Oct. 26, 1998 The University of Illinois at Chicago department of occupational therapy has received a $729,000 grant from the Rehabilitation Services Administration of the U.S. Department of Education to expand a pilot program to help people with HIV/AIDS return to work. The Employment Options program is the first government-funded project with this goal and one of just a few programs of its kind in the country.
Effective combination drug therapies to treat HIV have made returning to work possible for many people who had left their jobs, gone on disability and waited for death. Similarly, people on public assistance who gave up trying to find work when they developed HIV/AIDS may again be able to seek employment, said Gary Kielhofner, head of the UIC department of occupational therapy and principle investigator on the project.
The National AIDS Foundation estimates that 75 percent of the more than 150,000 HIV-positive people on combination therapy are healthy enough to consider working again. Experts expect new and more effective treatments to greatly increase the number of people living with HIV/AIDS. Most of these people will be in their 20s and 30s, prime years for work productivity.
People living with HIV/AIDS who are interested in employment, however, face a dilemma. Public policy leaves them with just two options-receive full Medicaid coverage and Social Security Disability income, or work full-time and get health insurance from the employer, said Brent Braveman, director of clinical services in UIC's department of occupational therapy and project director for the grant.
The problem is that many people with this illness find full-time employment intolerable. Medical conditions, complex medication regimens, and medication side effects are among the problems that can interfere with full-time work.
"It's a catch-22. If patients try to work full-time but can't, they might just work themselves out of their health benefits. Many also fear the impact of trying to work full-time on their health," Braveman said.
Today, HIV-infected individuals wrestle with whether to risk the loss of government assistance, but soon they may find themselves with no such benefits to risk. Public policy experts expect the government to begin cutting off benefits to HIV/AIDS patients when their cases come up for review and deny benefits to people newly diagnosed with HIV/AIDS.
Because the AIDS Foundation of Chicago recognized the need for vocational assistance, it awarded in 1997 a seed grant to metropolitan Chicago's Howard Brown Health Center, the Midwest's largest lesbian, gay and bisexual health organization, to develop a pilot back-to-work program for clients with HIV/AIDS. Howard Brown contracted with UIC to develop, implement and evaluate the program, which was launched in November.
The program's 20 slots were filled in the first hour of registration, suggesting that many people with HIV/AIDS are eager to get back to work, Braveman said. Five participants successfully returned to the workforce, and Braveman conservatively estimates that helping people with AIDS return to work could save the government $22,000 a year per person.
The $729,000 federal grant will make it possible to expand the program to UIC's Family Center for Infectious Disease, which serves a more racially diverse and economically disadvantaged population than does UIC's partner in the project, Howard Brown. Forty-two percent of the UIC center's clients are women and 81 percent are minorities. Roughly 60 percent of these clients say that they most likely contracted HIV through injection drug use, whereas most of Howard Brown's clients say the contracted the virus through sexual contact.
"When drug use comes into the picture, our work becomes even more complicated," said Braveman.
The clients at UIC's Family Center for Infectious Disease reflect recent trends in the HIV epidemic in Chicago and other large urban centers. Demographic studies in Chicago show that between 1990 and 1996, the proportion of HIV/AIDS cases among women increased from 9 to 20 percent. The proportion resulting from same-sex sexual contact decreased from 64 to 43 percent, and the proportion resulting from intravenous drug use increased from 21 to 35 percent.
HIV is spreading twice as quickly among African Americans as it is among whites and Latinos. The HIV incidence rate is declining only among whites and has been doing so since 1992.
UIC's department of occupational therapy will offer the three-year expanded employment options program to 108 clients at both the UIC Medical Center's Family Center for Infectious Disease and at Howard Brown. Clients will enter the program in groups of six and attend group sessions five days a week for two months. Occupational therapists at both sites will begin by determining what each participant needs to successfully obtain employment and provide referrals and access to services including health and training.
"A client-centered, culturally-sensitive approach to providing services and the use of peers to develop a supportive community are central to the success of the program," Braveman said.
In the next phase of the program, clients will spend three months as volunteers or temporary paid workers. Participants are expected to obtain permanent employment and receive ongoing support and services in the third phase of the program, and in the fourth phase to be monitored and referred for services as needed.
Building partnerships with Chicago-area employers to develop pre-employment opportunities and jobs for participants is another essential element of the program. A vocational placement specialist will work closely with the business community to help ensure successful placement of clients.
The researchers in UIC's department of occupational therapy and at Howard Brown will systematically examine the program's strengths, weaknesses and results, and create a manual to help organizations throughout the country develop employment option programs for people with AIDS.
The department of occupational therapy is located in UIC's College of Health and Human Development Sciences.
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