Evaluation of Vocational Rehabilitation for HIV+ Persons

Joseph Ramirez-Forcier, Positive Resource Center San Francisco; Adam Carrico, University of California San Francisco
Social and Behavioral Sciences
Targeted Theme: Practice Informed Translational and Interventions Research
Community Collaborative Research Award

Anti-retroviral therapy (ART) has dramatically improved the health of HIV-positive persons such that individuals are living longer, more active lives. As a result, many HIV-positive persons are interested in returning to the workforce to pursue career ambitions and achieve financial security. The scientific literature provides evidence that individuals with a higher socioeconomic status (SES) are more likely to engage in healthy behaviors.

Consequently, it is possible that programs that assist HIV-positive persons with finding more stable employment (i.e., improving SES) could increase ART adherence and reduce HIV transmission risk behavior.

The purpose of this project is to evaluate an existing HIV prevention intervention, the Employment Services Program. Administered by the Positive Resource Center (PRC) in San Francisco, the Employment Services Program provides comprehensive services to help HIV-positive persons find employment. Data from the PRC indicate that the Employment Services Program is successful in helping clients find jobs and gaining access to employer-subsidized healthcare. In the proposed study, the PRC is interested in the broader implications of providing these services to HIV-positive populations. This evaluation will examine if individuals in the Employment Services Program report improvements in ART adherence and decreases in HIV transmission risk behavior. Informed by these findings, our team will examine what specific components of the employment services program may be responsible for these changes and how the overall program achieves positive outcomes. In order to conduct the evaluation, our team will recruit 200 HIV-positive persons on ART who are newly initiating services at the PRC. Participants will complete a baseline assessment as well as 6-month and 12-month follow-up assessments to examine changes in HIV-related health behaviors as well as evaluate how the program may improve these outcomes. In order to examine the role of distinct Employment Services Program components, we will utilize both quantitative and qualitative methods. Using PRC client records, the study team will examine the extent to which participants utilize distinct PRC services (i.e., road-mapping, skills building, and job search and follow-up) and how this affects HIV-related health behaivors. We also plan to conduct in-depth qualitative interviews with a randomly selected subset of 20 participants who completed a baseline assessment for the evaluation. Qualitative interviews will be systematically coded by our study team to examine the perceptions of PRC clients regarding important aspects of the Employment Services Program as well as barriers to continuing to receive services at the PRC. If the PRC Employment Services Program is effective in improving ART adherence and reducing HIV transmission risk behavior, then this approach could be disseminated widely to mitigate the effects of poverty as a barrier to prevention with HIV-positive persons.