Many people living with HIV are able to work, and want to work, but are not working.
HIV disproportionately affects communities and individuals with historical experience of high rates of poverty, low literacy and unemployment.
For
many, an HIV diagnosis reinforces, deepens or results in a life of poverty.
HIV
related stigma and discrimination continue to play a pervasive role in
preventing PLHIV from taking advantage of available employment opportunities.
According
to the CDC, 90% of people living with HIV (PLHIV) are working-age adults.
Nonetheless,
for almost two decades, published estimates of unemployment among PLHIV range
from 40% to 70%, accompanied by studies documenting the negative relationship
between employment status, poverty, disease progression and mental health.
Few
HIV service providers have integrated responses meeting the employment needs of
PLHIV into the continuum of care – but their numbers are increasing.
HIV-specific
outreach, education and programmatic initiatives have been rare within vocational
programs for people with disabilities or all jobseekers in general. When
sought, representatives of these systems can regularly be found who are open
and interested in engagement.
In
most of the country - including areas with large populations of PLHIV - linkage
and coordination between these service systems have not been developed to
increase low rates of employment and participation in employment services of
PLHIV. The recent White House HIV & Employment Strategy Meeting hosted by
the Office of National AIDS Policy brought together community members and
representatives of key federal agencies and programs.
Hopes
have been raised of concrete action to increase access to employment and
employment services for PLHIV.
A 2013
survey for the New York State Department of Health’s AIDS Institute studied
service needs, barriers, gaps and disparities of PLHIV in New York State. The
majority of the 177 PLHIV survey respondents (59.5%) were not employed, but
were interested in considering employment (52.5%).
In the
NWPC Vocational Development and Employment Needs Survey (NWPC-VDENS) of over
2,500 PLHIV in the U.S. (2008-2009), over 68% were not working, though 63% had
been employed at the time of their diagnosis. About 71% of those currently
unemployed reported being either able to work (41%) or not sure if they could
work (31%). Less than a quarter reported use of state vocational rehabilitation
or One Stop Career Centers (American Job Centers) and less than a third were
familiar with either of these mainstream vocational service systems available
in almost all communities.
The
population of PLHIV in the U.S. has been estimated at 1.1 million. In a 2014 review
of 33 communities, representing 60% of the U.S. epidemic, only 4 host
significant HIV-specific employment initiatives (serving more than 30
individuals within the community a year).
Despite
evidence that antiretroviral medications can keep HIV viral load levels low,
only about 25% of people living with HIV in the U.S. are estimated to reach
undetectable viral loads. This underscores the importance of reaching beyond
medical science to understand and address social and economic determinants of
health that are key drivers of the epidemic, hinder medical interventions and
contribute to poor health outcomes.
- Connections and coordination must be developed between the service sectors essential to meeting the employment needs of PLHIV, including those providing HIV, housing, vocational rehabilitation, workforce development, education, rehabilitation and reentry services.
- Community-based and federal, state and local government policymakers and service providers need to hear that lifetimes of poverty and social marginalization are not acceptable for people living with HIV, our families and our communities – and will not bring the end of the AIDS epidemic that medical care and prevention advances have raised hopes of achieving.
On Labor Day 2015,
let's look back with pride at our efforts to increase
economic empowerment of people living with HIV!
