Employment as a Social Determinant of HIV Care and Prevention Outcomes

Advancements in HIV medicine have led to an increased desire and/or need to work for many people living with HIV. Despite the importance of work, relatively little attention has been devoted to specifically examining employment status as a social determinant of health. Unemployment/underemployment are associated with societal circumstances known to increase both the risk for acquiring and prevalence of HIV and other co-morbidity. Research indicates that being employed and use of vocational services is associated with positive physical and mental health outcomes. However, these positive outcomes can dissipate under poor or unstable work conditions. Transitions into or out of the workforce can also increase the risk of poor health associated with stress and potential disruptions or loss of access to critical health care. Given that individuals disproportionately impacted by HIV are also impacted by labor market discrimination, social exclusion, and poverty, there is an emerging sense of urgency to better respond to the employment needs of people living with HIV. This book chapter (a) reviews research related to employment as a social determinant of health, (b) provides an overview of the client-focused considering work model, (c) highlights key employment services, and (d) discusses implications for policy, service delivery and research.