Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV.

Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the "syndemic" model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69-1.47; 2 syndemic factors: 1.59, 0.89-2.84; 3 syndemic factors: 1.62, 0.44-5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care.

Measuring Phases of Employment Decision-Making and the Need for Vocational Services as a Social Determinant of the Health of Employed People Living with HIV.

(1) Background: Secure employment has been recognized as a social determinant of health for people living with HIV (PLHIV), but limited research has been conducted to understand the employment needs and vocational decision-making process of those who are employed. The purpose of this study is to examine the applicability of the client-focused considering-work model to assess the employment outcomes and employment decision-making phases of a sample of employed PLHIV. (2) Methods: This study analyzed data of 244 employed PLHIV who completed National Working Positive Coalition's Employment Needs Survey which included a 20-item Considering Work Scale-Employed version (CWS-Employed) and a single-item Classification of Employment Status Scale (CESS). Factor analysis was used to evaluate the CWS-Employed. Chi-square tests of homogeneity of proportions were conducted to assess the domain-specific needs of individuals in each phase of employment decision-making. (3) Results: Our findings revealed high rates of insecure employment and diverse vocational service needs among research participants. Additionally, the CWS-Employed accurately predicted 71% of the self-reported classification of phases of employment decision-making. (4) Conclusions: When investigating the role of employment as a social determinant of health, more research is needed to better understand the vocational needs and outcomes of PLHIV who are working. Improving the measurement of the phases of employment decision-making is needed to better identify appropriate vocational interventions that can lead to improved employment and related health outcomes for this population.

Counseling in Aphasia: Information and Strategies for Speech-Language Pathologists.

Purpose The purpose of this tutorial is to provide an overview of mental health concerns of persons with aphasia (PWAs), strategies that speech-language pathologists (SLPs) can use to address the mental health concerns of PWAs within their scope of practice, guidance related to how SLPs can help facilitate access to appropriate mental health services, and suggestions for the future of pre- and postcertification education regarding counseling in aphasia for SLPs. Method This tutorial begins with a case study that is used as a reference point throughout the tutorial. It then introduces the gap in mental health services for PWAs that prompted this work, walks SLPs through common mental health concerns PWAs experience, and provides guidance for SLPs related to counseling techniques they can utilize within their sessions and referral to counseling professionals. We end by reiterating the need for more mental health awareness and training for SLPs and suggestions for incorporating more training related to addressing client mental health concerns and developing effective collaborations with rehabilitation and mental health counselors, as needed. Conclusions The mental health needs of PWAs are not being met. This is partly due to a lack of training in counseling for SLPs and a lack of training in communication techniques for rehabilitation and mental health counselors. With this tutorial, we hope to bring more awareness to the current need for mental health services for PWAs and to provide SLPs with some tools for addressing these needs among their clientele.

Linking hope factors, barriers to employment and health outcomes for individuals living with Human Immunodeficiency Virus (HIV).

BACKGROUND: Employment and hope have been correlated with improved health outcomes in individuals with disabilities. OBJECTIVE: The objective of this study was to investigate the relationship among barriers to employment and hope theory factors and whether those factors mediate between barriers to employment and health outcomes in individuals living with Human Immunodeficiency Virus (HIV). METHODS: The sample from this study consisted of 1,702 participants who completed the National Working Positive Vocational Development and Employment Needs Survey NWPC-VDENS and identified as unemployed. A structural equation model was used to assess relationship among functioning level, past adversity, vocational goal setting, pathway thinking, agentic thinking, mental health, general health perception, and T-Cell counts. RESULTS: Overall, the fit of the final structural equation model was good (RMSEA = 0.055, TLI = 0.924, CFI = 0.945). In this model, all the paths were significant below 0.001 of p-value except the path from agency to T-cell count, which was also significant below 0.05 of p-value. CONCLUSIONS: Goal setting showed high direct effect on agentic thinking and pathway thinking. Functioning level and past adversity impacted pathway thinking and goal setting while outcomes of hope factors to health variables were significantly positive as hypothesized.

A Critical Review of Health, Social, and Prevention Outcomes Associated With Employment for People Living With HIV.

A growing need has emerged among HIV service providers, policymakers, and researchers to understand ways in which employment, as a key social determinant of health, can be leveraged toward improved health outcomes among people living with HIV (PLHIV) and the prevention of HIV transmission. This critical review summarizes and assesses current research related to (a) the employment needs and challenges among populations disproportionately impacted by HIV, (b) the relationship between employment and important health outcomes associated with the HIV Care Continuum, and (c) implications for policy, service provision, and future research. As a first step to deepening an understanding of these issues, this analysis identifies gaps in knowledge to underscore the need and direction for future research so that well-targeted interventions can be designed and evaluated and more responsive policies can be developed to address the public health implications of the vocational development and employment needs of PLHIV.

Validating the client-focused considering work model for people living with HIV and quantifying phases of change of commitment to work.

The primary purpose of this study was to validate the client-focused considering work model and to gain a better understanding of the nature of the relationship among the four domains purported to influence the considering work process (medical, psychosocial, financial/legal and vocational). A second goal of the study was to quantify the relationship between these four domains and the phases of considering work (contemplation, preparation, action, resolution). Structural equation modeling was used to analyze data of 1702 diverse (43% Black, 31% White, 19% Latino 7% other) unemployed respondents who were recruited from AIDS Service Organizations (ASO) and networks across the United States to complete the National Working Positive Vocational Development and Employment Needs Survey (NWPC-VDENS). Overall the results of this study supported the validity of the client-focused considering work model and helped to provide a deeper level of understanding of the relationship among the domains of influence and their contribution to the level of commitment to the considering work process. Implications for Rehabilitation This model enables rehabilitation professionals to consider interventions for clients at different phases (contemplation, preparation, action) of considering work. Rehabilitation professionals are encouraged to provide prevocational services to engage people with HIV in the considering work process. When assisting PLWH within the considering work process, it is important to assess not only medical status but also psychosocial, financial and vocational concerns.

The impact of vocational services and employment on people with HIV/AIDS.

The perceptions of vocational services and the impact of employment among 25 individuals with HIV/AIDS diagnoses were explored through a qualitative study. Participants who ranged in age from 22 to 58, represented diverse ethnic backgrounds and were at various stages of the employment process. The key themes that emerged from the data fell into three main areas: (a) personal impact of vocational services, (b) programmatic qualities of vocational services, and (c) impact of employment. Factors that influenced each of these themes and the implications for rehabilitation counselors are discussed.

Using the Americans with Disabilities Act to the advantage of persons with severe and persistent mental illness: what rehabilitation counselors need to know.

This article explains central constructs and definitions underlying the Americans with Disabilities Act (ADA) and discusses their implications for persons with severe and persistent mental illness, as well as for rehabilitation counselors working with this population. Focus is placed upon Title I of the ADA, which prohibits discrimination in employment. The article provides a brief review of legislative history relevant to the integration of people with mental illness into public life. It proceeds with a discussion of definitions under Title I of the ADA. Considerations in applying the ADA to assist persons with severe and persistent mental illness in employment are addressed throughout and are discussed in detail in the final section of the article.