Achieving Better Health Outcomes through Employment and Income Security

Understanding the Impact of Employment on Mental and Physical Health

Kenneth Hergenrather, a member of the National Working Positive Coalition and professor at George Washington University, delivered a presentation on employment as a social determinant of health. Hergenrather noted that the World Health Organization defines health as wellbeing, rather than the absence of disease or infirmity, and that the highest rates of HIV infection occur in areas where people live below the federal poverty level, have annual incomes of less than $36,000, have less than high school education or are unemployed.

Results of a meta-analysis on longitudinal research into the relationship between employment status and health reveal that mental and physical health both suffer in the face of unemployment. The analysis involved a scan of 4,500 papers, of which 48 articles on mental health and 22 articles on physical health met study criteria. Results revealed that:

  • 22% of participants in these studies had clinical depression – twice as many as in the general population
  • 25% had trauma or post-traumatic stress disorder (rates were higher among women)
  • Those who were unemployed had lower levels of social support, and showed symptoms of psychological distress and depression after three months to a year
  • Those who had been in non-permanent employment for two to twelve years displayed anger, nervous symptoms and psychological distress.

Hergenrather explained that depression correlates with worse immune functioning and a slower response to infection, as well as increased suicide risk. People living with HIV are up to seven times more likely to commit suicide compared to people who have not been diagnosed with HIV.

Overall, employment was associated with:

  • better mental health
  • less distress, anxiety and depression
  • better quality of life.

Job loss was associated with:

  • poorer mental health
  • more distress and depression
  • poorer mood.

People who were re-employed after a period of unemployment scored higher on measures of mental health and lower on measures of distress, depression and anxiety.

In terms of physical health people who were employed:

  • experienced better physical health, as measured by pain, fatigue and difficulty completing the daily activities of living
  • had more physical activity
  • experienced fewer limitations.

People who were unemployed experienced more hospitalization, higher mortality rates and more general medical complaints. The results were similar for participants who had experienced recent job loss.

Hergenrather explained that, in the United States, people living with HIV are eligible for state rehabilitation services under the 1973 Rehabilitation Act and the Americans with Disabilities Act. Of those who received vocational services between 2002-2007, 45% of people living with HIV reported successful employment.

Further Information

National Working Positive Coalition


(Un)Employment: Impact and Interventions

Employment and economic well-being of people living with HIV in the New York Eligible Metropolitan Area

Maiko Yomogida, Mailman School of Public Health, Columbia University

The success of antiretroviral therapies has shifted the focus of HIV care from mere survival to quality of life. Data are from the CHAIN study, an on-going prospective cohort study of people living with HIV in NYC and three northern counties (Tri-County; TC) were used to examine an important dimension of quality of life for people living with HIV: economic wellbeing and labor force participation. The CHAIN study sample was designed to be representative of people living with HIV receiving medical and/or social services in the NY Eligible Metropolitan Area. Trends in employment and economic well-being were analyzed by pooling all 5,911 interviews completed with 1,869 CHAIN cohort members between 2001 and 2013. The analyses of factors associated with employment were restricted to data obtained from the interviews, completed between 2008 and 2013. Results showed that despite the widespread use of antiretroviral therapy and reduced mortality rates, CHAIN participants’ labor force participation remained consistent over the 12-year period of this study and the reason most frequently noted for unemployment was poor health.


Foundations for living: An integrated HIV housing and employment intervention for people living with HIV

Liza Conyers, Penn State College of Education and National Working Positive Coalition

The Foundations for Living integrated HIV/AIDS housing and employment services program model provides housing assistance to people living with HIV who are interested in working or volunteering full or part-time or advancing their education. The FFL model was funded by a Special Project of National Significance grant through HOPWA to CARES, Inc. who coordinated services in two distinct regions of upstate New York: Rochester (relatively rural) and Albany (major city). Fundamental to the implementation of the FFL model is recognition of both individualized and systems level interventions. While participants in FFL worked with a service coordinator to develop individualized service plans, resource identification staff worked with key stakeholders in both Rochester and Albany to identify and reduce systemic barriers to integrated housing and employment services. Housing, health and HIV prevention outcomes were reported for a cohort of individuals who completed FFL in Albany and Monroe counties from January 2012 to December 2014.


Minimal to comprehensive: Strategies to increase employment opportunities and economic security of people living with or at greater risk for HIV

Mark Misrok, Board President, National Working Positive Coalition

The National Working Positive Coalition is connected to and has been involved with implementation of a range of employment service models implemented and evaluated by HIV care and prevention programs in North America. This presentation describes how HIV care and prevention, housing and other supportive services can link and coordinate with a range of federal, state and local education and employment programs and resources to increase effective participation by people living with or at risk for HIV. Organizations and communities need to first assess their readiness and capacity, then review, select and implement strategies to adapt or revise their service delivery to better meet employment information and service needs of people living with or at greater risk of HIV. Goals for ending the epidemic and a post-HIV landscape need to prioritize addressing the economic and vocational vulnerability of survivors and communities disproportionately affected. Efforts to maximize available resources to increase employment opportunities need to be implemented now for sustained positive health and prevention outcomes in the years ahead.


I’ve fallen and I can’t get back up

Vernita Perry, Community Health Worker, Positive Pathways with Sabrina Heard and Ronette Moton

The Community Health Worker (CHW) serves many roles including helping to bridge the gap between clients and doctors, and working with community members who are HIV-positive and using drugs. CHWs reach out to members and meet them “where they are at.” Some of our members have no support system and no one to help them. CHWs listen, offer support and show members that we care. By understanding the significance of the CHW role, people can learn from CHW experiences and gain new tools for working with HIV-positive populations.


From engagement to empowerment: Addressing the social drivers of HIV through peer employment in community-based research

James Watson, Coordinator, Community-Based Research and Peer Training, Ontario HIV Treatment Network and Lynne Cioppa, Bruce House, Ottawa, Ontario

The episodic nature of HIV has isolated many people with HIV/AIDS (PHAs) from regular workforce participation, often resulting in their underemployment or reliance on government assistance. Research employment as peer engagement is an empowerment strategy that can benefit the health, well‐being and quality of life of PHAs. Through its employment of PHAs as Peer Research Associates (PRAs), the Ontario HIV Treatment Network pioneered a community‐based research (CBR) model that put peer engagement into action. CBR is a field where lived experience and a desire to build capacity are highly regarded. As part of its research efforts, the OHTN successfully implemented a series of mixed‐method CBR studies that collected extensive data on the social determinants of health of PHAs. PRA experiences from three OHTN CBR studies (the Positive Space Healthy Places housing study, the Employment Change and Health Outcomes study, and the Impact of Food Security on Health Outcomes in People Living with HIV/AIDS Across Canada study) highlight the peer researcher role as an effective peer engagement empowerment intervention.


Common Threads: An integrated HIV prevention and vocational development intervention based upon the principles of trauma-informed care

Margot Kirkland-Isaac, CBA Program Manager, DC CARE Consortium

This presentation is designed to increase awareness and skills related to the need to implement trauma-informed vocational and HIV prevention interventions for African American women with HIV. The slides: (a) review the development of the Common Threads intervention, including a review of principles of trauma-informed care; (b) discuss the relationship between vocational development / employment and outcomes associated with the HIV Continuum of Care; (c) demonstrate the integration of a trauma-informed care activity as a key component of the Common Threads intervention; and (d) share initial research findings that demonstrate some of the outcomes of this approach in facilitating vocational development and improving health and prevention outcomes. Common Threads uses interactive activities, such as a personal timeline to explore the impact of life experience. These activities help participants develop strategies to infuse trauma-informed care into vocational and HIV prevention services to better engage African American women in HIV care and prevention.