HIV Status Disclosure in the Workplace: Positive and Stigmatizing Experiences of Health Care Workers Living with HIV.

We explored workplace experiences of 10 health care providers with HIV in the Netherlands. We used semi-structured interviews to discuss motivations for disclosure and concealment, reactions to disclosures, the impact of reactions, and coping with negative reactions. Reasons for disclosure were wanting to share the secret, expecting positive responses, observing positive reactions to others, wanting to prevent negative reactions, and being advised to disclose. Reasons for concealment included fearing negative reactions, observing negative reactions, previous negative experiences, having been advised to conceal, and considering disclosure unnecessary. Positive reactions included seeing HIV as a nonissue; showing interest, support, and empathy; and maintaining confidentiality. Negative reactions included management wanting to inform employees, work restrictions, hiring difficulties, gossip, and hurtful comments, resulting in participants being upset, taken aback, angry, depressed, or feeling resignation. Participants coped by providing information, standing above the experience, attributing reactions to ignorance, seeking social support, or leaving their jobs.

Disclosure of HIV Status to Health Care Providers in the Netherlands: A Qualitative Study.

We qualitatively investigated perspectives on HIV disclosure to health care providers (HCP) by people living with HIV (PLWH). Perspectives varied across PLWH and between PLWH and HCP. Some PLWH felt they should always disclose so that HCP could take necessary precautions or because disclosure optimized care. Others felt that disclosure was not an obligation but a courtesy. Still others felt that disclosure was unnecessary as all HCP should apply universal precautions or because HIV status was not relevant to care. Most HCP claimed they should be informed about patients' HIV status as this would reduce occupational risk of infection and improve care. HCP also felt that disclosure concerns by PLWH were unnecessary given the HCP' duty of professional confidentiality. Some acknowledged that disclosure was not always necessary but still indicated wanting to be informed. Perspectives on HIV disclosure in health care settings differed substantially between PLWH and HCP.

Prevalence and determinants of insufficient work ability in older HIV-positive and HIV-negative workers.

PURPOSE: To explore whether the prevalence and determinants of insufficient work ability (WA) of older HIV-positive workers differ from a comparable group of HIV-negative workers. METHODS: Cross-sectional data from 359 HIV-negative and 264 HIV-positive middle-aged individuals (45-65 years) participating in paid labor, collected within the AGEhIV Cohort Study between October 2010-September 2012, were selected. Data were collected by self-administered questionnaires and physical examination. Participants self-rated their current WA, ranging from 0 to 10. WA was dichotomized into insufficient (<6) and sufficient (≥6). Using univariable and multivariable logistic regression, we studied the independent effect of HIV status on insufficient WA and determinants of insufficient WA. RESULTS: Overall, 8% of participants reported insufficient WA (HIV-positive 9 vs. HIV-negative 7%, P = 0.20). Twice as many HIV-positive as HIV-negative individuals were declared partly unfit for work (6 vs. 3%, P = 0.02). HIV status itself was not associated with WA in univariable and multivariable analyses. Multivariable analyses revealed that low educational level, working fewer hours, being partly unfit for work, experiencing a high need for recovery after work, staying home from work ≥2 times in the past 6 months, and reporting depressive symptoms were associated with insufficient WA, independent of HIV status. CONCLUSIONS: HIV-positive individuals aged 45-65 years participating in paid labor seem to function as well at work as HIV-negative individuals. HIV-positive participants were more often formally declared partly unfit for work, but percentages were low in both groups. Knowledge of determinants of insufficient WA may help employers and professionals to optimize WA.

Patient and provider perspectives on HIV and HIV-related stigma in Dutch health care settings.

Ensuring that people living with HIV (PLWH) feel accepted in health care settings is imperative. This mixed methods study explored the perspectives of PLWH and health professionals on their interactions. A total of 262 predominantly gay men of Dutch origin participated in a survey study of possible negative interactions with health professionals, and semi-structured interviews were subsequently conducted with 22 PLWH and 14 health professionals. Again, most PLWH were gay men of Dutch origin. All health professionals were Dutch. PLWH reported negative experiences with health professionals including awkward interactions, irrelevant questions, rude treatment, blame, pity, excessive or differential precautions, care refusal, unnecessary referrals, delayed treatment, poor support, and confidentiality breaches. They also reported positive experiences including equal treatment, being valued as a partner in one's health, social support provision, and confidentiality assurances. Health professionals reported having little experience with PLWH and only basic knowledge of HIV. They contended that PLWH are treated equally and that HIV is no longer stigmatized, but also reported fear of occupational infection, resulting in differential precautions. Additionally, they conveyed labeling PLWH's files to warn others, and curiosity regarding how patients acquired HIV. The findings suggest that there is a gap in perception between PLWH and health professionals regarding the extent to which negative interactions occur, and that these interactions should be improved. Implications for stigma reduction and care optimization are discussed.

Psychological and social correlates of HIV status disclosure: the significance of stigma visibility.

HIV-related stigma, psychological distress, self-esteem, and social support were investigated in a sample comprising people who have concealed their HIV status to all but a selected few (limited disclosers), people who could conceal but chose to be open (full disclosers), and people who had visible symptoms that made concealing difficult (visibly stigmatized). The visibly stigmatized and full disclosers reported significantly more stigma experiences than limited disclosers, but only the visibly stigmatized reported more psychological distress, lower self-esteem, and less social support than limited disclosers. This suggests that having a visible stigma is more detrimental than having a concealable stigma. Differences in psychological distress and self-esteem between the visibly stigmatized and full disclosers were mediated by social support while differences between the visibly stigmatized and limited disclosers were mediated by both social support and stigma. These findings suggest that social support buffers psychological distress in people with HIV.

New ILO standard on HIV rejects discrimination against HIV-positive workers.

2010 saw a significant development in advocating for enhanced rights protection of HIV-positive workers: the adoption of an International Labour Organisation (ILO) recommendation on HIV/AIDS in the employment sphere. In this article, based on a presentation made at AIDS 2010, Ronald Brands outlines the key components of the document and how it seeks to protect employees and job-seekers from discrimination on the grounds of real or perceived HIV status.