A Practical Perspective to Understanding HIV and

Employment

By: Le-Ann DolanProgram Director

Canadian Working Group on HIV and Rehabilitation (CWGHR)

Presentation Overview

• Goal of Presentation• Introduction to CWGHR• Episodic Disability Framework• Barriers to Employment for People Living with HIV• Leading Practices in HIV and Employment

Goal of Presentation

Discuss a framework for understanding the impact of HIV on the work environment and

highlight leading practices to support patients living with HIV.

Canadian Working Group on HIV and Rehabilitation

(CWGHR)Established in 1998, CWGHR emerged as aninnovator in bridging the traditionally separateworlds of HIV, disability and rehabilitation

CWGHR is a national charitable organization aimingto address the complex and fluctuating health andsocial needs of people living with HIV and otherepisodic conditions by improving access torehabilitation care, support and services

How CWGHR works

CWGHR’s programs are based on 4 key pillars thatare essential to developing and implementingcomprehensive, effective and relevantrehabilitation policies and programs:

• Education/knowledge exchange • Policy• Practice• Research

How CWGHR works

CWGHR focuses on 4 principal areas within each of its 4 pillars of work:

1.Access to Rehabilitation2. Income Security and Employment 3. Integrated Approaches to Episodic Disabilities 4. International Linkages

HIV as an Episodic Disability

• Marked by fluctuating periods and degrees of wellness and illness

• Unpredictable• Other episodic disabilities include: some forms

of mental illness, HIV/AIDS, multiple sclerosis, diabetes, arthritis, and some forms of cancer

• Presents challenges for active labour force participation, insurance benefits, income security, and social inclusion

The Episodic Disability Framework

Exploring Episodic Disability from the Perspective of Adults Living with HIV

• Developed as part of a qualitative research study• Conducted a series of focus groups and interviews with 38 adults living with HIV• Participants were asked about health- related challenges living with HIV and how these impact on their overall health

O’Brien et al. 2008

Time (months, years living with HIV)

Social Supports

Living Strategies:Attitudes & Beliefs Living Strategies

Maintaining Control

Social Supports

Living Strategies:Blocking HIV out of the mind

Trigger:HIV Diagnosis

Living Strategies:Maintaining Control

Personal Attributes:Aging

Stigma

Le

vel o

f a

bili

tyEpisodic Disability Framework

Trigger:Opportunistic Infection

Day-to-Day

Depression

Barriers to Employment for People Living with HIV

Common Barriers to Employment

• Long work hours• Limited access to transportation• Limited paid sick leave• Attending medical appointments• Health uncertainty• Lack of access to timely care, treatment &

support• Stigma/Discrimination• New hire probationary periods• Lack of access to child care• Length of time out of workforce

Common Barriers to Employment cont.

• Medication side effects• Balancing work and other aspects of life• Demanding Physical duties (e.g. standing,

lifting)• Lack of access to flexible workplace policies• Lack of union protection / fair grievance

procedure• Lack of access to extended drug and health

benefits• Limited opportunities for advancement• Need for retraining and education

Helping Patients Understand HIV and Employment

• HIV-related illness varies over time• Possible concurrent conditions • Require long term perspective• Regular check-ins with patient• Need access to supports outside of the

workplace: emotional & community supports• Connect with an employment counselor or

occupational therapist• Workplace accommodations are available

Case Study Example

John, a long-term employee at a customerservice centre, was diagnosed HIV positive.Initially, the medications were affecting his abilityto get to work. He met with his manager toidentify that it was likely he would use allremaining sick days and still have days when hewould not be able to work.

What supports would help John to maintain his job?

When is an Accommodation Needed?

• Examples of times when a workplace accommodation may be needed:• Doctor’s appointments• Periods of personal illness• Periods of illness with a family member• Taking medications at work• Dealing with the side effects of medications

at work

Leading Practices in HIV and Employment

Helpful Hints for Nurses

• Help the patient understand that there will be periods of illness and wellness

• Determine if all needed medical supports are in place

• For patients returning to the workplace, encourage the patient to review the job requirements to determine if the core job requirements can be done over time

Helpful Hints for Nurses

• For patients currently working, encourage the patient to review the job requirements to determine which of the job requirement(s) requires an accommodation and give some thought as to what type of accommodation will be helpful

• Determine what other supports the patient has that can assist with employment issues i.e. employment counselor

• Encourage the patient to ask about the process of requesting an accommodation

• Know that disclosure of HIV status is not required in most cases but disclosure of any functional limitations related to the job is needed

Examples of Accommodation Leading Practices

• Flex time• A private space to take medications• More frequent breaks• A private space to rest• Adaptive technologies• Peer supports• Part-time with full benefits• Part-time with pro-rated benefits• Consult an occupational therapist (OT)• Visit the Job Accommodation Network website

Additional Workplace Supports

• Employee Assistance Programs (EAP)• Peer Associations• Variety of disability associations (e.g. National

Network on Mental Health (NNMH), The Arthritis Society, Canadian AIDS Society (CAS)

• Episodic Disabilities Employment Network (EDEN) website

Additional Information

Le-Ann Dolan

Program Director

Canadian Working Group on HIV and Rehabilitation

ldolan@hivandrehab.ca

416-513-0440

Thank You

For more information see www.hivandrehab.ca