a practical perspective to understanding hiv and employment by: le-ann dolan program director...
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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
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