Vocational Rehabilitation May Help People with HIV or AIDS and Substance Use Disorder Overcome Employment Challenges

A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

About 1.1 million Americans are living with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS), according to the Centers for Disease Control and Prevention. People with HIV/AIDS may develop long-lasting health problems which may lead to disability and impact their ability to work. Some people with HIV/AIDS also have substance use disorders (SUD), which can also impact employment participation. Research has shown that finding and maintaining a job can help people with HIV/AIDS and SUD to feel good about themselves, find meaning in their lives, and even enjoy physical health benefits, in addition to earning a living wage.

Although many people with HIV/AIDS and SUD can work, negative attitudes among employers may limit their job prospects or confidence in finding work. In addition, past studies have found that ethnic minorities such as non-Hispanic African Americans or Hispanics with HIV/AIDS and SUD may face additional discrimination and other challenges to employment, such as transportation access, education or training needs, and job availability in their communities. Vocational rehabilitation (VR) services such as counseling, training, or job placement, may help individuals with HIV/AIDS and SUD to overcome challenges in the job market. In a recent NIDILRR-funded study, researchers looked at the connections between receiving VR services and finding a job for people with HIV/AIDS and SUD. Among people with HIV/AIDS and SUD who received VR services, the researchers wanted to find out who was most likely to find a job, and which VR services were most strongly associated with successfully finding a job. They also wanted to find out if the benefit of VR services was greater for some ethnic groups than for others.

Researchers at the Rehabilitation Research and Training Center on Research and Capacity Building for Minority Entities looked at data from the Rehabilitation Services Administration (RSA-911), a database of VR consumers nationwide that includes data on employment outcomes. For this study, the researchers looked at data from 4,150 VR consumers ages 17-64 with HIV/AIDS and SUD who applied for and received VR services between 2002 and 2012. These consumers identified themselves as either non-Hispanic White, non-Hispanic African American, or Hispanic. The data included demographic information, such as the consumer’s ethnicity; information about disability benefits the consumer received, such as Supplemental Security Income (SSI) or Medicare; and information about the specific VR services that the consumer received, including counseling and guidance, job readiness supports, job placement, education and training, and transportation assistance. In addition, the database included information about whether or not each consumer had secured competitive employment when they ended VR services. Consumers were considered to have competitive employment if they had maintained a job for at least 90 days which paid a wage similar to that paid to people without disabilities doing similar work.

The researchers found that, on average, about 23% of the consumers with HIV/AIDS and SUD had competitive employment when they ended VR services. When the researchers looked at who was most and least likely to become competitively employed, they found that the consumers from all three ethnic groups were equally likely to become competitively employed. However, the consumers who were receiving SSI or Medicare benefits were less likely to be competitively employed when they ended VR than the consumers who were not receiving SSI or Medicare.

The researchers also found that the consumers who received some specific VR services were more likely to become competitively employed than the consumers who did not receive these services. They found the following results:

• The consumers who received on-the-job training were more than four times as likely to become competitively employed as the consumers who did not receive on-the-job training.
• The consumers who received job placement assistance or on-the-job supports from VR were more than three times as likely to be competitively employed as the consumers who did not receive job placement assistance or on-the-job-supports.
• The consumers who received financial supports during VR or miscellaneous/non-job-related training were more than twice as likely to be competitively employed as those who did not receive these services or supports.
• Other services increased the likelihood of finding competitive employment for those who received them, but to a smaller degree. These included counseling and guidance, information referral, transportation supports, college classes, occupational training, and job search assistance.

Finally, the researchers found that the consumers from the three ethnic groups benefited equally from most of the VR services. However, counseling and guidance services benefited non-Hispanic White more than non-Hispanic African American consumers. The non-Hispanic White consumers who received counseling and guidance services were more likely to become competitively employed than the non-Hispanic African American consumers who received counseling and guidance services.

The authors noted that a variety of VR services may assist people with HIV/AIDS and SUD to find jobs in their communities. Job placement assistance and on-the-job supports may help these individuals overcome challenges related to negative attitudes among their employers and coworkers. Based on the results of this study, the authors noted that people with HIV/AIDS and SUD who receive disability benefits may be hesitant to work full-time if they are concerned about losing income and healthcare coverage. The authors recommend benefits counseling for these individuals to learn how they can achieve employment while maintaining needed benefits.

In addition, according to the results of this study, non-Hispanic African American consumers may benefit less than non-Hispanic White from counseling and guidance services. Traditional VR counseling approaches developed with non-Hispanic White Americans in mind may also be effective for Hispanic consumers, but these approaches may not be sensitive to the cultural expectations and preferences of non-Hispanic African Americans and the community factors which may impact employment. Rehabilitation professionals may want to develop more culturally competent counseling practices that address the unique needs of ethnic minorities, as well as those in low-income communities who may especially benefit from skilled employment opportunities.

To Learn More

The Rehabilitation Research and Training Center for Evidence-Based Practice in Vocational Rehabilitation has tools and publications to help VR counselors and administrators learn about and apply evidence-based programs and practices with their clients. http://www.research2vrpractice.org

The Office of Disability Employment Policy at the Department of Labor offers Employment and Living with HIV/AIDS: A Resource Guide. The guide covers legal rights and protections, resources and strategies for getting a job, and financial impacts and tax incentives for employees and employers. https://www.dol.gov/odep/topics/hivaids/EmploymentLivingwithHIVAIDS.pdf

To Learn More About this Study

Diallo, A., Vang, C., Rivas, B., Aguirre, A., Flowers, C., and Kwan, N. (2017) The use of employment/vocational rehabilitation services for persons with HIV/AIDS and substance abuse: A potential health benefit. Journal of Applied Rehabilitation Counseling, 48(4), 28-37. The full journal is available free in full text. This article is also available from the NARIC collection under Accession Number J78131.