HIV/AIDS AND THE VOCATIONAL REHABILITATION PROCESS:
IMPLICATIONS FOR SERVICE DELIVERY
MODULE DESCRIPTION
This training module has been developed for vocational rehabilitation counselors
and related personnel to provide knowledge and skills-building experience necessary
to provide effective rehabilitation services to consumers with HIV/AIDS. This module
is intended to provide the vocational rehabilitation counselor and related personnel
with assistance in organizing an approach to the vocational rehabilitation of consumers
with HIV/AIDS considering the extensive problems they often encounter and the effect
these problems may have on the vocational rehabilitation process.
GOALS
1. Participants will understand HIV/AIDS as a Disability and the role of Vocational
Rehabilitation.
2. Participants will understand the importance of holistically considering all areas
of functioning of the consumer (Medical, Psychosocial, Economic, Vocational) in vocational
planning with people with HIV/AIDS.
3. Participants will understand issues related to order of selection,functional capacities
and limitations related to the employment needs of persons with HIV/AIDS.
OBJECTIVES
At the end of the training participants will be able to:
1 Describe rehabilitation counseling interventions that might be employed in working
with consumers with HIV/AIDS.
2. Understand the issues facing consumers with HIV/AIDS issues that may affect vocational
planning.
MATERIALS NEEDED
Overhead Project or 35mm slide projector.
Paper for the group activity.
Easel Paper and pens/blackboard for recording points from class discussion.
HIV/AIDS AND THE VOCATIONAL REHABILITATION PROCESS: IMPLICATIONS FOR SERVICE DELIVERY
INTRODUCTION
HIV/AIDS as a disability has a variable course with many factors that can interrupt
the vocational rehabilitation process such as level of medical stability at any particular
stage.
HIV/AIDS is now a chronic manageable disease with rehabilitation potential given
medical treatment advances such as antiviral agents such as protease inhibitors (Refer
to Medical Module). Longer periods of health and improvements in the quality of life
are the result bringing vocational possibilities for consumers with HIV Disease and
AIDS.
Vocational feasibility is related to several factors such as the particular stage
of the disease and the related functional limitations, existence of social support,
the unique life situation of the consumer, and the personality characteristics such
as coping strengths . Also important are vocational and educational background, functioning,
abilities, interests and capabilities.
HIV/AIDS AS A DISABILITY AND THE ROLE OF VOCATIONAL REHABILITATION
Federal Employment Standards and HIV/AIDS
The ADA's (Americans with Disabilities Act of 1990) non-discrimination standards
provides broad protection against AIDS or HIV discrimination.
A legislative history in regard to HIV preceded the passage of the ADA and can
shed light on how Congress addressed the issue of AIDS discrimination.
The Chapman Amendment and the Hatch Amendment in addressing Congress' concerns
with ADA coverage for persons with HIV infection employed as food service workers.
Legislative history of the ADA leaves no question that in general Congress intended
HIV disease to be included within that definition.
In many cases, because of the extent of illness, the question of whether an individual
diagnosed with AIDS has a disability is typically not disputed. However, whether
asymptomatic HIV disease or HIV disease with mild symptoms is a disability has been
analyzed in several ways.
Individuals who are suspected of being HIV-infected are protected under ADA insofar
as HIV infection itself is a disability or perceived as such.
In several cases relative to ADA;'s Definition f Qualified Individual, the courts
have ruled that plaintiffs are estopped from claiming protection under the ADA if
they had previously applied for disability benefits claiming that they were unable
to work.
In the case of an applicant or employee with HIV infection, the employer must undertake
steps to accommodate that individual's disability, but this duty is not unlimited.
The ADA's limitations on an employer's inquiries and use of medical examinations,
both for applicant and employees, eliminates an employer's ability to screen out
applicants or employees unfairly when HIV status does not bear any relationship to
job qualifications.
In general, circumstances in which HIV positive status cannot be accommodated would
be rare.
In regard to HIV-infected health care workers, an employer will have difficulty
meeting the "high probability of substantial harm" standard. Although the
harm may be substantial, that is, transmission of HIV, the risk of occurrence is
extremely remote.
After more than a decade of experience with the AIDS epidemic, public health officials
in the US have been unable to identify a single case of health care-provider to patient
HIV transmission with the exception of the case of Dr. Acer, the Florida dentist,
who through some means that had not been identified, infected six patients in his
dental practice.
In examining the meaning of individual with disability under the Rehabilitation
Act, the courts have generally concluded that individuals with HIV infection are
protected under either the first or third definitions of disability (i.e., Has a
physical or mental impairment that substantially limits one or more of such individual's
major life activities; and, Is regarded as having an impairment).
The view of HIV infection as a protected disability is rooted, at least in part,
in the Supreme Court's decision in School Board v. Arline, in which the court considered
a Rehabilitation Act employment discrimination claim of a public school teacher with
tuberculosis.
State and local laws regarding discrimination in state and local employment abound
and several issues apply related to whether state law or federal law provides coverage:
availability of remedies, administrative agency exhaustion requirements, exclusivity
of remedies, definition of discrimination, persons protected, workplaces covered,
choice of forum, statute of limitations, disclosure of information, sexual orientation
discrimination.
Workplace Safety Standards
HIV as a Workplace Hazard is concerned with the risk posed by employees with HIV
infection to others. The degree of the risk of HIV transmission in the workplace
is impossible to pinpoint but experts conclude that the risk if extremely low.
Workplace safety policy has been grounded on the Centers for Disease Control's
recommended use of universal precautions, that is, a method of infection control
in which all human blood or other potentially infectious materials or substances
are assumed to be infectious, thus requiring the use of universal precautions in
regard to contact with all such materials or substances.
PUBLIC BENEFITS FOR PERSONS WITH HIV/AIDS
In July 1993, the SSA issued final regulations describing what an individual with
HIV must prove in order to meet a disability listing. Social Security's listings
for HIV Disability set two standards, one for adults with HIV and one for children
with HIV.
Under the HIV listings, an adult claimant may qualify as disabled by HIV in one
of two ways: (1) a diagnosis of any one of 41 stand alone conditions (See Appendix);
or (2) a series of repeated manifestations of HIV disease accompanied by functional
impairment.
Claimants who do not have any of the 41 stand-alone indicator diseases as specifically
defined in the regulations have another opportunity to demonstrate disability by
listing other manifestations of HIV infection and providing evidence of functional
impairment.
The last significant feature of the new regulations is the exclusion of T-helper
lymphocyte, or CD4, counts from direct consideration as an indication either of HIV
infection or of disability.
In the Third Edition of AIDS and The Law, David W. Webber (1997) suggests practice
pointers for proving disability which include a thorough intake, developing medical
evidence, and persuasive writing.
Veteran's Disability and Health Benefits consider the special issue of HIV and
Willful Misconduct.
HIV Specific Programs are available in some states usually funded through Title
II of the federal Ryan White CARE Act. The most common CARE Act-funded health care
programs are the AIDS Drug Assistance Programs.
VOCATIONAL REHABILITATION ELIGIBILITY OVERVIEW
The applicant is an individual with a disability. This means the individual has
a physical or mental impairment which, for the individual, constitutes or results
in a substantial impediment to employment and that they can benefit in terms of an
employment outcome from the provision of vocational rehabilitation services.
The individual with a disability requires vocational rehabilitation services to
prepare for, enter, engage in, or retain gainful employment. It shall be presumed
that any applicant can benefit in terms of an employment outcome from the provision
of vocational rehabilitation services unless there is clear and convincing evidence
to document that the applicant is incapable of benefiting due to the severity of
his/her disability.
INTAKE
ORDER OF SELECTION
Individuals with HIV/AIDS, if they meet Order of Selection criteria and cut-off
level could conceivably be placed into any of the three categories required by Federal
regulations for Vocational Rehabilitation services; Most Severely Disabled, Severely
Disabled, and Disabled depending on the stage of the disease, their individual reaction
to the HIV Virus, their individual reaction to medication, symptoms and their functional
capacities.
HIV/AIDS as a disability or impairment is handled like any other disability, however
it is important to understand how this impairment has unique aspects that call for
unique interventions throughout the vocational rehabilitation process.
CONSUMERS POTENTIAL FEARS ABOUT VOCATIONAL REHABILITATION
Lack of Acceptance by the Counselor - "If an applicant who has HIV infection
is presently handicapped vocationally because of physical or mental limitations,
that applicant would meet the substantial handicap to employment test "(PAC,
p. 25). Physical and mental restoration services should be provided to people with
HIV/AIDS on the same basis as to other persons with disabilities.
Confidentiality Issues - Consumers face increasing danger of medical secrets ending
up in the wrong hands.
Disease Management - Depending on the medication being taken in connection with
HIV/AIDS, the schedule is demanding and fears about managing the disease are a reality.
Also, managing the disease while working also is a fear held by consumers including
such fears as not wanting to be seen taking medication frequently throughout the
day.
Fears about Losing Health Benefits - Because of the up and down nature of this
disease, consumers may fear not qualifying for vocational rehabilitation services
when they apply for services and at the same time jeopardizing any other benefits
they may be receiving. According to PAC, p. 29, "when a determination of client
ineligibility because it is no longer reasonable to expect that VR services would
benefit the individual in terms of employment, it is essential that it be made with
the full participation of the client"
Stress - According to Betty Kohlenberg, rehabilitation counselor of Kohlenberg
& Associates, San Francisco, California, stress is the most common medical problem
mentioned by people seeking new employment after an HIV positive status conversion.
Employees decide to give up a job rather than deal with the stressful situations.
In the section below on Job Placement, a review of what constitutes stressful situations
in the workplace will be listed.
Damaged Self Esteem - One of the first experiences following diagnosis of HIV infection
is depression. Also reflecting societys stigmatization, people with HIV/AIDS may
internalize the stigma and feel untouchable. According to the PAC, given the strong
impact of being diagnosed with HIV infection and/or AIDS, and at the onset of infection,
"particular attention should be given to the severe emotional impact on the
individual.. Following an evaluation by a physician skilled in the evaluation of
mental illness, or by a licensed psychologist in accordance with State laws, appropriate
therapy should be considered .
Fear of Acceptance in the Workplace - Similarly, fear of breach of confidentiality
and fear that employers and other workers might not be accepting of this disability
because misperceptions about contagion or because of discrimination associated with
cultural bias is a fear that is experienced by people with HIV/AIDS.
Lack of Identification - There is a lack of self-identification as HIV infected
both by consumers already in the DR system and those who have not yet requested services.
HIV/AIDS as Co-Existing Disability - It is important to know that because of the
stigma and discrimination attached to HIV/AIDS, there most probably are consumers
with other severe disabilities that have HIV/AIDS as a co-existing disability about
which they maintain silence.
CONFIDENTIALITY AND HIV/AIDS
Confidentiality and Department of Rehabilitation
In general, Federal regulations and most State regulations now require that all
information about applicants for Department of Rehabilitation services be kept confidential
and released only for a specific purpose after the applicant has given written permission.
The 1990 RSA Program Assistance Circular on HIV/AIDS (RSA-PAC-90-6). The purpose
of the PAC was issued to provide guidance to State Departments of Vocational Rehabilitation
(DR) agencies regarding the provision of rehabilitation services to persons infected
with HIV to assure that persons with HIV infection were protected by Section 504
of the Rehabilitation Act.
RSA-PAC-90-60 defined Confidentiality as of utmost importance to protect the legal
rights of an applicant and encourages state DR agencies to consider receiving informed
written consent each and every time records containing references of the presence
of symptoms or diagnosis of HIV infection are shared with an outside agent or agency
whether they be service providers, potential employers, or agencies to which an individual
is referred, explaining that there are confidentiality requirements and limits and
to whom and how information about DR cases is shared and under what circumstances.
It is important that confidentiality measures be reviewed with your supervisor
when working with a person with HIV/AIDS. It is possible that alternative confidentiality
systems can be explored. For example, depending on the capability of the agencys
computer system, files might be marked SENSITIVE when the vocational rehabilitation
counselor opens the case ensuring limited electronic access on a need to know basis,
such as only to counselor and supervisor.
Be clear about limits of confidentiality and the rehabilitation counselors role
(e.g., Adult/child abuse reporting requirements, Who has access to file, How long
the file is retained, etc.)
Medical verification of an HIV and/or AIDS diagnosis is obtained in the same way
as any other medical information. It is important to note however that in some localities,
providers of medical services will not release information about HIV/AIDS unless
specific written permission is obtained from the applicant.
Early in the intake interview, the consumer should be made aware of the extent
to which the counselor-client discussion is confidential. Failure to inform the consumer
of confidentiality can result in much information of a personal nature being denied.
This requires knowledge of agency and state laws and policies surrounding HIV/AIDS
disclosure. Wrongful disclosures can result in legal actions alleging violation of
constitutional rights, violation of statutory confidentiality protection, discrimination,
invasion of privacy, and intentional or negligent infliction of emotional distress,
according to the California State Office of AIDS.
AIDS, like other communicable diseases, is reported to public health systems through
either passive (notifying health departments of AIDS cases) or active surveillance
(health department searches for AIDS cases visiting hospitals, etc.)
General Confidentiality Statutes
Vocational Rehabilitation counselors should become familiar with confidentiality
statutes in their states.
California Civil Code, Section 56, (The Confidentiality of Medical Information
Act) governs the disclosure by health care providers of all types of medical information.
California Health and Safety Code Section 199.42 specifically requires state and
local public health agencies to maintain the confidentiality of AIDS-related records
containing personally identifying information. Except for defined public health purposes,
disclosure of such information is permitted only with written authorization from
the individuals involved.
AIDS-related public health records are not subject to subpoena. Persons who willfully
disclosure the content of confidential public health records are subject to civil
penalties.
Legal Basis for AIDS Case Reporting by State
Approximately 43 states are now reporting AIDS to the Centers for Disease Control
(CDC).
Under the California Code of Regulations, Title 17, Section 2500, AIDS is a reportable
condition. This regulation mandates that persons with knowledge of a known or suspected
AIDS should notify the local health department within seven days. Required information
includes the diagnosis, name, address, telephone number, occupation, ethnic group,
Social Security number, sex, date of birth, date of diagnosis, and date of death
of the patient, and the name, address, and telephone number of the person making
the report.
Section 2501 requires local health departments to send individual case reports
to the State Department of health Services. Failure to notify the local health department
of an AIDS case is a misdemeanor with a penalty of $50 to $1,000 or imprisonment
(California Health and Safety Code, Section 3354).
CDC (Centers for Disease Control) is the final recipient of locally-collected AIDS
surveillance data. CDC uses this data primarily for statistical and analytical summaries
from which no individual information can be segregated. No CDC AIDS surveillance
data that might be used to directly or indirectly identify individuals will be made
available to anyone for nonpublic health purposes.
Legal/Civil Rights Issues
Federal courts have recognized AIDS as a disability covered by the ADA.
Individual states have also enacted legislation that discourages discrimination
on the basis of HIV/AIDS.
The ADA protects people with HIV/AIDS. People with HIV/AIDS may wonder what an
employer can legally say and do or not do. DR counselors can address some of these
concerns in the pre-pre-vocational stage of planning and throughout the entire process
for that matter. For example, it is illegal for an employer to ask certain questions,
but it is not illegal for potential employees to answer.
One very effective strategy for consumers can be to answer the question the employer
should have asked in spite of the illegal question that was asked such as Are you
able to do the job or "I imagine what you are interested in is whether I'll
be a team member"?
The HIV/AIDS community has not easily accepted the label of disability and may
have very little information about services available from the state-federal vocational
rehabilitation system. The Vocational Rehabilitation Counselor can play an educational
role both with consumers and in the community.
POSSIBLE AREAS OF CLIENT RESISTANCE
Not wanting to risk confidentiality loss
Fear of losing their SSI/SSDI/Medi-Care benefits if they return to work.
Fear of discrimination because of the stigma and prejudice that sometimes accompany
this disease can easily lower consumers self-esteem.
Unwilling to be categorized as "disabled".
Fear of being rejected by counselor because of stereotype of disease involving
sexuality.
Denial of issues surrounding death and dying
Guilt reactions
Distrust of government agencies
Lack of knowledge about legal issues
Fear of dependence
Low energy to untangle bureaucratic mazes
Recurring anticipatory grief
Lack of social support
COUNSELOR EXPECTATIONS, MYTHS AND RESPONSES IN WORKING WITH HIV/AIDS CONSUMERS
Vocational Rehabilitation Wont Work - Counselors may believe that vocational
rehabilitation services are not necessary for people with HIV/AIDS because of impending
death.
Consumers will be unable to hold job or attend work consistently because of the
up and down nature of the disease.
Traditional vocational rehabilitation approaches will not work with this population.
Rehabilitation counselors may be resistant to working with people with HIV/AIDS
because of fear of contagion..
Counselors may feel urgency to hastily refer the consumer to a specific service
before the consumer is ready.
The link between substance abuse, in particular injection drug use and HIV/AIDS
as a primary route of transmission probably rules out vocational rehabilitation services
because of presumed active drug involvement.
The person may only be able to work part time or in temporary work that is difficult
to secure.
The individual with HIV/AIDS may encounter lack of acceptance in the workplace
due to such things as fear of infection and/or moral objection by the employer or
other employees.
POSSIBLE AREAS OF COUNSELOR RESISTANCE
The state vocational rehabilitation system may not have not emphasized services
for people with HIV/AIDS as a disability in part because of lack of training in this
area resulting in lack of knowledge.
It may be assumed that there is no model for providing vocational rehabilitation
services to people with HIV/AIDS. According to PAC, a diagnosis of AIDS does not
necessarily indicate that an applicant has a severe handicap under order of selection,
but they may have the signs, symptoms, and functional limitations that fully meet
these criteria.
Department of Rehabilitation counselors like any other rehabilitation professional
holds certain expectations regarding any disability group. HIV/AIDS as a disability
is no different. These expectations might be based on prior and present socialization
experiences or professional education and training.
Homophobic attitudes and cultural biases.
Expectation of resistant consumers based on distrust.
Fear of working in isolation , feeling unsupported, and fear of burnout.
If there is no prior experience with a person with HIV/AIDS, it is not uncommon
to have questions and fears about transmission and death and dying.
Counselors may be confused about the relationship between a consumer's sexual orientation
and HIV/AIDS.
Fear of discussing issues surrounding sexuality which in fact may not be necessary.
Threatened about their owns feelings around sexuality.
Lack of understanding of family constitution alternatives.
Fear of dealing with alternative support systems.
REHABILITATION COUNSELING APPROACHES
Engage the consumer in the rehabilitation process. This involves establishing
trust especially regarding issues of confidentiality. (Be sure to clarify with you
agency/office the policy on confidentiality).
Assist the consumer in dealing with the stigma, discrimination and fear surrounding
this disease by listening to concerns, apprehensions, and/or experiences in this
area.
Sustain a multicultural openness to consumers with varying lifestyles and values.
Be sensitive to dependency needs exhibited by consumers with HIV/AIDS yet retaining
a focus on independence as a rehabilitation goal.
Be aware of your burnout potential and symptoms
Network with other counselors to establish a support network
Monitor gains in psychosocial as well as educational and vocational development.
Retain focus on vocational or pre-vocational issues.
Assist the consumer in managing his or her own life and taking responsibility.
Keep updated on technological and medical advances in HIV/AIDS such as medications
with the assistance of Medical Consultants. The Internet is a valuable resource to
obtain this information.
Place vocational rehabilitation within the context of the consumer's disability
and course of disease.
Recognize that symptom recurrence and reactions to medications is part of the disease
process
Realize that the vocational rehabilitation process will not necessarily be a neat,
systematic process.
Be aware of the fear and stigma of consumers, employers, co-workers, and society.
Visualize what you may represent (e.g., Government workers, counselor, informer,
etc.) to the individual.
FACTORS TO CONSIDER AT INTAKE
Physical Factors- The rehabilitation counselor needs to assess the relative medical
stability of each client with HIV infection. It is important always to determine
the extent of disability and to determine how at any stage, the disability handicaps
employment potential? It is critical to remember that HIV may not be the primary
disability: Sometimes it is secondary and/or co-existing with another disability
such as alcoholism or other drug use and/or abuse, tuberculosis, deafness, visual
loss, or other physical or mental health problems.
Stages - During the course of HIV infection and AIDS, as with several other disabilities,
you can expect varying stages. HIV/AIDS affects people in many different ways. For
example, some individuals will suffer chronic exhaustion, others an impairment of
vision, others nausea, etc. The changeability of symptoms and functional limitations
commonly seen in people with HIV/AIDS can affect an individual without any warning.
The symptoms and functional limitations that are characteristic of HIV/AIDS can be
chronic, and often progressive. The absence of symptoms during the HIV infection
and the variety of symptoms and functional limitations that are characteristic of
AIDS infection will often require particular attention and reassessment by the DR
Counselor.
Psychological - Psychological evaluation, testing, and establishment of aptitudes
and abilities are an important resource when assisting people with HIV/AIDS. No longer
a death sentence, life for people with HIV/AIDS is being prolonged and resuming their
career or finding a new one is a reality. However, this new possibility can be stressful,
even though positive, and filled with stress and unexpectedness. The fear attached
to re-entering the work world after reduction of a death sentence can be incredibly
stressful. The Independent Living programs may offer services that are vital to the
well being of persons with HIV infection", especially peer counseling and social
support services.
Economic - Benefits are very complicated. The spectrum of benefits include SSDI,
SSI, local funding often called General Assistance, State Disability, Private Long
Term Disability LTD), trust funds, AIDS emergency local friends, and financial assistance
of friends. One of the worries that people with HIV/AIDS have is that as they improve
with drugs, they will have benefit coverage problems because they need to have symptoms
to keep benefits. However, because the course of the disease can be erratic, they
may fear losing benefits, then perhaps having to resume immediately thereafter and
accumulate further of the bureaucratic red tape necessary to resume services. Several
medications must be taken at once to manage the disease and can cost upwards of $16,000
per year to $25,000 in expense.
Educational/Vocational - Because of the lowering level of activity often required
when physical and emotional energy are depleted with AIDS, consumers must often quit
their jobs and join the ranks of unemployed even when they can still physically work
although at a lower functional level. Transferable skills analysis is particularly
important and useful as a tool to transition the consumer as he/she shifts from dying
to living and working. The eventual goal of the consumer can be part time or full
time work or even homemaker depending on the family situation.
Social Network and Social Support - The necessity for a supportive network increases
the likelihood that the individual with HIV can re-enter the workforce successfully.
Reinforcement of maintaining supportive networks including such things as peer group
support is crucial.
VOCATIONAL PLANNING FACTORS
ISSUES AFFECTING POTENTIAL FOR VOCATIONAL REHABILITATION SERVICES
Immunodeficiency - The rehabilitation possibilities for individuals affected by
HIV depends in large part on the level of their underlying immunodeficiency and the
appearance of any functional limitations arising from specific related disorders.
Individuals with greater proportion of immunodeficiency have less functional capacity
for rehabilitation.
Age - One positive characteristic of most persons with HIV disease in terms of
rehabilitation potential is age. HIV affects previously healthy young adults so they
can take reductions in strength and capacity. Only a minority of persons with AIDS
have little vocational potential and then only after having the condition for upwards
of several years. There is enough residual physical, mental, emotional and educational
capabilities to respond favorably to vocational rehabilitation .
Little or No Neuromuscular Limitations- Another positive factor is lack of spinal
cord damage, loss of limbs, reduction in mobility or other severely disabling neuromuscular
impairment. All ambulatory individuals with HIV can have the necessary residual neuromuscular
capacity to engage in at least sedentary work. Those with energy-restricting disorders
usually have enough residual capacity to participate in light to medium categories
of work (Brodwin, et al, 1994).
Functional Limitations - HIV infection can cause disturbances in the normal functioning
of many systems of the body including mental functioning. These disturbances often
progress to functional physical and mental impairments. Chief among the bodys systems
that can be physically impaired by HIV infection and AIDS are (1) respiratory, gastrointestinal
and cardiac systems; (2) musculoskeletal system (3) neurological system, and (4)
the various sensory systems such as the eyes. Mental impairments related to HIV infection
also can cause significant functional limitations
DEVELOPING THE INDIVIDUALIZED VOCATIONAL REHABILITATION PLAN (IWRP)
Rehabilitation planning depends very much on the adequacy of the information gathered
from the intake interview. According to PAC, p. 26, "in developing an IWRP for
an individual with HIV infection or AIDS, the program should be kept flexible and
reflect changes in a client's physical and mental condition and the types of work
the client is capable of performing".
As the consumer's physical and mental condition change, so will the types of tasks/jobs
that the consumer will be capable of performing at various phases and stages of the
disease/disability necessitating re-evaluation. Questions that may arise include
the following: If an education plan is contemplated, how often can the consumer miss
class? Would college be indicated given the necessity of attendance? Are there any
alternatives?
The consumer's response to the natural course of HIV infection and AIDS sets the
stage for a rehabilitation process that must be flexible to periodic opportunistic
disorders and diminishing strength and energy over time. On the other hand, with
new medications, disease trajectory can be dramatically turned around in a very short
time.
Vocational planning must consider environmental setting. For example, exposure
to any infectious agents such as is found in hospital settings could possibly be
e contraindicated as a job placement consideration, though not necessarily. For other
individuals with disabilities caused by HIV infection, the implications depend on
the organ system involved and are not unique to persons with AIDS.
JOB PLACEMENT/EMPLOYMENT OUTCOME IMPLICATIONS
As understanding of HIV/AIDS as a disability increases, DR agencies can expect more
individuals with HIV/AIDS to apply for services. This will include consumers who
are already employed, but (fearful) of losing their jobs because of a negative attitude
toward him or her in the workplace. Job retention services, job training and placement
services, or supported employment are individualized DR services which may benefit
many persons with impairments caused by HIV infection.
POTENTIAL VOCATIONAL LIMITATIONS
HIV/AIDS medication can be comprised of a complex set of drugs and vitamins that
require a time consuming schedule which must be coordinated with other activities,
including keeping appointments, being to work on time, taking medication in the workplace
which might require an accommodation of frequent breaks.
Medication side effects such as nausea, headaches, intestinal upsets which can
complicate social interaction including interaction in the workplace.
Decreased stamina and inability to sustain prolonged standing or sitting.
Marked weight loss, diarrhea and other intestinal problems that might require accommodations
such as a workstation closer to restrooms or special padded seating.
Vision problems due to CMV retinitis which possibly could be accommodated with
magnification devices or computer screen reading software that can read aloud what
is being typed as well as read the computer commands.
Dermatological problems such as rashes, fungal infections, or seborrhea. This may
necessitate vocational options that avoid frequent hand washing, prolonged rubber
glove use or exposure to harsh cleaning solvents. Exposure to extremes of cold such
as walk in refrigerators, or damp heat, as in kitchens, may cause discomfort or aggravation
of symptoms and may have to be avoided during these stages.
Cognitive impairments including memory loss and problems in concentration.
Substance use and abuse which could range from a history of drug use with the potential,
especially during crises, of depression and seeking escape from depression to relapse
to alcoholism. For people with HIV/AIDS who have a long history or background of
substance abuse such as injecting drug use, the job placement process may be the
first long-term vocational planning the consumer has ever done and more time may
be spent in the pre-vocational stages of the job placement phase.
Stress as a medical problem to be avoided at all costs is a serious concern to
consumers with HIV/AIDS. Sources of stress are manifold and individual, however,
the following sources of stress have been identified in the literature: Time pressure
in job tasks; Evaluation by supervisors; Interaction with customers; Interaction
with co-workers especially is fearing discrimination or hostility; Large span of
responsibility such as administrative or supervisors job positions; Repetitive, non-changing
job tasks; Fear of loss of benefits; Competitive work atmosphere where quotas are
maintained such as in productivity; and, the unpredictable course of HIV/AIDS.
COMMON MISPERCEPTIONS ABOUT BARRIERS TO EMPLOYMENT FOR PEOPLE WITH HIV/AIDS
The individual can no longer work with the public.
The individual can no longer work in the health services field.
The individual poses a health threat to co-workers.
The perception, real or imagined that the person with HIV/AIDS cannot continue
satisfactorily performing the duties of the job.
Unrealistic and/or unattainable goals coupled with lack of information regarding
requirement of skills and knowledge, structure requirements, and psycho-social strengths
and vocational potential of consumer.
Lack of prevocational intervention, especially in those districts where vocational
rehabilitation counselors do not do placement and instead contract out for services.
Lack of continuity in job placement with subcontractor for services.
EFFECTIVE JOB PLACEMENT PRACTICES
Individualized Approach - It is important as rehabilitation counselors deal with
the uncertainty of the stability of HIV/AIDS as a disability, that they be able to
provide assistance tailored to the individual needs of consumers.
Pre-Employment Services - Individuals with HIV/AIDS are likely to need several
services prior to becoming employed. Following is a list of those services.
1. Information about their legal status as disabled persons, and the rights and protections
it provides.
2. Encouragement and support during the process of preparing for and seeking work.
3. Assistance with independent living needs while in training or while seeking work
such as housing, transportation, and/or personal assistance
4. Expert advice using career counseling techniques providing information about new
occupations they can undertake, given their new functional limitations or capacities.
5. Work incentive programs (e.g., PASS/, etc., to maintain income and, more importantly,
medical benefits).
Thorough Transferable Skills Analysis- Because of the up and down nature of HIV
Disease, consumers may have to leave work settings to fit their functional limitations
on a more frequent basis. It is crucial therefore that complete knowledge of work
skills possessed and how these may transfer into other job possibilities becomes
even more necessary than usual.
Educate Training Facilities - The stigma and discrimination in the workplace that
is feared by consumers with HIV Disease is also feared in training facilities.
Make every effort to work with reasonable accommodation methods to return the consumer
to the previous job.
Effective Job Modification Considerations -According to Betty Kohlenberg, previously
cited, job accommodations can take many forms including the following:
1. Modified work schedules such as part-time, flex time and longer breaks.
2. Modified work locations such as at home.
3. Reassignment to a vacant position.
4. Acquisition of assistive devices and equipment.
5. Providing qualified assistance such as help in devising accommodation, readers
or interpreters.
Encourage Job Seeking Skills Training - Given that self esteem can suffer greatly
given the stigma and discrimination experienced with this disability, job seeking
skills training may be particularly useful to re-motivate and inspire consumers
in their job search.
Consider Direct Placement - Direct job placement while not impossible for consumers
with HIV/AIDS. However, job placement programs are developing and in California,
Positive Resource provides job placement services specifically for consumers with
HIV/AIDS.
Maintain a Career Mind-Set in Rehabilitation Planning - The advent of antiviral
agents has opened up life for people with HIV/AIDS. Career-mind set is an important
feature of all rehabilitation counseling and no different for people with HIV/AIDS.
No longer do vocational rehabilitation counselors think only in terms limited employment
outcome. Instead, a job can be seen as one step in a career trajectory.
HIV/AIDS WORKPLACE ISSUES
STRESSFUL SITUATIONS IN THE WORKPLACE
Lack of control over allocation of time and task priorities.
Having to hide personal information such as sexual orientation or health status.
Dealing with discrimination, stigmatization and hostility. It is important to understand
that generally speaking, in most employment settings, the potential for transmission
of HIV is minimal. However, employers and employees do need to be educated about
this fact.
Working with frequent deadlines
Doing boring work.
Fear of job and subsequent income loss.
Fear of loss of benefits.
Competition.
Responsibility for others actions.
ADA AND DIRECT THREAT
Definition of Direct Threat - EEOC interprets Direct Threat as a significant
risk of substantial harm to the health or safety of the HIV infected individual or
others in the workplace that cannot be eliminated or reduced by reasonable accommodation.
(A Technical Assistance Manual, 1991, p. B-28). Assessment of whether there is a
direct threat or not must be made on an individualized basis of the applicant or
employee.
Clarification of HIV Transmission - HIV which causes AIDS is transmitted (a) From
mother to child before or at the time of birth; (b) through sexual activities, primarily
anal and vaginal intercourse; (c) sharing of hypodermic needles; and (d) transfusion
of contaminated blood, or other blood-to-blood contact with an infected person. Thus,
in all but a small percentage of occupational settings, the potential for HIV transmission
does not constitute a direct threat to others. Occupations where questions remain
include medical positions, especially where blood-to-blood contact may be expected,
and areas such as dentistry and firefighting.
ADVOCACY AND PARTNERSHIP WITH EMPLOYERS
It is important for rehabilitation counselors to understand HIV/AIDS Workplace
issues and to advocate in the workplace for employees who are infected for several
reasons including the following because:
Insurance required to continue medical treatment and decent standard of living.
Benefits crucial in preserving mental and physical health
Long latency characteristic of HIV means that productivity decrease and/or need
for extensive accommodation may take years.
Fear of discrimination may produce hesitancy in seeking testing putting of possible
treatment
Stress on HIV infected individual may be produced because of passing as non-infected
or as heterosexual which they may view as necessary to maintain employment.
Rumors and speculation regarding presumed serostatus of employees is reinforced
by discrimination in the workplace.
COLLABORATING WITH EMPLOYERS AS A CONSUMERS OF SERVICES
In most instances the DR Counselor will not reveal the individual's disability
when referring him or her to an employer. This is a matter for the consumer to decide.
Most people with HIV/AIDS will not want their disability revealed, and the DR Counselor
should be alert to and comply with that preference. In some states it is a violation
of law to reveal an individual's HIV status.
In other cases, however, the person with HIV/AIDS will prefer that the employer
know his or her disability in order to avoid problems in the future. This attitude
should be encouraged because most of the time it will help to de-mystify HIV/AIDS
and allow it to be considered solely as a disabling condition.
Many job seekers with HIV/AIDS will need assistance with completing a job application
and preparing for a job interview. The DR Counselor should advise them about what
does not need to be revealed on a job application or at a job interview, such as:
a medical condition that does not affect job performance; medical treatment that
is not relevant to the ability to work; gaps in the employment record.
In some instances the DR Counselor will need to advise the individual about the
possibility of seeking a reasonable accommodation that will be required from the
employer in order to do the job, or speak to the employer directly about obtaining
one.
Persons with HIV/AIDS may need some type of independent living support before they
can undertake a job, such as housing, child care, personal assistance services, transportation,
etc. The DR Counselor needs to be aware of service agencies in the community that
provide these kinds of support for the person with HIV/AIDS.
POTENTIAL EMPLOYERS QUESTIONS ABOUT HIV/AIDS
Exposure and Risk
Precautions Necessary
Inservice Training Possibilities
Americans With Disabilities Act
HIV/AIDS Testing
How does HIV/AIDS affect me in the workplace?
How does one contract HIV/AIDS?
How can I reduce risk for HIV infection in my personal life?
If I work with someone who has HIV or AIDS, are there any special precautions I
should take?
FOLLOW-UP
Follow-up contact with both consumers and employers is critical in the success
of the rehabilitation plan. We often think of follow-up as continuing only until
the required number of days of the plan is completed.
Transitory crises can occur early in placement and with support can be mitigated.
Rehabilitation counselor's mind set can include thinking of follow-up contact as
continuing contact with the employer to nurture a continuing job placement resource.
Difficulties may ensue for the individual in performing the job.
There may be transportation problems
There may be attitudinal challenges from co-worker attitudes and behavior.
COUNSELOR INTERVENTIONS
When dealing with these difficulties , the DR Counselor should be alert to the
possibility of a change in the course of the disease and an improvement or progressive
worsening of symptoms that may affect the abilities and capacities of the person
disabled with HIV/AIDS.
This may require additional or broader accommodation and flexibility by the employer.
It is the DR Counselor's responsibility to assist the individual, either by seeking
an accommodation from the employer, or by assisting the client to remedy the problem
unilaterally.
The DR Counselor should be aware of resources and service agencies in the community
that provide supportive services including independent living support for people
with HIV/AIDS, such as housing, child care, personal assistance services, emotional
support, transportation, etc.
CLOSURE
Rehabilitation counselors deal with termination of services with consumers in
a variety of ways. It is helpful to give advance notice to consumers that closure
is approaching. A relationship will have formed and psychosocial issues related to
ending relationships can emerge. Counselors and other rehabilitation personnel also
must sometimes prepare to cope with death and dying of consumers and this disability
is no different. The difference with HIV/AIDS is that the population is very young
and termination due to death is a traummatic event for everyone involved. (Refer
to Psychosocial Module)
REFERENCES
HOW TO COLLABORATE WITH EMPLOYERS ABOUT HIV/AIDS ISSUES IN THE WORKPLACE
A. Evaluate the organizational climate.
1. Has attention to HIV/AIDS in the workplace yet come to the attention of the organization?
If so, in what way?
Examples:
a. Does the organization have any experience with HIV/AIDS.
b. Have employees requested information.
c. Has management requested information.
d. Have disability policy issues arisen.
e. Has the Risk management Prevention team been involved in these issues.
f. Have there been any complaints or lawsuits.
B. At what levels of the organization is there awareness of HIV/AIDS?
Examples:
a. Management
b. Staff
C. Evaluate resources within the organization for HIV/AIDS education and training.
a. Is there a medical department? nurse? medical doctor?
b. Is there a disability management program? Rehabilitation Counselor?
c. Is there an Employee Assistance Program (EAP) program? external? internal?
d. What is the relationship of the personnel department to whomever handles disability
workplace issues.
e. Is the local community (AIDS activist organization? Red Cross?) involved as a
resource?
f. Have any employees with HIV/AIDS been identified. Where are they in the organization?
D. Evaluate potential intervention options depending on the answers to the above
questions.
Examples:
1. Collaborate with personnel in development of HIV/AIDS policy in conjunction.
2. Develop a curriculum for lunch bag talks or for formal training.
3. Provide community resource referral information for the organization.
4. Provide counseling and reasonable accommodation options.
THE RED CROSS WORKPLACE HIV/AIDS PROGRAM
The Workplace HIV/AIDS program was designed for general workplaces such as those
that operate in service, manufacturing, or office settings. This program may serve
as an employer resource.
Shares with employees and employers reliable information about HIV and AIDS, including
facts about transmission and prevention.
Encourages discussion about topics including employee and employer rights and responsibilities,
legislation such as the Americans with Disabilities Act of 1990 (ADA), medical confidentiality,
and reasonable accommodation.
Helps employees understand that they an work safely alongside people living and
working with HIV or AIDS without fear.
Promotes a compassionate environment for workers living with HIV, their family
members, and partners who are HIV positive.
Identifies local resources and services.
Brodwin, Et Al's, 19 Categories Of Functional Limitations
Difficulty in Interpreting information
Limitations of sight and total blindness
Limitations of hearing and total deafness
Susceptibility to fainting, dizziness, and seizures
Incoordination
Limitation of stamina
Limitation of sensation
Difficulty in lifting, reaching, and carrying
Difficulty in handling and fingering
Inability to use the upper extremities
Difficulty in sitting
Difficulty in using the lower extremities
Poor balance
Cognitive limitation
Emotional limitation
Limitation due to disfigurement
Substance abuse
Pain limitation
Source: Brodwin, M., Parker, R.M., & DeLaGarza, D. (1996). Disability and Accommodation
in E.M Szymanski & R.M. Parker, (Eds.), (1996).Work and Disability, Pro-Ed: Austin,
Texas.
HIV/AIDS Information Resources
The CDC National AIDS Clearinghouse provides information and materials on HIV and
AIDS to organizations involved in a variety of HIV/AIDS services. The services of
trained reference specialists are available from 9:00 am to 7:00 pm, Monday through
Friday, except holidays. The services can e accessed by writing the CDC national
AIDS Clearinghouse at PO. Box 6003, Rockville, MD 208a49, by calling toll free, 1-800-458-5231,
or by FAX, 301-738-6616. Send e-mail: sjm4@oddhiv1.em.cdc.gov
The Centers for Disease Control and Prevention's (CDC) National AIDS Clearinghouse
is an activity of the Prevention Communications Branch, Division of HIV/AIDS Prevention,
National center for HIV/STD, and TB prevention.
Accommodation Factors
Reasonable accommodations are usually very low cost even though public perception
is to the contrary. Types of reasonable accommodations can be described in five areas:
Physical Access Accommodation: This might include changing or modifying the physical
structure such as situating a job on the first floor or near a parking lot.
Resource Accessibility Accommodation: This involves providing an assistive person
to assist in job duties. One example is providing a note taker or sign language interpreter
for a person with a hearing impairment.
Adaptive Equipment Accommodation: This can involve low tech or high tech assistive
devices such as special pen/pencil holders, turntable on a desk for someone with
a reaching problem, providing a slant board on a desk for a neck problem, or providing
a computer with specialized keyboard and electronic wheelchair with assistive devices.
Job Modification: This involves modifying the performance of job duties while maintaining
the same job duties: This could include adjusting hours, less field appointments,
carrying less weight by making more frequent trips
Job Restructuring: This involves changing some of the actual job duties performed
such as less field work or shift in duties.
Accommodation Examples for HIV/AIDS Consumers
Transfer of Job Duties
Providing Equipment
Working at Home
Sample Accommodations and Costs
Note: This information is based on the Job Accommodation information available
on the internet.
Providing a drafting table, page turner, and pressure sensitive tape recorder for
a sales agent paralyzed from a broken neck (approximately $950)
Changing a desk layout from the right to the left side for a data entry operator
who had a shoulder injury($0)
Supplying a telephone amplifier for a computer programmer who was hard of hearing
($56)
Providing a special chair for a district sales agent to alleviate pain caused y
a back injury($400)
Using an articulating keyboard tray to alleviate strain of repetitive motion and
carpal tunnel syndrome ($150)
Remember
Job Accommodations are usually not expensive
Job Accommodations may be as simple as a rearrangement of equipment.
Job Accommodations can reduce workers' compensation and other insurance costs for
employers.
Job Accommodations can increase the pool of qualified employees.
Job Accommodations can create opportunities for persons with functional limitations.
Accommodations suggested by JAN (The Job Accommodation Network) to assist employees
with all kinds of limitations, include the following:
Sensory Limitations (vision, hearing, speech).
Motor limitations (loss of limb, paralysis, carpal tunnel syndrome)
Neurological functioning (specific learning disabilities, mental illness, mental
retardation, and head injury)
Multiple limitations (multiple sclerosis, cerebral palsy, muscular dystrophy)
Other disabilities such as allergies, diabetes, heart disease, HIV/AIDS.
Specific information on how to contact JAN and request accommodation information
is listed in Reference Section.
The Job Accommodation Network
The Job Accommodation Network was established in 1983 as a service of the President's
Committee on Employment of People with Disabilities It is an information network
and consulting resource to enable qualified workers with disabilities to be hired
or retained. Businesses, rehabilitation professionals, and persons with disabilities
can discuss their concerns and information needs with JAN's Human Factors Consultants
and receive immediate suggestions on solutions to accommodation problems JAN offers
comprehensive information on methods and available equipment that have prove effective
for a wide range of accommodations. Included will be names, addresses and phone numbers
of appropriate resources. The Toll Free phone number is 1-800-526-7234. The Computer
Bulletin Board number is 1-800-DIAL-JAN. The Job Accommodation is also on the internet.
Any time you have questions about possible accommodations given specific functional
limitations.
In the pre-pre job placement phase stage of rehabilitation planning to assist the
consumer with HIV/AIDS of the possibilities.
When an employer would like to hire a person with a disability
When you are attempting to assist a person return to work from injury or illness.
When you want to promote a person with a disability.
When you need to assist a person perform a present job more easily
When you need information about how to comply with the Americans with Disabilities
Act.
When you contact JAN, a professional consultant will need to obtain information
about the requirements of the job, the worker, and the work environment. In e-mail
messages, it would be helpful to include as much of this information as possible.
The consultant will search JAN's files to discover readily-available solutions
and may also engage other experts to assist determine appropriate accommodations
for your solution.
You will receive information about possible solutions for your particular situation.
You may also receive names and phone numbers of employers or workers who have made
such accommodations and lists of other helpful information such as funding resources
and tax incentives.
Guiding Questions at Intake
Physical/Medical
Is the individual at high risk for HIV/AIDS?
What is the extent of disability?
What is the current medical treatment?
What is frequency of clinic appointments?
How often do illnesses/symptoms/hospitalizations occur?
What is the consumers perception of disability?
Is the disability progressive or stable?
Is there a history of chemical dependency
Can the consumers functioning in activities of daily living be improved?
How much assistance in activities of daily living will the client always need?
Is the disability stable enough to initiate rehabilitation programming.
To what degree has the consumer adjusted to the handicapping aspects of the disability?
Psychosocial
Are any physical symptoms that appear psychologically based?
Does the consumer have the emotional stability to engage in a vocational rehabilitation
program at the present time? In the near future?
Which personal counseling and/or family counseling services would be necessary
(psychotherapy, personal adjustment training, relaxation training, etc.)?
What positive or negative role will the consumers family and friends play in the
rehabilitation process (e.g., supportive, overprotective, unrealistic?
How is the consumer adjusting to a new lease on life if on protease inhibitors?
Economic
Can the consumer manage personal finances?
Does the consumer have sufficient financial support at present?
Do disability-related financial benefits create disincentives to the consumers
rehabilitation?
Could current debts affect the completion of the consumers rehabilitation program.
Vocational
How does the disability limit employment potential?
What types of accommodations are needed at this point or stage in the disease?
What type of vocational training or jobs does the consumers educational history
suggest?
What educational and vocational services are needed (e.g., remedial education,
vocational training, work adjustment training, job seeking skills training, job club?)
Are consumers vocational aspirations and educational history compatible?
What vocational skills does the consumer possess? Can he/she develop that could
impact the functional limitations of the disability?
Does the consumer have a realistic perception of current strengths and limitations
as a worker, potential for vocational skills development?
Can the consumer independently locate job openings?
Can the consumer satisfactory meet the demands of competitive work (e.g., accepting
supervision, working independently, getting along with coworkers, maintaining an
adequate production rate?
QUESTIONS FOR THE REHABILITATION COUNSELOR TO SELF-EXAMINE ATTITUDES
Have you had experiences providing job seeking assistance for people with HIV/AIDS?
What is different about rehabilitation planning for a person with HIV/AIDS?
Am I interacting with this individual in an empathetic and objective way without
making any unwarranted assumptions?
Am I developing a rehabilitation plan with this person that focuses on a career
rather than just a job?
Is it realistic and reasonable to expect this individual to achieve it?
Stand-Alone Disabling HIV Conditions for Adults
Source: Webber, D. (1997). AIDS and the Law.
BACTERIAL INFECTIONS
1. Mycobacterial infection
2. Pulmonary tuberculosis resistant to treatment
3. Nocardiosis
4. Salmonella bacteremia, recurrent non-typhoid.
5. Syphillis or neurosyphillis resulting in neurologic or other sequelae.
6. Multiple or recurrent bacterial infections(s), including pelvic inflammatory disease,
requiring hospitalizaiton or intravenous antiibiotic treatment 34 or more times in
1 year.
FUNGAL INFECTION
7. Aspergillosis
8. Candidiasis, at a site other than the skin, urinary tract, intestinal tract, or
oral or vulvovaginal mucous membrfanes; or candidiasis involving the esophagus, trachea,
bronchi, or lungs
9. Coccidioidomycosis, at a site other than the lungs or lymph nodes.
10. Cryptococcosis, at a site other than the lungs
11. Histoplasmosis, at a site other than the lungs or lymph nodes
12. Mucormycosis
PROTOZOAN OR HELMINTHIC INFECTIONS
13. Cryptosporidiosis, isosporiasis, or microsporidiosis, with diarrhea lasting
for 1 month or longer
14. Pneumocystis carinii pneumonia or extrapulmonary pneumocystis carinii infection
15. Strongyloidiasis, extra-intestinal
16. Toxoplasmosis of an organ other than theliver, spleen, or lymph nodes.
VIRAL INFECTIONS
17. Cytomegalovirus disease, at a site other than the liver, spleen, or lymph
nodes.
18. Herpes simplex virus causing mucocutaneous infection lasting for 1 month or longer;
or infection at a site other than the skin or mucous membranes; or disseminated infection
19. Herpes zoster, disseminated or with multidermatomal eruptions that are resisttant
tot reatment
20. Progressive multifocal leukoencephalopathy
21. Hepatits, resulting in chronic liver disease manifested by appropriate findings
MALIGNANT NEOPLASMS
22. Carcinoma of the cervic, invasive, FIGO stage ii and beyond
23. Kaposi's sacroma, with extensive oral lesions; or involvemenet of the gastrointestinal
tract, lungs, or other visceral organs; or involvement of the skin of mucous membranes
with extensive fungating or ulcerating lesions not responding to treatment
24. Lymphoma of any type
25. Squamous cel carcinoma of the anus
SKIN or MUCOUS MEMBRANES
26. Conditions of the skin or mucous membrans, with extensive fungating or ulcertaing
lesions not responding to treatment
HEMATOLOGIC ABNORMALITIES
27. Anemia (hematocrit persisting at 30% or less) requiring one or more blood
transfuions on an average of at least once every 2 months
28. Granulocytopenia, with absolute neutrophil counts repeatedly below 1,000 cells/mm3
and documented recurrent systemic bacterial infections occurring at least 3 time
sin the alst 5 months.
29. Thrombocytopenia with platelet counts repeatedly below 40,000/mm3; with at least
one spontaeous hemorrhage, requiring transfuions in the last 5 months; or intracranial
bleeding inthe alst 12 months.
NEUROLOGICAL ABNORMALITIES
30. HIV encephalopathy, characterized by cognitive or motor dysfunction that
limits function and progresses.
31. Other neurological manifestations of HIV infection with singificant and persistent
disorganizaiton of motor function in 2 extremities resulting in sstained disturbance
of gross and dexterous movements, or gait and station.
HIV WASTING SYNDROME
32. HIV wasing syndrome, characterized by involuntary weight loss of 10% or more
of baseline...and, in the absence of a concurrent illness that could explain the
findings, involving: chronic diarrhea with 2 or more loose stools daily lasting for
12 month or longer; or chronic weakness and documented fever greater than 100.4 degrees
fareheneheit for the majority of 1 month or longer.
DIARRHEA
33. Diarrhea, lasting for 1 month or longer, resistant to treatment, and requiring
intravenous nydration, intravenous alimentation, or tube feedings.
CARDIOMYOPATHY
34. Cardiomyopathy
NEPHROPATHY
35. Nephropathy, resulting in chronic renal failure
INFECTIONS RESISTANT TO TREATMENT OR REQUIRING HOISPITALIZAITON OR INTRAVENOUS
TREATMENT 3 OR MORE TIMES IN 1 YEAR.
36. Sepsis
37. Meningitis
38. Pneumonia (non-PCP)
39. Septic Arthritis
40. Endocarditis
41. Sinusitis, radiographically documented.
PRIMARY HIV/AIDS ISSUES DIRECT THREAT ISSUES
(OBrien, G. V., & Schiro-Geist, C. (1997). Primary, secondary, and tertiary
direct threat: Issues in the employment of persons with HIV/AIDS. Rehabilitation
Education, Vol. 11, No. 1 & 2, pp. 101-110.
Primary direct threat issues regarding the transmission of HIV in the workplace
pertain to whether particular occupations carry a high potential for risk for HIV
which in turn depends on the following:
(a) The essential functions of the job (nature of job, amount of time employee is
expected to spend accomplishing the function, resulting consequences should employee
not be able to adequately perform the task, and whether other employees can perform
the function without an untoward degree of workplace disturbance; (b) Risk to others
should an employee with HIV perform these essential functions; and (c) Can the risk,
if too high, be minimized to an acceptable level through reasonable accommodations.
If occupation areas include invasive, subcutaneous medical procedures as essential
feature of job, a job-related qualification may include the absence of HIV infection
and employees may be required to prove negative HIV serostatus by antibody test.
IN order to comply wit the ADA, all persons in such positions should be tested, not
only those who are known or presumed to be at high risk for having the virus (e.g.,
people of color, substance users/abusers, gay men).
SECONDARY HIV/AIDS DIRECT THREAT ISSUES
Hepatitis B and Tuberculosis as coexisting conditions. Generally, opportunistic
infections which are secondary to HIV/AIDS do not adversely affect those persons
whose immune systems are not compromised by an immunological disorder. We all encounter
most of this viral agents. Further, hepatitis B is not transmitted as easily as hepatitis
A and therefore regulating the employability of an individual with hepatitis B would
not be appropriate. Persons with these two conditions can be treated like any other
individual with such a condition and the HIV status should be irrelevant to the employers
response or to Effect of AIDS-related dementia (ADC).
In most workplaces, employers may not discriminate against HIV/AIDS infected applicants
or employees fearing or conjecturing that ADC will eventually arise. Rather, they
may only consider particular behaviors in question demonstrated by an individual
who is HIV infected.
In the latter stages of AIDS, cognitive impairments may be frequent in persons
with HIV. These signs include impaired concentration skills and incapability to carry
out complicated mental assignments, deterioration of mental ability and manual dexterity,
and behavioral alterations such as anxiety, mild ataxia, impaired of attention in
behavioral action, and the demonstration of other different behaviors (Lansing &
Loeschen, 1989). This affects employability of such individuals by potentially posing
a direct threat to third parties in the workplace and employers may be liable but
primarily where safety concerns are high. For example, OBrien and Schiro-Geist report
that it is legal to deny airline pilots medical permission to fly if they are diagnosed
with AIDS. HIV positive status is dealt with on an individual basis. (p. 106).
Rare cases where HIV infected individual threatens to harm others in the workplace.
In those rare cases where an HIV infected employees causes panic in the workplace
with threatening behavior is accepted by courts as basis for employers to take action
against such an employee.
Altruistic Defense
Employers must exhaust potential reasonable accommodations before they can
take action against the employee based on the possible harm to that employee by placing
them at risk for acquiring or exacerbating the effects of an opportunistic infection
that may exist in the workplace by continuing in that particular work environment.
TERTIARY DIRECT THREAT ISSUES
In many cases, even if the employer realizes that low potential for transmission,
they may act based on how others potential adverse reaction to employment of an HIV
infected worker and fears of a negative effect and disturbance in the workplace.
Employers that are particularly concerned are in food service , cosmetics and hairstyling
industries. The courts have ruled however that in those cases where employers fear
economic losses due to others fear of HIV infected employees, the courts have required
that HIV-related training to staff be provided as a settlement component.
BIBLIOGRAPHY
Brodwin, M., Parker, R.M., & DeLaGarza, D. (1996). Disability and Accommodation
in E.M Szymanski & R.M. Parker, (Eds.), (1996).Work and Disability, Pro-Ed: Austin,
Texas.
Kohlenberg, B. (Undated Material). Employment Issues for
People Living with HIV/AIDS. Kohlenberg & Associates, San Francisco, California.
Webber, D. W. (1997). AIDS and the Law, Third Edition, Wiley Law Publishers.