Online Program

Characteristics associated with employment among HIV-positive New York City ryan white clients

Monday, November 4, 2013

Laura McAllister, MPH, Bureau of HIV/AIDS Prevention and Control, NYC DOHMH, Queens, NY
Mary Irvine, DrPH, Bureau of HIV/AIDS Prevention & Control, New York City Department of Health and Mental Hygiene, Queens, NY
Graham Harriman, MA, Bureau of HIV/AIDS, Care and Treatment, New York City Department of Health and Mental Hygiene, Long Island City, NY
John Rojas, MPA, Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
M. Monica Sweeney, MD, MPH, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, Long Island City, NY
Unemployment is widespread among persons living with HIV (PLWH) who access publicly-funded service programs. Survival and quality-of-life gains due to effective antiretroviral regimens place more PLWH in a position to join/re-join the workforce. Using client data reported by New York City (NYC) Ryan White HIV service providers, we assessed baseline characteristics associated with current employment status. For 16,358 HIV-positive NYC Ryan White clients served in 2012, we examined employment status as of January 2013 against baseline measures for gender, age, race/ethnicity, birth country, education, marital status, housing status, CD4 count and viral load (VL). We constructed multivariate logistic regression models to identify predictors of employment. The sample at baseline was largely male (64%), >45 years old (61%), black or Hispanic (86%), US-born (60%), ≤high school-educated (73%), never married (39%), and stably housed (62%). Of those reporting clinical data, 58% had VL ≤400 and 59% had CD4 count ≥350. As of January 2013, employment status was full- or part-time for 1,979 (12%); "out of workforce" for 1,985 (12%); "unpaid volunteer" for 143 (1%); unemployed for 9,607 (59%); and missing/declined for 2,644 (16%). In multivariate logistic regression, modifiable factors associated with lack of employment included unstable housing (AOR: 3.76, CI=3.03-4.66), VL >400 (AOR: 1.14, CI=1.01-1.29) and CD4 <350 (AOR: 1.18, CI=1.04-1.33). Client baseline characteristics, including housing and clinical status, predicted employment. In a context of improved health outcomes, limited resources and healthcare systems change, it is important to understand subgroup differences in employment, and shape programs supporting employment and self-sufficiency among PLWH.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify the relationships between sociodemographic characteristics and employment status in the study population of HIV-positive individuals accessing HIV services. Describe the implications of the findings for the design of HIV medical and social services that promote self-sufficiency among persons living with HIV. Discuss directions for future research on employment status among HIV-positive populations, including assessing the impact of cofactors over time and addressing the challenges of causal inferences.

Keyword(s): HIV/AIDS, Self-sufficiency and Empowerment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the lead analyst on several federal and state-funded public health program evaluations focusing on HIV and other infectious diseases. I have significant experience conducting analyses on HIV data from program reporting and other sources. My scientific interests have included research on health disparities, specifically evaluation of risk factors for HIV-related health outcomes, with the goal of informing design of HIV service programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.