National HIV/AIDS strategy. Three key research questions are addressed: (a) What is the relationship among factors associated with the use of vocational rehabilitation services for people living with HIV/AIDS? (b) Are the factors associated with use of vocational rehabilitation also associated with access to health care, supplemental employment services and reduced risk of HIV transmission? and (c) What unique role does use of vocational rehabilitation services play in access to health care and HIV prevention? METHOD: Survey research methods were used to collect data from a broad sample of volunteer respondents who represented diverse racial (37% Black, 37% White, 18% Latino, 7% other), gender (65% male, 34% female, 1% transgender) and sexual orientation (48% heterosexual, 44% gay, 8% bisexual) backgrounds. RESULTS: The fit of the final structural equation model was good (root mean square error of approximation = 0.055), with 90% upper bound of 0.058, Comparative Fit Index = 0.953, TLI = 0.945). Standardized effects with bootstrap confidence intervals are reported. CONCLUSIONS: Overall, the findings support the hypothesis that vocational rehabilitation services can play an important role in health and prevention strategies outlined in the National HIV/AIDS strategy.

A narrative literature review regarding job retention strategies for people with chronic illnesses.

Job retention is a major concern for individuals with chronic illnesses, who represent a rapidly growing vocational rehabilitation (VR) consumer population. The purpose of this article is to examine selected job retention considerations for consumers with chronic illnesses. The authors (a) describe distinguishing characteristics of chronic illnesses in terms of populations affected and psychosocial implications, (b) discuss the vocational implications of chronic illnesses, (c) provide general considerations for the provision of job retention services, and (d) examine job retention strategies aimed at improving employment outcomes for individuals with chronic illnesses.