Transcript A Practical Perspective to Understanding HIV and Employment

A Practical Perspective to
Understanding HIV and
Employment
By: Le-Ann Dolan
Program Director
Canadian Working Group on HIV and
Rehabilitation (CWGHR)
Presentation Overview
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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 an
innovator in bridging the traditionally separate
worlds of HIV, disability and rehabilitation
CWGHR is a national charitable organization aiming
to address the complex and fluctuating health and
social needs of people living with HIV and other
episodic conditions by improving access to
rehabilitation care, support and services
How CWGHR works
CWGHR’s programs are based on 4 key pillars that
are essential to developing and implementing
comprehensive, effective and relevant
rehabilitation policies and programs:
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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 Rehabilitation
2. 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 healthrelated challenges living with HIV and
how these impact on their overall health
O’Brien et al. 2008
Episodic Disability Framework
Living Strategies:
Attitudes & Beliefs
Living Strategies
Maintaining Control
Level of ability
Depression
Stigma
Social
Supports
Personal
Attributes:
Aging
Living Strategies:
Blocking HIV out of
the mind
Living Strategies:
Maintaining
Control
Trigger:
HIV
Diagnosis
Day-to-Day
Social
Supports
Trigger:
Opportunistic Infection
Time (months, years living with HIV)
Barriers to Employment for
People Living with HIV
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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
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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 customer
service centre, was diagnosed HIV positive.
Initially, the medications were affecting his ability
to get to work. He met with his manager to
identify that it was likely he would use all
remaining sick days and still have days when he
would 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
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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
[email protected]
416-513-0440
Thank You
For more information see
www.hivandrehab.ca